BACKGROUND In health economic evaluation, utility associated with a health state is outcome-oriented and usually measured using the QALY methodology. Even though there is consistent evidence of utility not only being derived from outcomes but also from procedures, process utility has not been fully integrated in QALY calculations. The aim of this paper is twofold: first, to provide evidence of process utility associated with an alternative treatment to angioplasty, and second, to estimate a monetary value of such process utility using the willingness to pay (WTP) approach. METHODS A total of 1514 people were polled on their WTP to avoid angioplasty to have a drug-eluting stent (DES) implanted. WTP is estimated with a contingent valuation (CV) survey. Individuals are also asked if they would be WTP for a non-invasive procedure with similar results being achieved. WTP responses were analyzed using a double bounded (DB) logit model. RESULTS Most of the participants showed positive preferences for avoiding angioplasty, with an estimated mean WTP of €5692.87. Using QALY gains for avoiding angioplasty, varying from 0.0035 to 0.08 QALYs, our WTP estimate imply monetary values per QALY that range from €71,160.87 to €1,626,534.28. DISCUSSION A WTP of €5692.87 to avoid angioplasty imply a monetary value per QALY that greatly exceed the cost per QALY thresholds established in different countries to consider health programs as beneficial to society. Our results reflect how different methodologies for HTA may lead to different conclusions. From the ICER perspective, the cost that would make the treatment with pills option cost-effective, using a threshold of €40,000/QALY, would be €224. However, a cost-benefit approach could support health programs even with a higher cost. CONCLUSION WTP methodology captures outcome and process factors related to angioplasty as our WTP estimations are non-significantly different for the costs of angioplasty. WTP approach must be considered as a genuine alternative to QALY approaches to value process utility.

中文翻译：

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过程效用的经济评估：阐明对治疗再狭窄的非侵入性程序的偏好。

背景在健康经济评估中，与健康状态相关的效用是以结果为导向的，通常使用 QALY 方法来衡量。尽管有一致的证据表明效用不仅来自结果，而且来自程序，但过程效用尚未完全整合到 QALY 计算中。本文的目的是双重的：首先，提供与血管成形术替代治疗相关的过程效用的证据，其次，使用支付意愿 (WTP) 方法估计这种过程效用的货币价值。方法 共有 1514 人接受了关于他们的 WTP 的调查，以避免血管成形术植入药物洗脱支架 (DES)。WTP 是通过一项或有估值 (CV) 调查来估计的。还询问个人是否愿意接受非侵入性手术并获得类似结果。使用双界 (DB) logit 模型分析 WTP 响应。结果 大多数参与者对避免血管成形术表现出积极的偏好，估计平均 WTP 为 5692.87 欧元。使用 QALY 收益来避免血管成形术，从 0.0035 到 0.08 QALY 不等，我们的 WTP 估计意味着每个 QALY 的货币价值从 71,160.87 欧元到 1,626,534.28 欧元不等。讨论 为避免血管成形术而支付的 5692.87 欧元的 WTP 意味着每个 QALY 的货币价值大大超过了不同国家为将健康计划视为对社会有益而建立的每个 QALY 阈值的成本。我们的结果反映了不同的 HTA 方法可能会导致不同的结论。从ICER的角度来看，使用 40,000 欧元/QALY 的阈值，使药物治疗具有成本效益的成本为 224 欧元。然而，即使成本更高，成本效益方法也可以支持健康计划。结论 WTP 方法捕获与血管成形术相关的结果和过程因素，因为我们的 WTP 估计对于血管成形术的成本没有显着差异。WTP 方法必须被视为对价值过程效用的 QALY 方法的真正替代。