title: Willingness to pay for sensory attributes of intranasal corticosteroids among patients with allergic rhinitis.
abstract: OBJECTIVE
  Sensory attributes of intranasal corticosteroids (INSs) differ by product based on chemical composition. We previously reported that patients are able to demonstrate preferences for certain INS sensory attributes, which may affect their willingness to adhere to therapy. As part of the same study, we also sought to determine if these same patients are willing to pay for products not containing certain sensory attributes.
  
  
  METHODS
  We conducted a 2-part cross-sectional study of 120 patients with allergic rhinitis at 4 allergy and immunology clinics in the United States in November and December 2003. In the first part of the study, the patients chose between pairs of hypothetical INS products that differed in the intensity of 6 sensory attributes (smell, taste, aftertaste, throat rundown, nose runout, and feel of spray in nose/throat; results were reported in the Annals of Allergy, Asthma & Immunology [2004;93:345-50]). In the second part of the study, reported here, discrete choice experiment methodology was used in which the patients chose among hypothetical INS products that differed in the intensity of the 6 sensory attributes and monthly copayments of dollar 15, dollar 30, and dollar 50. Each sensory attribute was characterized by 3 intensity levels, e.g., no aftertaste (mild intensity), weak aftertaste (moderate intensity), or strong aftertaste (severe intensity). The strength of preferences, shown as marginal willingness to pay to avoid certain sensory attributes, was measured in U.S. dollars per month. We also evaluated the effect of annual household income on willingness to pay.
  
  
  RESULTS
  Demographic results indicated that 86.7% of participants had prior experience with at least 2 INS products. Seven patients (5.8%) were excluded from the willingness-to-pay analysis due to inconsistent responses to the logic checks used to confirm patient engagement in the study instrument. On average, the 113 remaining patients were willing to pay $11 (95% confidence interval [CI], dollar 9-dollar 13) per month in 2003 dollars to get an INS with no smell instead of strong smell, dollar 12 (95% CI, dollar 10-dollar 14) for no taste instead of strong taste, dollar 20 (95% CI, dollar 18-dollar 22) for no aftertaste instead of strong aftertaste, dollar 10 (95% CI, dollar 9-dollar 12) for no throat rundown instead of a lot of throat rundown, dollar 11 (95% CI, dollar 9-dollar 13) for no nose runout instead of a lot of nose runout, and dollar 6 (95% CI, dolalr 4-dollar 8) for a spray with a wet feel instead of a dry feel. Comparing moderate intensity levels of each sensory attribute with the mildest, only 3 attributes had statistically significant willingness to pay: aftertaste, throat rundown, and nose runout. Patients with a higher income were willing to pay more to avoid a lot of throat rundown and nose runout than those with a low income (P <0.01), but this relationship did not hold for the other sensory attributes.
  
  
  CONCLUSIONS
  Patients demonstrated significant willingness to pay to avoid certain sensory attributes of INSs. Sensory attributes of INS products appear to be potentially important considerations when evaluating alternative INS products for drug therapy selection or formulary placement.
authors.affiliation: Global Health Economics, Amgen, Inc., 555 13th St. NW, Suite 600 West, Washington, DC 20004, USA. parthivm@amgen.com
authors.forename: Parthiv
authors.initials: P
authors.lastname: Mahadevia
authors.forename: Shailen
authors.initials: S
authors.lastname: Shah
authors.forename: Sally
authors.initials: S
authors.lastname: Mannix
authors.forename: Jessica
authors.initials: J
authors.lastname: Brewster-Jordan
authors.forename: Leah
authors.initials: L
authors.lastname: Kleinman
authors.forename: Christopher
authors.initials: C
authors.lastname: Liebman
authors.forename: Liza
authors.initials: L
authors.lastname: O'Dowd
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D002755:Choice Behavior; D017047:Cost Sharing / Q000191:economics; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics*; D006801:Humans; D007182:Income; D008297:Male; D010361:Patients / Q000523:psychology*; D011306:Prescription Fees; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy* / Q000191:economics*; D013678:Technology, Pharmaceutical
chemical_list: D005938:Glucocorticoids