Why Perspective Matters In Health Outcomes Research Analyses

Health outcomes research typically uses cost-effectiveness or cost-utility analysis. These approaches take a narrow perspective of the individual effects, typically from the payer or the provider point-of-view. However, using these narrow perspectives misses macro-level, or societal level, benefits and costs that could significantly alter whether an intervention is considered beneficial or cost-effective. The societal perspective accounts for all the effects impacting patients, their families, the public, and government expenditures for a healthcare intervention. Such a perspective is vital for healthcare interventions for illnesses where morbidity and long absences from work are probable. A cost-benefit analysis would account for all the societal benefits and costs, allowing policy-makers to observe an outcomes analysis more closely reflective of the real impacts. This paper clearly presents why a societal perspective using cost-benefit analysis should be the preferred method of health outcomes research. An example of breast cancer interventions is used to illustrate this point

A systematic review of studies eliciting willingness-to-pay per quality-adjusted life year: does it justify CE threshold?

Background: A number of studies have been conducted to estimate willingness to pay (WTP) per quality-adjusted life years (QALY) in patients or general population for various diseases. However, there has not been any systematic review summarizing the relationship between WTP per QALY and cost-effectiveness (CE) threshold based on World Health Organization (WHO) recommendation. Objective: To systematically review willingness-to-pay per quality-adjusted-life-year (WTP per QALY) literature, to compare WTP per QALY with Cost-effectiveness (CE) threshold recommended by WHO, and to determine potential influencing factors. Methods: We searched MEDLINE, EMBASE, Psyinfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Center of Research Dissemination (CRD), and EconLit from inception through 15 July 2014. To be included, studies have to estimate WTP per QALY in health-related issues using stated preference method. Two investigators independently reviewed each abstract, completed full-text reviews, and extracted information for included studies. We compared WTP per QALY to GDP per capita, analyzed, and summarized potential influencing factors. Results: Out of 3,914 articles founded, 14 studies were included. Most studies (92.85%) used contingent valuation method, while only one study used discrete choice experiments. Sample size varied from 104 to 21,896 persons. The ratio between WTP per QALY and GDP per capita varied widely from 0.05 to 5.40, depending on scenario outcomes (e.g., whether it extended/saved life or improved quality of life), severity of hypothetical scenarios, duration of scenario, and source of funding. The average ratio of WTP per QALY and GDP per capita for extending life or saving life (2.03) was significantly higher than the average for improving quality of life (0.59) with the mean difference of 1.43 (95% CI, 1.81 to 1.06). Conclusion: This systematic review provides an overview summary of all studies estimating WTP per QALY studies. The variation of ratio of WTP per QALY and GDP per capita depended on several factors may prompt discussions on the CE threshold policy. Our research work provides a foundation for defining future direction of decision criteria for an evidence-informed decision making system

Flow diagram of study selection.

<p>Flow diagram of study selection.</p

Methodology difference in WTP per QALY.

<p>Methodology difference in WTP per QALY.</p

WTP per QALY compared to GDP per Capita.

<p>Abbreviations: GDP, gross domestic product; No, number; HRT, hormone replacement therapy; HS, health state, No, number; GP, general population; QoL, quality of life;UK, united Kingdom;</p><p>ROK, Republic of Korea; US, United states;</p><p>¶ mild or severe osteoarthritis;</p><p>*EQ-5D described severity;</p><p>^{^} CSM,general medical clinic,cerebral aneurysms;</p><p>^{^^}Knee osteoarthritis;</p><p>€chronic prostatitis</p><p>WTP per QALY compared to GDP per Capita.</p

Exploration of the relationship between numerous factors associated with the ratio of WTP per QALY compared to GDP per capita.

<p>Abbreviations: GDP, gross domestic product; SD, standard deviation; CI, confidence interval; n, number of study</p><p>* no statistical significance</p><p>§ Comparator</p><p>Exploration of the relationship between numerous factors associated with the ratio of WTP per QALY compared to GDP per capita.</p