This presentation is part of: Poster Session - Utility Theory; Health Economics; Patient & Physician Preferences; Simulation; Technology Assessment
AN INTERNET SURVEY OF PUBLIC PREFERENCES FOR CHARACTERISTICS OF HEALTH INTERVENTIONS
Lisa A. Prosser, PhD1, Thomas W. Concannon, MS1, Steven D. Pearson, MD1, and James K. Hammitt, PhD2. (1) Harvard Medical School and Harvard Pilgrim Health Care, Ambulatory Care and Prevention, Boston, MA, (2) Harvard School of Public Health, Center for Risk Analysis, Boston, MA
Purpose: To measure the relative effect of specific intervention characteristics on willingness-to-pay (WTP) for coverage of health interventions and to assess the feasibility of an insurance coverage question for capturing such preferences. Methods: An internet-based survey was conducted on a random sample of respondents whose characteristics were matched to those of the U.S. general population (n=1999). Respondents were asked their willingness-to-pay for an increase in their annual insurance premium to cover a hypothetical health intervention using dichotomous-choice double-bounded questions. Each respondent was randomized to one of four scenarios which simultaneously varied age (children or adult) and prevention (vaccination) or treatment and one of two scenarios comparing an intervention for a condition perceived to be involuntary (heart disease) with a similar intervention for a condition perceived to be voluntary (obesity). Scenarios also included information on efficacy, side effects, cost, size of the affected population, and cost-effectiveness that did not vary between scenarios. Survival analysis was used to estimate the median WTP for each additional coverage option both adjusted and unadjusted for respondent characteristics. Covariates included sociodemographic variables, type of health insurance, and familiarity with and self-assessed risk for conditions described in the hypothetical scenarios. Results: Respondents were not willing to pay a significantly different amount for an intervention in children compared with adults or for a prevention compared with a treatment. They were, however, willing to pay more (p<0.01) for an intervention for a condition perceived to be involuntary (heart disease) as compared with a similar intervention for a condition associated with voluntariness (obesity). Results were consistent using both adjusted and unadjusted models. Important covariates were voluntariness of condition, plan type, and total out-of-pocket expenses. Conclusions: Perceived personal accountability for health conditions appears to influence values the public places on health interventions. In contrast to other studies, we did not find differences in willingness-to-pay associated with the age of a patient or when comparing prevention with treatment. Possible explanations are that our insurance coverage question was insufficiently sensitive to detect preferences among intervention characteristics or that vaccines may be associated with greater value than other preventive interventions. Further research on measuring public preferences for specific intervention characteristics could help inform public and private coverage decisions.
