Willingness to pay for a quality-adjusted life year in Iran: a systematic review

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BACKGROUND: The monetary value assigned to a quality-adjusted life year (QALY) serves as a fundamental threshold in cost-effectiveness evaluations, contributing to informing resource allocation decisions within healthcare systems given the more severe resource constraints. The present study aims to conduct a systematic review of the existing literature in terms of the methodologies employed, estimated values, and key determinants affecting willingness to pay per QALY in the context of Iran. METHODS: We undertook a systematic review of the published work on willingness to pay (WTP) per QALY by searching eight international and national databases from inception of databases to March 2025, including PubMed, Embase, Web of Science, Scopus, Iran Medex, SID, Magiran, and the Barkat Knowledge Network system. NIH quality assessment tool was used for quality appraisal. RESULTS: The search yielded in 517 articles. After screening, seven articles were eligible. The findings showed that the range of WTP per QALY in Iran is very wide, varying from $1,032 (0.22 times GDP per capita) for neck and back pain interventions to $14,173 (1.98 times GDP per capita) for cancer interventions. The median of WTP/QALY was 0.4 of GDP per capita and was roughly $1921 per QALY, substantially lower than the WHO’s recommended threshold. Education, income, employment, marital status, being head of household, age, gender, were the most important determinants of WTP among all included studies. CONCLUSION: Current WTP/QALY estimates fall substantially below WHO thresholds, suggesting the need to revise Iran’s cost-effectiveness threshold framework. However, further studies are needed and future research should aim to minimize bias in WTP estimates and decision-making criteria to enhance the resource allocation process.