Determination of Cost-Effectiveness Threshold for Health Care Interventions in Malaysia

• Published in: Value in health Vol. 20; no. 8; pp. 1131 - 1138
• Main Authors: Lim, Yen Wei, MSc, Shafie, Asrul Akmal, PhD, Chua, Gin Nie, MPharm, Ahmad Hassali, Mohammed Azmi, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2017; Elsevier Science Ltd
• Subjects: Adult; Contingent valuation; contingent valuation method; Cost analysis; Cost-Benefit Analysis; cost-effectiveness threshold; Cross-Sectional Studies; Delivery of Health Care - economics; Delivery of Health Care - methods; Educational Status; Female; Financing, Personal - economics; Health care expenditures; Health care policy; Health Status; Humans; Income - statistics & numerical data; Internal Medicine; Intervention; Malaysia; Male; Middle Aged; Prioritizing; Quality of Life; Quality-Adjusted Life Years; quality-adjusted life-year (QALY); Random sampling; Regression Analysis; Socioeconomic Factors; Socioeconomic status; Statistical sampling; Surveys and Questionnaires; Technology; Thresholds; Willingness to pay; willingness to pay (WTP); Young Adult; Malaysia; Malaysia; contingent valuation method; cost-effectiveness threshold; quality-adjusted life-year (QALY); willingness to pay (WTP)
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.04.002

Abstract Background One major challenge in prioritizing health care using cost-effectiveness (CE) information is when alternatives are more expensive but more effective than existing technology. In such a situation, an external criterion in the form of a CE threshold that reflects the willingness to pay (WTP) per quality-adjusted life-year is necessary. Objectives To determine a CE threshold for health care interventions in Malaysia. Methods A cross-sectional, contingent valuation study was conducted using a stratified multistage cluster random sampling technique in four states in Malaysia. One thousand thirteen respondents were interviewed in person for their socioeconomic background, quality of life, and WTP for a hypothetical scenario. Results The CE thresholds established using the nonparametric Turnbull method ranged from MYR12,810 to MYR22,840 (~US $4,000–US $7,000), whereas those estimated with the parametric interval regression model were between MYR19,929 and MYR28,470 (~US $6,200–US $8,900). Key factors that affected the CE thresholds were education level, estimated monthly household income, and the description of health state scenarios. Conclusions These findings suggest that there is no single WTP value for a quality-adjusted life-year. The CE threshold estimated for Malaysia was found to be lower than the threshold value recommended by the World Health Organization.