Determination Of Cost-Effectiveness Threshold For Malaysia
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Date
2015-10
Authors
YEN WEI, LIM
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Abstract
In healthcare system, decisions on the cost-effectiveness (CE) of healthcare technologies are difficult especially when alternatives are more expensive but more effective. In this situation, an external criterion in the form of CE threshold or willingness-to-pay for a quality-adjusted life-year (WTP/QALY) is necessary to decide on the CE of healthcare interventions. Nevertheless, current practice in Malaysia on coverage decisions of new healthcare technologies is made without an explicit CE threshold. Thus, this study aimed to determine a CE threshold value for healthcare interventions in Malaysia. A cross-sectional, contingent valuation study was conducted using stratified multistage cluster random sampling technique in Penang, Kedah, Selangor and Kuala Lumpur Federal Territory. Respondents aged between 20 – 60 years old who can understand either English or Malay language were interviewed face-to-face. They were asked for the socioeconomic background, quality of life and their WTP for a hypothetical scenario (treatment, extended life in terminal illness and life saving situations with three severities and two QALY gained levels – 0.2 QALY and 0.4 QALY). The mean ratio of the amount of WTP for an additional QALY gained was explored by non-parametric Turnbull method and parametric interval regression model. Parametric interval regression model was also used to analyse the factors that affect the CE threshold. One thousand thirteen respondents were interviewed during the survey. The CE threshold explored from non-parametric Turnbull method ranged from MYR 12,810 – 22,840 (~
USD 4,000 – 7,000) whereas it was estimated to range between MYR 19,929 – 28,470 (~ USD 6,200 – 8,900) using parametric interval regression model. Key factors that affect the CE threshold were education level, estimated monthly household income and the description of health state scenarios.
The cost-effectiveness threshold found in this study was reported as MYR 19,929 – 28,470. The findings support that there is no single value of a QALY. The CE threshold estimated for Malaysia was found to be lower than the threshold value of one to three times the gross domestic product per capita recommended by the World Health Organisation.
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Keywords
Determination Of Cost-Effectiveness , Threshold For Malaysia