Willingness-to-Pay for a QALY in Germany

鉴于医学的快速发展和公共或半公共资金的有限资源，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（欧洲质量价值）项目试图衡量公民对质量调整生命年的货币价值。调查的主要方法是在不包括德国在内的10个欧洲国家进行在线调查。在这个项目中，我们通过创建和管理两种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，并在在线调查（计算机辅助网络访谈，CAWI）中进行管理；版本B，这是一个修改，旨在提高受访者的理解，并在计算机辅助个人访谈（CAPI）中进行管理。结果表明，两种情况下的中位数反应差异很大。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使用的阈值。这一发现的问题在于，目前尚不清楚两种设计变化（问卷的不同措辞和面试官的存在）中哪一种导致了结果的差异。因此，我们建议用迄今为止在CAPI设置中使用的问卷B版本重复CAWI调查，以理清这两个变化的影响。

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.