Willingness to pay in healthcare: interpreting value for money

In a cost-effectiveness analysis, a willingness-to-pay threshold is a reference value for one additional unit of health benefit, usually a QALY. It helps interpret whether additional benefits justify additional costs.

It is not the same as what an individual patient is willing to pay, and it does not guarantee reimbursement.

Compare an ICER with a threshold

For an intervention that improves health and increases costs, compare its ICER with the relevant threshold.

Suppose an intervention adds €50,000 in costs and 0.8 QALYs per patient over the same lifetime horizon. Its ICER is €62,500 per QALY. At an illustrative threshold of €80,000 per QALY, the intervention has a positive incremental net monetary benefit.

Net monetary benefit

Incremental NMB = (additional QALYs × threshold) − additional costs

For this example: (0.8 × €80,000) − €50,000 = €14,000 per patient.

Positive incremental NMB favours the innovation over its comparator at that threshold. This is a monetary expression of health value, not money saved in a healthcare budget. Compare alternatives using consistent populations, perspectives and horizons.

Use the relevant decision framework

Thresholds differ across decision makers and may depend on disease severity or other criteria. The Dutch assessment framework sets reference values of €20,000, €50,000 and €80,000 per QALY for specified disease-burden categories. These are reference ceilings rather than target prices.

Avoid applying a single universal threshold across countries. Consult the responsible assessment body's guidance for the decision being made.

Value for money is not affordability

Even with positive NMB, an intervention can require substantial upfront spending or extra workforce capacity. Consider budget impact, uncertainty, clinical benefit and implementation alongside cost-effectiveness.

Further reading

Zorginstituut Nederland: assessment framework for cost-effectiveness.