Valuing a Quality-Adjusted Life Year (QALY): willingness to pay among older adults in Iran

Abstract Background: Understanding this helps policymakers allocate healthcare resources efficiently, especially in aging societies with budget constraints. Measuring WTP clarifies the economic justification for life extension and the rationale for prioritizing end-of-life care. This study, examined the WTP for one additional QALY among older adults in Tehran and its influencing factors in 2024. Methods : This cross-sectional study included 494 older adults selected through multi-stage cluster sampling from Tehran’s 22 districts and nursing homes. Data were gathered via interviews using a demographic checklist, a researcher-developed WTP questionnaire, and the validated EQ-5D instrument. Given the high likelihood of selection bias, the Heckman two-step method was employed to account for potential sample selection issues. Statistical analyses were performed in STATA 14. Results : Participants were willing to trade 8.84 months of full healthy time for one year of their current life. The mean WTP for one QALY was $3,313 (1,969 million Iranian Rials, IRR), with half offering under $495 (294 million IRR). Based on Heckman method, retirees and homemakers had lower WTP, while higher education, income, and expenses increased it. Living in developed areas and religious commitment also positively influenced WTP likelihood. Conclusions : These findings provide a valuable reference threshold for cost-effectiveness studies on interventions for older adults, enabling policymakers to assess the economic viability of allocating healthcare resources to this population. Furthermore, policymakers can consider the reasons behind older adults' reluctance to invest in longer, healthier lives, which could inform targeted strategies to encourage greater investment in their health.