Purpose: It is reported in utility elicitation that people with a disability value their health state more highly than community members who have not experienced the disability. We compared the willingness to pay (WTP) to avoid loss of visual function in a community based sample of people to people with visual impairment (VI) using a discrete choice experiment (DCE).
Methods: A DCE was constructed in which visual function was described using 9 attributes. These were used to construct a DCE describing “insurance policies” which offered a 100% guarantee that the participant would never experience functional loss worse than described in the scenario. Attributes were presented in three levels of difficulty ranging from “never a problem” to “always a problem”. Premiums ranged from $60 to $12,000/year. Each respondent chose between two scenarios consisting of five attributes selected from the 9 (the insurance premium was always included). The community sample was recruited from a volunteer registry. All community participants had self-reported vision of “excellent” or “good”. The VI sample was recruited from retina practices or the volunteer registry. All had best-corrected vision of 20/40 or worse, or self-reported vision of “fair” or “poor”. Preference scores from the DCE were estimated using multinomial logit regression and a demand curve for the prevention of loss of visual function was fitted.
Results: The DCE was completed by 194 community participants and 56 participants with VI. In the Figure below we plot the demand curves for preserving vision function. The curve for people with VI is inelastic compared to that of the community based sample. This indicates a higher value placed on preserving visual function for the VI sample than the community based sample.
Conclusions: We demonstrated using a WTP approach to health state valuation that people with VI place a higher value on maintaining visual function than did those in the community. Whether this is true of all people with disabilities, or an artifact of our sample merits further investigation. 
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