title: How much are patients willing to pay to avoid intraoperative awareness?
abstract: OBJECTIVE
  To determine how much patients are willing to pay to avoid intraoperative awareness?
  
  
  METHODS
  Observational study
  
  
  METHODS
  University-affiliated metropolitan hospital.
  
  
  METHODS
  60 patients who completed a questionnaire (39 F, 21 M). The mean age was 43 years and the median household income range of 45,000-60,000 US dollars.
  
  
  METHODS
  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.
  
  
  RESULTS
  Patients were willing to pay (WTP) 34 US dollars, 10 US dollars to 42 US dollars (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 US dollars, 20 US dollars to 77 US dollars (p < 0.0,001) (median, interquartile range), if the insurance company was making the payment and the WTP value only decreased minimally to 33 US dollars if the incidence of awareness was reduced 10-fold.
  
  
  CONCLUSIONS
  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).
  
  
  CONCLUSIONS
  The median value for patients' WTP for a monitor that might prevent awareness under anesthesia was 34 US dollars 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.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. gan0001@mc.duke.edu
authors.forename: Tong J
authors.initials: TJ
authors.lastname: Gan
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Ing
authors.forename: Guy
authors.initials: G
authors.lastname: de L  Dear
authors.forename: David
authors.initials: D
authors.lastname: Wright
authors.forename: Habib E
authors.initials: HE
authors.lastname: El-Moalem
authors.forename: David A
authors.initials: DA
authors.lastname: Lubarsky
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000191:economics*; D001294:Attitude to Health; D001364:Awareness; D005260:Female; D005382:Financing, Personal; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D016343:Monitoring, Intraoperative / Q000191:economics; D010149:Postoperative Pain / Q000191:economics; D020250:Postoperative Nausea and Vomiting / Q000191:economics; D011795:Surveys and Questionnaires