Abstract 3232: Willingness to Pay for Implantable Cardioverter Defibrillator Therapy; A Contingent Valuation from Canadian Patients’ Perspective
Implantable cardioverter defibrillator (ICD) therapy has been proven effective at reducing the risk of sudden cardiac death in secondary and primary prevention. Traditional economic evaluation that focuses on cost-effectiveness may overlook some of the value of expensive technologies from the patient’s perspective. We desired to assess patients’ willingness to pay (WTP) for a hypothetical scenario of ICD replacement. We used a contingent approach to evaluate the WTP among 237 ICD recipients followed at a large Canadian tertiary centre. The scenario described the hypothetical situation of the end-of-life of their present ICD and a theoretical situation where the government would not pay for the next ICD. Patients were asked to indicate their out-of-pocket WTP for their replacement ICD. The question was close-ended and seven different “take-it-or-leave-it” amounts ($5000, $10 000, $15 000, $20 000, $25 000, $30 000, $35 000) were randomly varied among the patients. WTP responses were analyzed by non-parametric methods. Multiple logistic regression models were generated to identify factors associated with WTP. Patients were mostly male (84%), with a mean age of 64 years. The majority of patients had not reached college (56%). Household income was lower than $60 000 in 79% of respondents, and 83% were unemployed or retired. The median WTP was estimated at $4124. The willingness to pay was influenced positively by higher gross family income (odds ratio [OR]=2.5 95% confidence interval [CI] 1.00 – 6.41) and higher education (OR=2.1 95%CI 0.90– 4.87). History of a previous shock (OR=1.29 95%CI 0.50–3.34) or the indication (primary vs. secondary prevention) of ICD therapy (OR=0.58 95%CI 0.24–1.40) did not influence the WTP. Every $1000 increase of the bid was associated with a lower WTP (OR=0.96 95%CI 0.92–1.00). The median willingness to pay of ICD recipients for the replacement of their ICD represents less than one fifth of the actual price of the device. However, considering that the majority of patients had a modest household income, the amount they were willing to pay suggests that they believe this treatment is of substantial value. Previous shocks or the indication of ICD therapy did not have any impact on WTP.