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      Empirical Monetary Valuation of a Quality-Adjusted Life-Year in the Kingdom of Saudi Arabia: A Willingness-to-Pay Analysis

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          Abstract

          Background

          No willingness-to-pay (WTP) per quality-adjusted life-year (QALY) value exists for the Kingdom of Saudi Arabia (KSA).

          Objective

          The primary objective of this study was to determine the WTP for a QALY in the KSA.

          Methods

          Adult citizens of the KSA, patients with cancer, or members of the general public (MGP) were recruited to participate in a time trade-off survey to elicit health utilities. Cancer was chosen as the disease of interest for patients and the MGP, with a scenario describing stage 3 colorectal cancer, because it is a disease condition that impacts on both quality of life and survival time. In a second step, respondents were asked about their WTP to move from the estimated health state to a state of perfect health for 1 year (QALY). Finally, that amount was processed to generate the WTP for a full QALY. The second step was repeated with a 5-year horizon. Sensitivity analyses were performed without outliers.

          Results

          From 400 participants, data from 378 subjects were obtained and usable: 177 patients, 201 MGP; 278 male, 100 female subjects; 231 aged 26–65 years. Demographic distribution varied widely between the two subgroups for age, education level, and employment status, but with less variation in sex and income. Elicited health utilities were 0.413 (0.472 after adjustment) for the overall group, 0.316 (0.416) for patients, and 0.499 (0.508) for MGP. Overall WTP for a QALY was $US25,600 (adjusted $US32,000) for the 1-year horizon and $US19,200 (adjusted $US22,720) for the 5-year horizon.

          Conclusion

          This was the first empirical attempt to estimate the WTP per QALY for the KSA. Results are comparable to those in some other countries and to gross domestic product figures for the KSA. Further research in a country-wide sample is warranted.

          Electronic supplementary material

          The online version of this article (10.1007/s41669-020-00211-0) contains supplementary material, which is available to authorized users.

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          Most cited references21

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          Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold.

          Scott D Grosse (2008)
          Cost-effectiveness analyses, particularly in the USA, commonly use a figure of $50,000 per life-year or quality-adjusted life-year gained as a threshold for assessing the cost-effectiveness of an intervention. The history of this practice is ill defined, although it has been linked to the end-stage renal disease kidney dialysis cost-effectiveness literature from the 1980s. The use of $50,000 as a benchmark for assessing the cost-effectiveness of an intervention first emerged in 1992 and became widely used after 1996. The appeal of the $50,000 figure appears to lie in the convenience of a round number rather than in the value of renal dialysis. Rather than arbitrary thresholds, estimates of willingness to pay and the opportunity cost of healthcare resources are needed.
          Article 0 comments Cited 182 times – based on 0 reviews     Review now
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            Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold.

            Karl Claxton, Steve L. Martin, Marta Oliveira Soares … (2015)
            Cost-effectiveness analysis involves the comparison of the incremental cost-effectiveness ratio of a new technology, which is more costly than existing alternatives, with the cost-effectiveness threshold. This indicates whether or not the health expected to be gained from its use exceeds the health expected to be lost elsewhere as other health-care activities are displaced. The threshold therefore represents the additional cost that has to be imposed on the system to forgo 1 quality-adjusted life-year (QALY) of health through displacement. There are no empirical estimates of the cost-effectiveness threshold used by the National Institute for Health and Care Excellence.
            Article 0 comments Cited 134 times – based on 0 reviews     Review now
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              How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations.

              A Laupacis, D Feeny, A S Detsky … (1992)
              Because economic evaluations of health care services are being published with increasing frequency it is important to (a) evaluate them rigorously and (b) compare the net benefit of the application of one technology with that of others. Four "levels of evidence" that rate economic evaluations on the basis of their methodologic rigour are proposed. They are based on the quality of the methods used to estimate clinical effectiveness, quality of life and costs. With the use of the magnitude of the incremental net benefit of a technology, therapies can also be classified into five "grades of recommendation." A grade A technology is both more effective and cheaper than the existing one, whereas a grade E technology is less or equally effective and more costly. Those of grades B through D are more effective and more costly. A grade B technology costs less than $20,000 per quality-adjusted life-year (QALY), a grade C one $20,000 to $100,000/QALY and a grade D one more than $100,000/QALY. Many issues other than cost effectiveness, such as ethical and political considerations, affect the implementation of a new technology. However, it is hoped that these guidelines will provide a framework with which to interpret economic evaluations and to identify additional information that will be useful in making sound decisions on the adoption and utilization of health care services.
              Article 0 comments Cited 117 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Michael Iskedjian: miskedjian@pharmideas.com
                Journal
                Journal ID (nlm-ta): Pharmacoecon Open
                Journal ID (iso-abbrev): Pharmacoecon Open
                Title: PharmacoEconomics Open
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 2509-4262
                ISSN (Electronic): 2509-4254
                Publication date (Electronic): 14 April 2020
                Publication date PMC-release: 14 April 2020
                Publication date Collection: December 2020
                Volume: 4
                Issue: 4
                Pages: 625-633
                Affiliations
                [1 ]GRID grid.415310.2, ISNI 0000 0001 2191 4301, Section of Medical Oncology, , King Faisal Specialist Hospital and Research Centre, ; Riyadh, Kingdom of Saudi Arabia
                [2 ]GRID grid.415310.2, ISNI 0000 0001 2191 4301, Biostatistics, Epidemiology, and Scientific Computing, , King Faisal Specialist Hospital and Research Centre, ; Riyadh, Kingdom of Saudi Arabia
                [3 ]GRID grid.415310.2, ISNI 0000 0001 2191 4301, Department of Pharmacy, , King Faisal Specialist Hospital and Research Centre, ; Riyadh, Kingdom of Saudi Arabia
                [4 ]GRID grid.415310.2, ISNI 0000 0001 2191 4301, Department of Pediatric Hematology/Oncology, , King Faisal Specialist Hospital and Research Centre, ; Riyadh, Kingdom of Saudi Arabia
                [5 ]GRID grid.415254.3, ISNI 0000 0004 1790 7311, Drug Policy and Economics Center, , National Guard Health Affairs, King Abdulaziz Medical City, ; Riyadh, Kingdom of Saudi Arabia
                [6 ]GRID grid.56302.32, ISNI 0000 0004 1773 5396, Department of Pharmaceutics, , King Saud University, ; Riyadh, Kingdom of Saudi Arabia
                [7 ]PharmIdeas USA Inc., 1967 Wehrle Drive, Unit 9, Williamsville, NY 14221 USA
                [8 ]GRID grid.14848.31, ISNI 0000 0001 2292 3357, Associate Clinician, Faculty of Pharmacy, , University of Montreal, ; Montreal, Canada
                Article
                Publisher ID: 211
                DOI: 10.1007/s41669-020-00211-0
                PMC ID: 7688848
                PubMed ID: 32291726
                SO-VID: fe504034-4182-4c6e-a791-1ce8a4641e68
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004319, Pfizer;
                Funded by: FundRef http://dx.doi.org/10.13039/100002491, Bristol-Myers Squibb;
                Funded by: FundRef http://dx.doi.org/10.13039/100004339, Sanofi;
                Funded by: FundRef http://dx.doi.org/10.13039/100004326, Bayer;
                Categories
                Subject: Original Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

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