Willingness-to-Pay for a QALY in Germany

鉴于医学的快速发展和来自公共或半公共资金的有限资源，发达国家的医疗保健系统必须找到合理的方法来评估金钱的价值。在民主国家，这些价值观必须以某种方式基于公民的偏好。由欧盟委员会资助的EuroVaQ(欧洲QALY价值)项目是一项尝试，旨在衡量公民对经质量调整的生活年的货币价值。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：-版本A，这是英语问卷的直接翻译，在在线调查(计算机辅助网络访谈，CAWI)中管理；-版本B，这是一个旨在提高受访者理解的修改，并在计算机辅助个人访谈(CAPI)中管理。事实证明，两种设置的中位数反应有很大差异。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，因此更接近英国等实行明确配给程序的国家使用的阈值。这一发现的问题在于，尚不清楚两种设计变化(问卷措辞不同和采访者在场)中的哪一种导致了结果的差异。因此，我们建议使用迄今为止在CAPI设置中使用的问卷B版本来重复CAWI调查，以区分这两种变化的影响。

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.