What do patients value? Willingness to pay for ultrasound in normal pregnancy

Abstract

Evaluations of diagnostic tests have focused primarily on their value in clinical decisions. Patients may attach value to 1) information that has little or no medical significance, and 2) information (medical or nonmedical) that has no bearing on decisions to be made by the doctor or the patient. Ultrasound in pregnancy, which provides a great deal of information to both doctor and patient, was chosen as the example with which to explore these hypotheses. Sixty-two women with current or recent normal pregnancies were given a structured interview to elicit their willingness to pay for ultrasound information. Among these women, 26% of the value attached to the test related to information having no decisional significance, and 37% of the value related to information of use to the patient, but not the doctor. Overall, 44% of the value of the test, from the patients' point of view, pertained to uses outside the realm of medical decisions. On the average, interviewees alleged that they would pay +706 for the information contained in an ultrasound test in an uncomplicated pregnancy. Decision analyses and cost-effectiveness analyses that take note only of the medical, decisional uses of test information may overlook a high proportion of the value patients attach to the information.