Use of an Interactive Tool to Assess Patients' Willingness-to-Pay

Abstract

Assessment of willingness to pay (WTP) has become an important issue in health care technology assessment and in providing insight into the risks and benefits of treatment options. We have accordingly explored the use of an interactive method for assessment of WTP. To illustrate our methodology, we describe the development and testing of an interactive tool to administer a WTP survey in a dental setting. The tool was developed to measure patient preference and strength of preference for three dental anesthetic options in a research setting. It delivered written and verbal formats simultaneously, including information about the risks and benefits of treatment options, insurance, and user-based WTP scenarios and questions on previous dental experience. Clinical information was presented using a modified decision aid. Subjects could request additional clinical information and review this information throughout the survey. Information and question algorithms were individualized, depending on the subject's reported clinical status and previous responses. Initial pretesting resulted in substantial modifications to the initial tool: shortening the clinical information (by making more of it optional reading) and personalizing the text to more fully engage the user. In terms of results 196 general population subjects were recruited using random-digit dialing in southwestern Ontario, Canada. Comprehension was tested to ensure the instrument clearly conveyed the clinical information; the average score was 97%. Subjects rated the instrument as easy/very easy to use (99%), interesting/very interesting (91%), and neither long nor short (72.4%). Most subjects were comfortable/very comfortable with a computer (84%). Indirect evaluation revealed most subjects completed the survey in the expected time (30 min). Additional information was requested by 50% of subjects, an average of 2.9 times each. Most subjects wanted this type of information available in the provider's office for use in clinical decision making (92%). Despite extensive pretesting, three "bugs" remained undiscovered until live use. We have demonstrated that the detailed information, complex algorithms, and cognitively challenging questions involved in a WTP survey can be successfully administered using a tailor-made, patient-based, interactive computer tool. Key lessons regarding the use of such tools include allowing the user to set the pace of information flow and tailor the content, engaging the user by personalizing the textual information, inclusion of tests of comprehension and offering opportunities for correction, and pretesting by fully mimicking the live environment.

Implant overdentures for edentulous elders: study of patient preference

“…In societies with limited available resources for health care, preference (or utility) based measurement is an important step in technology diffusion for health services 19 . However, the science of measuring population preferences is new to dentistry, and there are no data on the determinants of utilities and choice of dental treatments by the population at large 3 .…”

“…WTP is important in health technology assessment and in providing insight into the impact that the risks and benefits of treatments have on society 19 . Johannesson and Meltzer have recommended that investigation of societal WTP for health care benefits should be a ''research priority'' 27 .…”

Consumer Participation in Quality Improvements for Chronic Disease Care: Development and Evaluation of an Interactive Patient-Centered Survey to Identify Preferred Service Initiatives

“…The relative prioritization exercise was perceived to be a helpful and easy exercise that could be completed in a relatively short amount of time. Similar Web-based exercises have been successfully used to explore consumers’ research priorities and decision preferences [ 24 , 34 ]. With limited health care resources available, simplified willingness-to-pay exercises may be an appropriate data collection approach to strategically determine funding priorities according to consumers’ preferences.…”

“…In a recent literature review of needs assessment tools frequently used in oncology care, no tool included a priority setting exercise capable of generating a comprehensive yet concise list of specific service initiatives [ 23 ]. Efforts that generate such information, such as willingness to pay or contingent valuation, are complex tasks for participants to complete using the traditional pen-and-paper format [ 24 ]. A Web-based tool with interactive survey content can be used to efficiently examine consumers’ priorities.…”

How can we associate an economic evaluation with a clinical trial?

“…When WTP values are not available, parallel well-designed studies 20 are supposed to be planned to obtain these values and permit performing such type of analysis. 21 Therefore, the CBA may produce an interesting answer for the economic question, but it may demand an additional effort. The WTP should be calculated depending on the perspective set for economic evaluation.…”