{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:54:09Z","timestamp":1791986049738,"version":"4.4.0"},"reference-count":30,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"unspecified","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["21H04396"],"award-info":[{"award-number":["21H04396"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JPJSCCB20200002"],"award-info":[{"award-number":["JPJSCCB20200002"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,7,16]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Context-specific cost-effectiveness thresholds (CETs) informed by societal willingness to pay (WTP) are crucial for healthcare resource allocation in low- and middle-income countries. This study investigated WTP for health per quality-adjusted life year (QALY) in Bhutan.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A WTP survey was conducted alongside the 2023 National Health Survey in Bhutan, sampling 1869 households. Using contingent valuation, respondents assigned monetary values to three hypothetical scenarios: 1 year of cancer symptom-free life, 1 year of perfect health and 5 years of perfect health. We used generalised linear regression to estimate WTP, controlling for demographic, socioeconomic and health-related factors, as well as elicitation methods. Multilevel analyses examined WTP variations within and between districts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>WTP estimates were 76\u2009836 Bhutanese ngultrum (BTN) (0.26 times gross domestic product (GDP) per capita; 95%\u2009CI: 71\u2009397 to 82 275) for a year without cancer symptoms, 104\u2009381 BTN (0.35 times GDP per capita; 95%\u2009CI: 96\u2009405 to 112\u2009357) for 1 QALY and 235\u2009237 BTN (0.78 times GDP per capita; 95%\u2009CI: 218\u2009674 to 251\u2009800) for 5 QALYs. WTP variations were driven by within-district individual characteristics, particularly income and education, rather than between-district differences.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Minimal between-district WTP variations support a national-level CET for Bhutan. However, WTP-based CETs would be biased upward by wealthier and more educated groups. This bias could justify expensive technologies that strain public resources in Bhutan\u2019s government-funded healthcare system.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2025-019098","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T10:30:16Z","timestamp":1755772216000},"page":"e019098","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Valuing health across groups: a cross-sectional population-based willingness-to-pay survey in Bhutan"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4494-0259","authenticated-orcid":false,"given":"Ying","family":"Yao","sequence":"first","affiliation":[{"name":"Faculty of Economics, Keio University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Mizanur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Pempa","sequence":"additional","affiliation":[{"name":"Department of Health Services, Ministry of Health, Thimphu, Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yot","family":"Teerawattananon","sequence":"additional","affiliation":[{"name":"Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand"},{"name":"Saw Swee Hock School of Public Health, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3217-6452","authenticated-orcid":false,"given":"Ryota","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"2025082103300831000_10.8.e019098.1","unstructured":"OECD . 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