title: Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences.
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.
authors.affiliation: 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. jmfernandez@salud.madrid.org.
authors.forename: Jesus
authors.initials: J
authors.lastname: Martín-Fernández
authors.forename: Elena
authors.initials: E
authors.lastname: Polentinos-Castro
authors.forename: Ma Isabel
authors.initials: MI
authors.lastname: del Cura-González
authors.forename: Gloria
authors.initials: G
authors.lastname: Ariza-Cardiel
authors.forename: Victor
authors.initials: V
authors.lastname: Abraira
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Gil-LaCruz
authors.forename: Sonia
authors.initials: S
authors.lastname: García-Pérez
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005382:Financing, Personal; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D013030:Spain; D011795:Surveys and Questionnaires