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Measuring the end-of-life premium in cancer using individual ex ante willingness to pay

Olofsson S, Gerdtham UG, Hultkrantz L and Persson U

To assess the value of new therapies in healthcare, Health Technology Assessment (HTA) agencies often review the cost per Quality-Adjusted Life-Year (QALY) gained. Some HTA agencies accept a higher cost per QALY gained when the treatment prolongs survival for patients with a short expected remaining lifetime, a so-called End-Of-Life (EoL) premium.

The objective of this study is to elicit the existence and size of an EoL premium in cancer. Data was collected from 509 individuals in the Swedish general population aged 20 to 80 using a web-based questionnaire. Preferences were elicited using subjective risk estimation and the contingent valuation (CV) method. A split-sample design was applied to test for order bias.

The mean value of a QALY was MSEK4.8 (€528,000), and there was an EoL premium of 4-10% at 6 months of expected remaining lifetime. Using subjective risk resulted in more robust and valid estimates of the value of a QALY. The order of scenarios did not have a significant impact on the WTP and the result showed scale sensitivity.

Our result provides some support for the use of an EoL premium based on individual preferences when expected remaining lifetime is short and below 24 months. Furthermore, we find support for a value of a QALY that is above the current threshold of several HTA agencies.

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European Journal of Health Economics 2018; 19(6): 807-820
DOI: 10.1007/s10198-017-0922-6