Propension à payer pour la guérison d'une maladie chronique: Différences de perception des patients et de la population générale à propos de la polyarthrite rhumatoïde

The willingness-to-pay (WTP) method aims at the valuation of benefits not accessible on the marketplace, such as health benefits. Objective: 1 - To estimate the feasibility of a WTP survey about a hypothetical cure of rheumatoid arthritis (RA), a chronic and disabling condition, in a representative sample of the French general population (GP) and in people living with RA. 2 - To study WTP variations according to respondents' medical status, as well as cure funding and payment vehicles as described in the study presentation. Methods: The survey was conducted on 454 members of the general population and 150 RA patients. A brochure presenting the main features of RA was sent to all participants. Then, they were asked for their maximum WTP for a hypothetical cure of RA through payment cards. Two scenarios were successively presented to respondents: a private insurance-based funding (annual premium) making the cure available for the respondent and his/her family; or coverage by the public health insurance (through an additional income tax), rendering the cure accessible for the entire population. WTP determinants were studied by an ordered logit regression model. Results: Survey questions were considered difficult by 39% of the GP participants, as well as 47% of RA patients; 46% and 57% of them, respectively, thought these questions should be left for experts. However, 91% and 95% provided a WTP amount. Although the majority of the participants expressed a preference for a public coverage, the mean WTP for this scenario was 127 € (median 69 €), lower than that for the private insurance scenario, 235 € (median 85 €) (p<0.01). Null responses (WTP = 0 €) were obtained in 19% and 16% for each scenario, respectively. RA patients' mean WTP was 2 to 3 fold higher than that of the general population (p<0.0001): 400 € (median 126 €) and 490 € (median 229 €) for each scenario, respectively, with 12% and 10% of null responses. GP WTP determinants were age (higher WTP in younger respondents), household structure (living in couples), and payment card with the highest values. In addition, a negative impact on WTP of the presence of pictures in the brochure was observed in RA patients. Conclusion: WTP phone surveys for health problems are feasible. However, several parameters related to scenario and question framing do impact WTP responses, compromising the potential of WTP studies to adequately value a health benefit.