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  • 1.
    Vu Nu, Anh
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Van Hoang, Minh
    Department of Health Economics, Hanoi University of Public Health, Hanoi City, Viet Nam.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sahlen, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nguyen, Cuc Thi Thu
    Department of Pharmaceutical Management and Economics, Faculty of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, Hanoi City, Viet Nam.
    Sun, Sun
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden.
    A systematic review on the direct approach to elicit the demand-side cost-effectiveness threshold: implications for low- and middle-income countries2024In: PLOS ONE, E-ISSN 1932-6203, Vol. 19, no 2, article id e0297450Article, review/survey (Refereed)
    Abstract [en]

    Several literature review studies have been conducted on cost-effectiveness threshold values. However, only a few are systematic literature reviews, and most did not investigate the different methods, especially in-depth reviews of directly eliciting WTP per QALY. Our study aimed to 1) describe the different direct approach methods to elicit WTP/QALY; 2) investigate factors that contribute the most to the level of WTP/QALY value; and 3) investigate the relation between the value of WTP/QALY and GDP per capita and give some recommendations on feasible methods for eliciting WTP/QALY in low- and middle-income countries (LMICs). A systematic review concerning select studies estimating WTP/QALY from a direct approach was carried out in seven databases, with a cut off date of 03/2022. The conversion of monetary values into 2021 international dollars (i$) was performed via CPI and PPP indexes. The influential factors were evaluated with Bayesian model averaging. Criteria for recommendation for feasible methods in LMICs are made based on empirical evidence from the systematic review and given the resource limitation in LMICs. A total of 12,196 records were identified; 64 articles were included for full-text review. The WTP/QALY method and values varied widely across countries with a median WTP/QALY value of i$16,647.6 and WTP/QALY per GDP per capita of 0.53. A total of 11 factors were most influential, in which the discrete-choice experiment method had a posterior probability of 100%. Methods for deriving WTP/QALY vary largely across studies. Eleven influential factors contribute most to the level of values of WTP/QALY, in which the discrete-choice experiment method was the greatest affected. We also found that in most countries, values for WTP/QALY were below 1 x GDP per capita. Some important principles are addressed related to what LMICs may be concerned with when conducting studies to estimate WTP/QALY.

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