Monetary value of health-a practical decision-making framework combining equity considerations and WTP

Area of Science:

• Health Economics
• Health Technology Assessment
• Value-Based Healthcare

Background:

• Central and Eastern European countries, including Croatia, lack empirical research on cost-effectiveness thresholds.
• Existing GDP-based thresholds may be inadequately supported, potentially impacting healthcare pricing and reimbursement.
• There is a need to establish demand-side cost-effectiveness thresholds informed by public preferences.

Purpose of the Study:

• To estimate the monetary value of a health gain in Croatia, establishing the first such valuation in the country.
• To assess the empirical support for equity considerations, specifically age and health severity (proportional shortfall), in valuing health gains.
• To propose a pragmatic framework integrating equity into cost-effectiveness thresholds.

Main Methods:

• Employed the contingent valuation method with a representative Croatian sample (N=1,500) via an online survey.
• Elicited willingness to pay (WTP) per Quality-Adjusted Life Year (QALY) using 29 EQ-5D health states and payment scales/open-ended questions.
• Utilized parametric and non-parametric tests, including multilinear regression, to analyze data and test theoretical validity.

Main Results:

• The estimated monetary value of health gain in Croatia is €17,000, equivalent to 1.15 times GDP per capita.
• Age is a significant equity factor: WTP for children (€14,200) was higher than for adults (€11,700-€11,900).
• Higher proportional shortfall (greater severity) correlated positively with WTP; proposed thresholds range up to €20,308 for severe pediatric conditions.

Conclusions:

• Empirical evidence is crucial for developing value-based assessment frameworks in Central and Eastern Europe.
• Current reliance on GDP-based thresholds without empirical backing may lead to suboptimal pricing and reimbursement decisions.
• The study provides a foundation for evidence-based cost-effectiveness thresholds incorporating public preferences and equity.