How much are patients willing to pay to avoid intraoperative awareness?

Abstract

Study objective To determine how much patients are willing to pay to avoid intraoperative awareness? Design Observational study Setting University-affiliated metropolitan hospital. Patients 60 patients who completed a questionnaire (39 F, 21 M). The mean age was 43 years and the median household income range of US$45,000 –$60,000. Interventions Patients completed an interactive computer-generated questionnaire on the value of preventing intraoperative awareness and their willingness to pay for a “depth of anesthesia” monitor. Their willingness to pay for the prevention of postoperative pain, nausea and vomiting, postoperative grogginess, and sleepiness was also determined as a means of comparison. Measurements and main results Patients were willing to pay (WTP) $34, $10 to $42 (median, interquartile range) for a monitor that would assist an anesthesia care provider assess the depth of anesthesia in an effort to avoid awareness. This increased to $43, $20 to $77 (p < 0.0,001) (median, interquartile range), if the insurance company was making the payment and the WTP value only decreased minimally to $33 if the incidence of awareness was reduced 10-fold. Conclusion The incidence of intraoperative awareness and WTP value for monitoring awareness have a nonlinear relationship (a risk averse utility function), which suggests that patients assign an intrinsic base value for a rare or very rare possibility of an event. Other healthcare economic analyses (such as cost effectiveness) do not take this factor into account and assume a linear value relationship (i.e., if something occurs ten times less frequently, it has ten times less value). Implication The median value for patients’ WTP for a monitor that might prevent awareness under anesthesia was $34 given an incidence of 5/1,000 cases. The incidence of awareness and WTP value have a nonlinear relationship suggesting that patients assign an intrinsic base value for the possibility of awareness.