ECONOMICS AND HEALTH SYSTEMS RESEARCH SECTION EDITOR RONALD D. MILLER How Much Are Patients Willing to Pay to Avoid Postoperative Nausea and Vomiting? Tong J. Gan, MB, FRCA, FFARCS(I)*, Frank Sloan, PhD†, Guy de L Dear, MB, FRCA*, Habib E. El-Moalem, PhD*, and David A. Lubarsky, MD, MBA*‡ *Department of Anesthesiology, Duke University Medical Center; †Center for Health Policy, Law, and Management, Duke University; and ‡Fuqua School of Business, Duke University, Durham, North Carolina Postoperative nausea and vomiting (PONV) are un- pleasant experiences. However, there is no drug that is completely effective in preventing PONV. Whereas cost effectiveness analyses rely on specific health out- comes (e.g., years of life saved), cost-benefit analyses assess the cost and benefit of medical therapy in terms of dollars. We hypothesized that patients were willing to pay for a hypothetical new drug that would eliminate PONV. Eighty elective day surgical patients using gen- eral anesthesia participated in the study. After their re- covery in the postanesthetic care unit, they were asked to complete an interactive computer questionnaire on demographics, the value of avoiding PONV, and their willingness to pay for an antiemetic. Patients were will- ing to pay US$56 (US$26 –US$97; median, 25%–75%) for an antiemetic that would completely prevent PONV. Patients who developed nausea (n = 21; 26%) and vom- iting (n = 9; 11%) were willing to pay US$73 (US$44 – US$110) and $100 (US$61–US$200; median, 25%–75%), respectively (P  0.05). Seventy-six percent of patients considered avoiding postoperative nausea and 78% of patients considered avoiding vomiting as important (50 mm on a 0 –100-mm visual analog scale). Nausea or vomiting in the postanesthetic care unit, greater pa- tient income, previous history of PONV, more impor- tance placed on avoiding nausea and vomiting, increas- ing age, and being married are independent covariates that increase the willingness to pay estimates. Patients associated a value with the avoidance of PONV and were willing to pay between US$56 and US$100 for a completely effective antiemetic. (Anesth Analg 2001;92:393–400) C ost-effectiveness and cost-benefit analyses are analytical techniques that can help physicians and policy makers by comparing health care practices and technologies in terms of their relative economic efficiencies in providing health benefits (1). Cost-effectiveness analysis compares the net monetary costs of a health care intervention with some measures of clinical outcome or effectiveness, such as increased longevity, expressed most often as life-years saved. Whereas other health care outcomes, e.g., dollar per episode of postoperative nausea and vomiting (PONV) avoided, can be calculated with a cost-effectiveness anal- ysis, there is no standard against which to measure the value obtained. Cost-effectiveness analysis is also pater- nalistic, i.e., someone who manages the delivery of health care (neither patients nor their doctors) will de- cide what is worthwhile. In a cost-benefit analysis, the costs of a health care intervention are assessed the same way as in cost-effectiveness analysis, but measures of clinical outcomes or effectiveness are typically converted into monetary units (2). The patients will determine what monetary value they place on their therapy and what they want to fund from their own resources, their insurance, or tax dollars. Many new drugs have been introduced in anesthe- sia, often replacing older and less expensive drugs. Much has been written on the benefits of these newer drugs in terms of physiological and pharmacological responses of patients. Little is known of the value patients put on the benefits of these new drugs. PONV is an unpleasant experience that occurs often after surgery. The results of several studies suggest that patients not only rank the absence of PONV as being important (3) but also rank it as more important than an earlier discharge from an ambulatory surgical unit (4). We hypothesized that patients were willing to pay (WTP) for an antiemetic that would eliminate PONV and that the WTP amount was related to the patient’s demographic characteristics. Supported in part by Glaxo Wellcome, Inc. Accepted for publication October 20, 2000. Address correspondence and reprint requests to T. J. Gan, Depart- ment of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710. Address e-mail to gan00001@mc.duke.edu. ©2001 by the International Anesthesia Research Society 0003-2999/01 Anesth Analg 2001;92:393–400 393