Willingness-to-Pay for a QALY in Germany

鉴于医学发展迅速，而公共或半公共基金的资源有限，发达国家的卫生保健系统必须找到合理的方法来评估资金的价值。在民主国家，这些价值观必须以公民的偏好为基础。由欧盟委员会资助的EuroVaQ（质量调整生命年的欧洲价值）项目试图衡量公民对质量调整生命年的货币价值。主要方法包括在10个欧洲国家（不包括德国）进行的在线调查。在这个项目中，我们通过创建和管理两个不同版本的调查问卷，将EuroVaQ研究扩展到德国样本：- A版，是英文问卷的直接翻译，在网上调查中进行（计算机辅助网络访谈，CAWI），-版本B，这是一个修改，旨在提高被调查者的理解，并在计算机辅助个人访谈（CAPI）管理。结果表明，两种情况下的平均反应差异很大。虽然CAWI的结果与其他欧洲国家的结果相当，但CAPI的反应要高得多，因此更接近英国等具有明确配给程序的国家所使用的阈值。这一发现的问题是，它是不清楚的两个设计的变化（不同的措辞的问卷和面试官的存在）造成的差异，因此，我们建议重复CAWI调查的版本B的问卷，这是迄今为止使用的CAPI设置，以解开这两个变化的影响。

Given the rapid medical progress and limited resources from public or semi-public funds, health care systems in developed countries must find rational methodologies to assess value for money. In democracies these values must be somehow based on the preferences of the citizens. The EuroVaQ (European Value of a QALY) project, which was funded by the European Commission is an attempt to measure the monetary value that citizens place on a quality-adjusted life year. The main methodology consisted in online-surveys conducted in 10 European countries not including Germany. In this project, we extended the EuroVaQ study to a German sample by creating and administering two different versions of the survey questionnaire: - Version A, which is a direct translation of the English questionnaire and which was administered in an online survey (computer-assisted web interview, CAWI),- Version B, which is a modification aimed at improving the understanding by the respondents and which was administered in computer-assisted personal interviews (CAPI). It turned out that median responses differ considerably between the two settings. While the CAWI results were comparable with those in the other European countries, CAPI responses were considerably higher and thus closer to the threshold values used in countries with explicit rationing procedures such as England. The problem with this finding is that it is unclear which of the two design changes (different wording of the questionnaire and the presence of an interviewer) caused the difference in the results.We therefore propose to repeat the CAWI survey with the version B of the questionnaire which was so far used in the CAPI setting in order to disentangle the effects of the two changes.