Willingness to pay for a quality-adjusted life year (QALY) in Pakistan: implications for health policy

Allocating healthcare resources in developing countries like Pakistan is constrained by economic limitations and uneven distribution. Therefore, in this study, we aimed to investigate the Willingness to Pay (WTP) for one additional Quality-Adjusted Life Year (QALY) among the general population in Pakistan to establish contextually relevant thresholds for health technology assessment (HTA). We conducted a cross-sectional survey using the convenient sampling technique to estimate the WTP for one additional QALY among the general population of Pakistan. The contingent valuation method (CVM) using the payment card technique was used to assess its monetary value. A total of 600 participants participated in the survey and resulted in 1200 WTP responses for further analysis. The mean WTP/QALY was 114,006.4 Pakistani rupee (PKR) (United States Dollar 410.11), equivalent to 0.29 times Pakistan’s GDP per capita. The WTP/QALY for the quality-of-life improvement scenario was lower than the life-extension scenario. The two-part regression model showed that higher education and income were positively associated with WTP value. This study provides empirical evidence of the monetary value of one additional QALY from a sample of the Pakistani population. These findings highlight country-specific cost-effectiveness benchmarks, and incorporating WTP insights into the healthcare policy for better resource allocation, affordability, and long-term sustainability of the interventions