Willingness to pay for a quality-adjusted life year: In search of a standard
Willingness to pay for a quality-adjusted life year: In search of a standard
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DOI：
10.1177/0272989x0002000310
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发表时间：
2000-07-01
影响因子：
3.6
通讯作者：
Weissert, WG
中科院分区：
文献类型：
--
作者：
Hirth, RA;Chernew, ME;Weissert, WG
成本效益分析（CBA）提供了一个明确的决策规则：如果其收益的货币价值超过其成本，则进行干预。然而，由于不愿意用货币来描述健康效益，成本效用和成本效益分析的用户必须依赖任意的标准（例如，<50，000美元/QALY），以认定项目“具有成本效益”。“此外，对于资源分配决定所依据的每一质量调整生命年的适当美元价值，没有达成共识。为了解决这个问题，作者确定了生命价值文献所暗示的QALY值，并将该值与常用的成本效益任意阈值进行了比较。文献检索确定了42个适合纳入的生命价值估计值。这些估计按方法分类：人力资本（HK），或有估值（CV），显示偏好/工作风险（RP-JR）和显示偏好/非职业安全（RP-S），以及美国或非美国，起源。在将这些生命价值估计值转换为1997年美元后，研究人群的预期寿命、特定年龄的QALY权重和3%的真实的贴现率被用来计算QALY的隐含价值。普通最小二乘回归的研究类型和民族血统的QALY值解释了28.4%的研究之间的方差。大多数解释的差异是由于研究类型;民族血统并没有显着影响的值。按研究类型列出的中位值分别为24，777美元（HK估计值）、93，402美元（RP-S估计值）、161，305美元（CV估计值）和428，286美元（RP-JR估计值）。除香港外，这些都远远超过了“经验法则”，经常用来确定是否干预措施产生了可接受的增加健康福利，以换取增量支出。
Cost-benefit analysis (CBA) provides a clear decision rule: undertake an intervention if the monetary value of its benefits exceed its costs. However, due to a reluctance to characterize health benefits in monetary terms, users of cost-utility and cost-effectiveness analyses must rely on arbitrary standards (e.g., < $50,000 per QALY) to deem a program "cost-effective." Moreover, there is no consensus regarding the appropriate dollar value per QALY gained upon which to base resource allocation decisions. To address this, the authors determined the value of a QALY as implied by the value-of-life literature and compared this value with arbitrary thresholds for cost-effectiveness that have come into common use. A literature search identified 42 estimates of the value of life that were appropriate for inclusion. These estimates were classified by method: human capital (HK), contingent valuation (CV), revealed preference/job risk (RP-JR) and revealed preference/non-occupational safety (RP-S), and by U.S. or non-U.S, origin. After converting these value-of-life estimates to 1997 U.S, dollars, the life expectancy of the study population, age-specific QALY weights, and a 3% real discount rate were used to calculate the implied Value of a QALY. An ordinary least-squares regression of the value of a QALY on study type and national origin explained 28.4% of the variance across studies. Most of the explained variance was attributable to study type; national origin did not significantly affect the values. Median values by study type were $24,777 (HK estimates), $93,402 (RP-S estimates), $161,305 (CV estimates), and $428,286 (RP-JR estimates). With the exception of HK, these far exceed the "rules of thumb" that are frequently used to determine whether an intervention produces an acceptable increase in health benefits in exchange for incremental expenditures.