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Determination of a Cost-Effectiveness Threshold for Cancer Interventions in Iran Publisher



Safari H1 ; Poder TG2, 3 ; Afshari S4 ; Nahvijou A5 ; Arabzozani M6 ; Moradi N7 ; Ameri H8
Authors
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Authors Affiliations
  1. 1. Health Promotion Research Centre, Iran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
  3. 3. Centre de recherche de l’Institut universitaire en sante mentale de Montreal, CIUSSS de l’Est de l’ile de Montreal, Montreal, QC, Canada
  4. 4. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
  5. 5. Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
  7. 7. Department of Health Management and Economics, School of Public Health, Iran University of Medical Science, Tehran, Iran
  8. 8. Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Source: Frontiers in Oncology Published:2022


Abstract

Background and objectives: The estimation of a cost- Effectiveness (CE) threshold from the perspective of those who have experienced a life-threatening disease can provide empirical evidence for health policy makers to make the best allocation decisions on limited resources. The aim of the current study was to empirically determine the CE threshold for cancer interventions from the perspective of cancer patients in Iran. Methods: A composite time trade-off (cTTO) task for deriving quality adjusted life-year (QALY) and a double-bounded dichotomous choice (DBDC) approach followed by open-ended question for examining patients’ willingness-to-pay were performed. A nationally representative sample of 580 cancer patients was recruited from the largest governmental cancer centers in Iran between June 2021 and January 2022, and data were gathered using face-to-face interviews. The CE threshold was calculated using the nonparametric Turnbull model and parametric interval-censored Weibull regression model. Furthermore, the factors that affect the CE threshold were determined using the parametric model. Results: The estimated CE threshold using the nonparametric Turnbull model and parametric interval-censored Weibull regression model was IRR 440,410,000 (USD 10,485.95) and IRR 595,280,000 (USD 14,173.33) per QALY, respectively. Gender, age, education, income, type of cancer, and current treatment status were significantly associated with the estimated CE threshold. Conclusions: The value of parametric model-based threshold in this study was 1.98 times the Iranian GDP per capita, which was lower than the CE threshold value recommended by the WHO (i.e., 3 times the GDP per capita) for low-and middle-income countries. Copyright © 2022 Safari, Poder, Afshari, Nahvijou, Arab-Zozani, Moradi and Ameri.
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