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건강개선 정도에 따른 지불의사금액 추정 연구

A study of identifying factors affecting cost-effectiveness threshold calculation in Korea

박선영|박주연|안정훈|송현진|배은영|신상진|김윤희
한국보건경제정책학회 (The Korean Association of Health Economics and Policy)|2010.08|보건경제와 정책연구 (The Korean Journal of Health Economics and Policy)|제16권 제2호|pp. 79-100

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참고문헌

키워드

QALYCost-effectivenessEconomic Evaluation경제성 분석지불의사금액(WTP)Willingness To Pay(WTP)비용-효과성점증적 비용 효과비(ICER)질보정생존년수(QALY)Incremental Cost Effectiveness Ratio(ICER)
주제분류사회과학일반

초록

한국에서 경제성 분석의 활용이 점차 확대되고 있으나 비용-효과성을 판단할 기준에 대한 정보가 부족하여 의사결정의 불확실성이 존재하고 갈등의 요인이 되고 있다. 본 연구는 사회적으로 수용 가능한 비용-효과비의 범위를 추정하고자 수행되었다. 이를 위해 관련 방법론을 검토하고 일반인 100명을 대상으로 조건부 가치측정법을 사용하여 지불의사금액(Willingness To Pay: WTP)을 조사하였다. 분석 결과 건강개선 정도, 효용 계측 방법, EQ-5D 환산수식의 다양함을 고려하였을 때 1 QALY(Quality Adjusted Life Years)당 WTP는 1,050만원에서 3,642만원 수준으로 산출되었다. 노인집단, 저소득집단에서 낮은 지불의사금액을 제시하였고 건강개선 수준이 낮을수록 1 QALY당 WTP가 높았다. 본 연구를 시작으로 우리나라에서 경제성 분석과 관련된 많은 연구들이 축적된다면 비용-효과성 기준에 대한 정보의 부재로 인한 의사결정의 불확실성은 점차 줄어들고, 이를 통해 비용-효과성 결과를 이용한 보다 투명한 정책집행이 가능해져서 사회적으로 갈등요인이 줄어들게 될 것으로 기대한다.

Abstract

This study was performed to search for cost-effectiveness threshold in Korea. A survey questionnaire using EQ-5D to measure QALY improvements and WTP in hypothetical scenarios were developed. 100 citizens in Seoul were interviewed face-to-face with this questionnaire in 2009. Each person’s WTP was asked for five scenarios chosen from each health improvement level based on Korean EQ-5D tariff: 0~0.2, 0.2~0.4, 0.4~0.6, 0.6~0.8, 0.8~1.0. The questionnaire also included questions on demographics, disease status, and a visual analog scale (VAS) measure of each scenario presented. Consistency of each respondent was checked by matching ranks of five scenarios between WTPs and QALY improvements either by VAS or Korean EQ-5D tariff. The WTP for an additional QALY (calculated by VAS and three existing Korean EQ-5D tariffs) was around 10.5~36.4 million won on average for those (N=70) who passed consistency check and not under medical assistance program. The relationship between WTP and QALY improvements measured by VAS was monotonic (people more appreciate significant improvements) whereas the relationship between WTP and QALY improvements measured by Korean tariffs were highest in 0~0.2 level. The choice of method to calculate QALY improvement seems crucial in cost-effectiveness threshold study in Korea. However, we expect this study can contribute to resolve the frictions over the interpretation of CEA in Korea.

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