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Measuring the end-of-life premium in cancer using individual ex ante willingness to pay
The Swedish Institute for Health Economics (IHE), Lund, Sweden; Health Economics Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
The Swedish Institute for Health Economics (IHE), Lund, Sweden; Health Economics Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; School of Economics and Management, Institute of Economic Research, Lund University, Lund, Sweden; Department of Economics, School of Economics and Management, Lund University, Lund, Sweden.
Örebro University, Örebro University School of Business.ORCID iD: 0000-0003-1172-1076
The Swedish Institute for Health Economics (IHE), Lund, Sweden; School of Economics and Management, Institute of Economic Research, Lund University, Lund, Sweden.
2017 (English)In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601Article in journal (Refereed) Epub ahead of print
Abstract [en]

For the assessment of value of new therapies in healthcare, Health Technology Assessment (HTA) agencies often review the cost per quality-adjusted life-year (QALY) gained. Some HTA agencies accept a higher cost per QALY gained when treatment is aimed at prolonging survival for patients with a short expected remaining lifetime, a so-called end-of-life (EoL) premium. The objective of this study is to elicit the existence and size of an EoL premium in cancer. Data was collected from 509 individuals in the Swedish general population 20-80 years old using a web-based questionnaire. Preferences were elicited using subjective risk estimation and the contingent valuation (CV) method. A split-sample design was applied to test for order bias. The mean value of a QALY was MSEK4.8 (€528,000), and there was an EoL premium of 4-10% at 6 months of expected remaining lifetime. Using subjective risk resulted in more robust and valid estimates of the value of a QALY. Order of scenarios did not have a significant impact on the WTP and the result showed scale sensitivity. Our result provides some support for the use of an EoL premium based on individual preferences when expected remaining lifetime is short and below 24 months. Furthermore, we find support for a value of a QALY that is above the current threshold of several HTA agencies.

Place, publisher, year, edition, pages
2017.
Keyword [en]
Cancer, Contingent valuation, End of life, Individual preferences, Value of a QALY, Willingness to pay
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:oru:diva-61723DOI: 10.1007/s10198-017-0922-6PubMedID: 28803265OAI: oai:DiVA.org:oru-61723DiVA: diva2:1155250
Available from: 2017-11-07 Created: 2017-11-07 Last updated: 2017-11-09Bibliographically approved

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