Setting cost-effectiveness thresholds for health technologies in Vietnam: A WTP/QALY approach

Objectives: Cost-effectiveness analysis is considered a foundational element for discussions of fair pricing by policymakers, comparing against a predetermined benchmark referred to as the cost-effectiveness threshold (CET), which determines if technology expenses are eligible for reimbursement. In Vietnam, the CET has not been established, creating a significant gap in the country's health policy decision-making process. This study aimed to establish a threshold for healthcare services by estimating the willingness to pay for a quality-adjusted life year (WTP/QALY). Methods: A total of 2,261 Vietnamese individuals were enrolled in this study and randomly assigned to scenariobased questionnaires. WTP values were collected via a contingent valuation approach, which included dichotomous bidding and open-ended inquiry. Generalized linear models and logistic regression were used to evaluate the influence of variables on WTP/QALY. Results: The mean WTP/QALY of the whole sample was USD 12,532 (VND 296.06 million), which is 3.01 times the country's gross domestic product (GDP) per capita. The mean WTP/QALY varied under different scenarios, with the highest in the life-saving scenario at USD 14,893 (VND 351.84 million), followed by the life-extension scenario at USD 14,547 (VND 343.64 million), and the life-improvement scenario at USD 10,146 (VND 239.69 million), ranging from 2.41 to 3.54 times the GDP per capita. Educational attainment, income level, proportion of certainty in treatment outcome, and scenario type substantially influenced WTP/QALY valuation. Conclusions: The results indicate that the established threshold is slightly greater than that proposed by the World Health Organization. This finding provides a foundational reference point for the development of health policy in Vietnam, ensuring fair pricing and effective allocation of healthcare resources.