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Assessment of cost-effectiveness threshold using a double-bounded dichotomous choice model
Taito Kitano1, Shinya Tsuzuki1,2,3
1AMR Clinical Reference Center, National Center for Global Health and Medicine, Japan Institute for Health Security, Tokyo, Japan.
Public Health in Practice (Oxford, England)
|January 8, 2026
Summary
Japanese adults show consistent willingness to pay (WTP) for a quality-adjusted life year (QALY) post-COVID-19. Survey methodology significantly impacts WTP values, necessitating further research into pandemic-related shifts.
Area of Science:
- Health Economics
- Public Health
- Survey Methodology
Background:
- Willingness to pay (WTP) for a quality-adjusted life year (QALY) is a critical metric in health economics.
- WTP values are known to be sensitive to survey methodologies and temporal variations.
- Assessing WTP in the post-COVID-19 era is crucial for understanding evolving societal health preferences.
Purpose of the Study:
- To evaluate the Japanese population's willingness to pay (WTP) for an additional quality-adjusted life year (QALY).
- To assess WTP using a double-bounded dichotomous choice method in the post-COVID-19 pandemic context.
- To identify potential influences of survey design on WTP estimations.
Main Methods:
- A cross-sectional online survey was conducted in 2024 with 2,500 Japanese adults.
- The double-bounded dichotomous choice method was employed to elicit WTP values.
- Four distinct health scenarios were presented, considering non-fatal and fatal diseases from societal and individual perspectives.
Main Results:
- Mean WTP per QALY gain varied across scenarios, ranging from 3.30 to 9.95 million Japanese Yen (JPY).
- Specific WTP values were reported for moderate/severe non-fatal disease (3.30-7.34 million JPY) and fatal disease scenarios (3.38-9.95 million JPY).
- No significant change in WTP was detected compared to pre-pandemic estimates.
Conclusions:
- Japanese WTP per QALY remains relatively stable post-COVID-19, with no significant observed changes.
- The study highlights the substantial impact of questionnaire design on WTP response patterns.
- Further research is recommended to comprehensively understand the pandemic's long-term effects on WTP values.
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