DETERMINATION OF COST-EFFECTIVENESS THRESHOLD FOR MALAYSIA
Method(s): A cross-sectional, contingent valuation study was conducted using stratified multistage cluster random sampling technique in the states of Penang, Kedah, Selangor and Kuala Lumpur Federal Territory in Malaysia. Respondents aged between 20–60 years old who can understand either English or Malay language were interviewed face-to-face using pre-designed questionnaires. They were asked for the socioeconomic background, quality of life and their willingness-to-pay (WTP) for a hypothetical scenario (treatment, extended life in terminal illness and life saving situations with three severities and two quality-adjusted life-year (QALY) gained levels – 0.2 QALY and 0.4 QALY). Bidding game technique and double-bounded dichotomous-choice approach were applied in eliciting WTP amount for each respondent. 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.
Result(s): A total of 1100 respondents were approached and the overall response rate was recorded at 92.1%. The CE threshold found from the non-parametric Turnbull method was ranged from MYR 12810 – 22840 (~ USD 4000 – 7000). Using the parametric interval regression model, the CE threshold was estimated to be ranged from MYR 19929 – 28470 (~ USD 6200 – 8900). Key factors that affect the CE threshold were education level, estimated monthly household income and the description of health state scenarios.
Conclusion(s): The findings in this study support that there is no single value of a QALY. The CE thresholds estimated for Malaysia in this study were found to be lower than the normally used threshold value of one to three times the gross domestic product per capita as recommended by the World Health Organisation.