Estimating the Willingness-to-Pay per Quality-Adjusted Life-Year to Aid Health Technology Assessment in India

The study aimed to estimate the willingness to pay (WTP) for a quality-adjusted life-year (QALY) to help determine the threshold for cost-effectiveness in India. We also assessed the factors affecting WTP/QALY.

We used a multistage stratified random sampling strategy to select 5460 respondents across 6 Indian states. Participants were interviewed to gather household socioeconomic and demographic data, followed by assessments of health gains using time trade-off and WTP. Respondents were presented with 12 hypothetical health states to gauge health gains and their WTP to restore health. These values were combined to determine WTP per QALY using an aggregated approach. The health gains were discounted at 3%. Weighted estimates based on state, residence, gender, age, and education were computed. A mixed-effect regression model explored the relationship between socio-demographic variables and WTP/QALY.

Based on 21 640 observations, we found that mean weighted WTP/QALY was estimated to be INR 2 12 307 (US$ 2535). Based on the different health states, the WTP/QALY ranged from INR 1 70 414 (US$ 2034) to INR 2 58 985 (US$ 3092). Age, gender, family size, education, marital status, occupation, presence of health insurance, consumption expenditure, and number of earning members in the household significantly impacted WTP per QALY.

To our knowledge, our study reports the first-ever estimate of WTP/QALY for the Indian population. The WTP/QALY ranges from 1 to 1.52 times the gross domestic product per capita. This could be considered as the cost-effectiveness threshold for health technology assessment in India.