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Med Decis Making. 2005 Nov-Dec;25(6):655-66.

Willingness to pay per quality-adjusted life year in a study of knee osteoarthritis.

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Department of Epidemiology and Public Health, University of Miami, Florida 33136, USA.



Determining whether a particular medical intervention is cost-effective requires that a threshold of cost per benefit gained be established. As debate continues over the appropriate threshold, we present measures of willingness to pay (WTP) per quality-adjusted life year (QALY) for own health and 2 hypothetical osteoarthritis scenarios.


One hundred ninety-three persons, located through random digit dialing in Harris County, Texas, completed face-to-face interviews collecting demographic information and health preferences using visual analog scale, time tradeoff, standard gamble, and WTP methodologies.


The mean WTP/QALY for all methods was lower (range, $1221-$5690/QALY) than many estimates from revealed preference studies and lower than the oft-cited arbitrary cutoff of $50 000. WTP/QALY was highest when participants were judging their personal health improvements as opposed to hypothetical scenarios. There were some significant differences in WTP/QALY across elicitation methodologies for the same scenario. Demographic characteristics were not associated with WTP/QALY measures.


The health states and improvements in health evaluated here do not contain a risk of mortality, unlike many situations in which WTP/QALY has been previously evaluated. The lower WTP/QALY values found here may indicate that the presence of a mortality risk reduction substantially increases stated WTP/QALY. Appropriate thresholds for cost-effectiveness may be dependent on the context of a situation, including risk of mortality.

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