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International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?


  • Takeru Shiroiwa

    (Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan)

  • Yoon-Kyoung Sung

    (Department of Rheumatology, The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea)

  • Takashi Fukuda

    (Department of Health Economics and Epidemiology Research, School of Public Health, The University of Tokyo, Tokyo, Japan)

  • Hui-Chu Lang

    (Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan)

  • Sang-Cheol Bae

    (Department of Rheumatology, The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea)

  • Kiichiro Tsutani

    (Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan)


Although the threshold of cost effectiveness of medical interventions is thought to be £20 000-£30 000 in the UK, and $50 000-$100 000 in the US, it is well known that these values are unjustified, due to lack of explicit scientific evidence. We measured willingness-to-pay (WTP) for one additional quality-adjusted life-year gained to determine the threshold of the incremental cost-effectiveness ratio. Our study used the Internet to compare WTP for the additional year of survival in a perfect status of health in Japan, the Republic of Korea (ROK), Taiwan, Australia, the UK, and the US. The research utilized a double-bound dichotomous choice, and analysis by the nonparametric Turnbull method. WTP values were JPY 5 million (Japan), KWN 68 million (ROK), NT$ 2.1 million (Taiwan), £23 000 (UK), AU$ 64 000 (Australia), and US$ 62 000 (US). The discount rates of outcome were estimated at 6.8% (Japan), 3.7% (ROK), 1.6% (Taiwan), 2.8% (UK), 1.9% (Australia), and 3.2% (US). Based on the current study, we suggest new classification of cost-effectiveness plane and methodology for decision making. Copyright © 2009 John Wiley & Sons, Ltd.

Suggested Citation

  • Takeru Shiroiwa & Yoon-Kyoung Sung & Takashi Fukuda & Hui-Chu Lang & Sang-Cheol Bae & Kiichiro Tsutani, 2010. "International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?," Health Economics, John Wiley & Sons, Ltd., vol. 19(4), pages 422-437.
  • Handle: RePEc:wly:hlthec:v:19:y:2010:i:4:p:422-437
    DOI: 10.1002/hec.1481

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    References listed on IDEAS

    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
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    25. Beth Woods & Paul Revill & Mark Sculpher & Karl Claxton, 2015. "Country-level cost-effectiveness thresholds: initial estimates and the need for further research," Working Papers 109cherp, Centre for Health Economics, University of York.

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