The Intricacies of The Willingness-To-Pay Threshold in Cancer Care

The willingness-to-pay threshold metric aids in determining the value of oncology interventions across diverse global health systems, according to Samuel A. Kareff, MD, MPH. In a recent discussion with CancerNetwork®, Kareff, a medical oncologist and hematologist at Lynn Cancer Institute of Baptist Health South Florida, emphasized that while certain benchmarks are frequently cited in literature, these thresholds must be individualized to the economic realities of specific countries to ensure equitable access to life-saving treatments.

The discussion occurred following the recent publication of 2 studies about the cost-effectiveness of durvalumab (Imfinzi) in patients with stage III non–small cell lung cancer (NSCLC) and limited-stage small cell lung cancer (SCLC).^1,2

The core of Kareff’s analysis involved the application of willingness-to-pay thresholds to assess the cost-effectiveness of various therapeutic regimens. These thresholds represent the maximum amount a health system or society is willing to spend for an additional unit of health, typically measured in quality-adjusted life years.

In the US, Kareff noted that a common benchmark utilized in international analyses is a threshold of approximately $150,000 per year of treatment. The application of this static number becomes problematic when evaluating international markets with different fiscal capacities.

Kareff’s research highlighted the necessity of adjusting these figures based on local context. For example, in Brazil, the analysis moves away from the flat US dollar amount and instead utilizes a formula based on the national economy. In this context, the threshold is adjusted to 3 times the annual GDP per capita. This calculation ensures that the economic evaluation of a drug reflects the actual purchasing power and healthcare budget of the population in question, resulting in a threshold that is a mere fraction of the standard US benchmark.

Kareff underscored that these economic models are intended to be flexible tools for clinicians and policymakers rather than rigid mandates. He noted that the individualized nature of these thresholds is essential for a realistic understanding of global health equity.

Transcript:

This is a pretty complex topic, but essentially, this willingness-to-pay threshold is individualized to each country and each health system. The literature supports various willingness-to-pay thresholds on each context. From there, we can generalize that number to the appropriate country we're looking at. For instance, in our international analyses, we used a pretty traditional willingness-to-pay threshold, something like $150,000 per year for treatment as a number that's often cited in literature. But when you look at country-specific context, namely Brazil, where we also conducted literature, that number is actually adjusted to [3] times the annual GDP per capita of patients who would be living in Brazil, such that [this] number is a fraction of what we see in the US. This willingness-to-pay threshold is a general economic recommendation; it’s certainly by no means dogma or gospel, but it could be used as a reference as we're looking at these analyses in all sites of context.

References

1. Kareff SA, Han S, Haaland B, et al. International cost-effectiveness analysis of durvalumab in stage III non-small cell lung cancer. JAMA Netw Open. 2024;7(5):e2413938. doi:10.1001/jamanetworkopen.2024.13938
2. Jani CT, Manoharan A, Han S, et al. Cost-effectiveness analysis of durvalumab in limited-stage small cell lung cancer in the United States. JCO Glob Oncol. 2025;11:e2500225. doi:10.1200/GO-25-00225