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Open Access Research article

Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences

Jesus Martín-Fernández1*, Elena Polentinos-Castro2, Ma Isabel del Cura-González3, Gloria Ariza-Cardiel4, Victor Abraira5, Ana Isabel Gil-LaCruz6 and Sonia García-Pérez7

Author Affiliations

1 Consultorio Local de Villamanta (C.S Navalcarnero). Gerencia de Atención Primaria. Servicio Madrileño de Salud, Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Avda de la Libertad s/n, Villamanta 28610, Madrid, Spain

2 Unidad Docente de Atención Familiar y Comunitaria Norte. Gerencia de Atención Primaria, Servicio Madrileño de Salud. Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), C/Alfonso Rodríguez Castelao, nº 17-28035 Madrid, Spain

3 Unidad de Apoyo a la Investigación. Gerencia de Atención Primaria. Servicio Madrileño de Salud. Departamento de Medicina Preventiva y Salud Pública, Rey Juan Carlos I University. Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Avda San Martin de Porres, nº6, 28035 Madrid, Spain

4 Unidad Docente de Atención Familiar y Comunitaria Oeste. Gerencia de Atención Primaria, Servicio Madrileño de Salud. Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), C/Alonso Cano 8, 28933 Móstoles, Madrid, Spain

5 Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, Servicio Madrileño de Salud, CIBER de Epidemiología y Salud Pública (CIBERESP), Ctra. Colmenar km 9.100, Madrid 28034, Madrid, Spain

6 Departamento de Dirección y Organización de Empresas. Escuela de Ingeniería y Arquitectura, Universidad de Zaragoza, María de Luna, 3; Campus Río Ebro, 50018 Zaragoza, Spain

7 Instituto de Salud Carlos III. Agencia de Evaluación de Tecnologías Sanitarias, Madrid, Spain, Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Av. Monforte de Lemos 5-28029 Madrid, Spain

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BMC Health Services Research 2014, 14:287  doi:10.1186/1472-6963-14-287

Published: 3 July 2014

Abstract

Background

This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response.

Methods

Health-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic and socioeconomic characteristics, as well as usage of health services by the subjects were collected. The attitude towards risk was evaluated by collecting risky behaviors data, by the subject’s self-evaluation, and through lottery games.

Results

Six hundred and sixty two subjects participated and 449 stated a utility inferior to 1. WTP/QALY ratios varied significantly when payments with personal money (mean €10,119; median €673) or through taxes (mean €28,187; median €915) were suggested. Family income, area income, higher education level, greater use of healthcare services, and the number of co-inhabitants were associated with greater WTP/QALY ratios. Age and female gender were associated with lower WTP/QALY ratios. Risk inclination was independently associated with a greater WTP/QALY when “out of pocket” payments were suggested. Clear discrepancies were demonstrated between linearity and neutrality towards risk assumptions and experimental results.

Conclusions

WTP/QALY ratios vary noticeably based on demographic and socioeconomic characteristics of the subject, but also on their attitude towards risk. Knowing the expression of preferences by patients from this outcome measurement can be of interest for health service planning.

Keywords:
Economics; Willingness to pay; Quality-adjusted life year; Risk-taking; Contingent valuation; Primary care