Original Contributions *Associate Professor †Associate ‡Assistant Professor §Assistant Research Professor Professor Address correspondence and reprint re- quests to Dr. Gan at the Department of Anesthesiology, Duke University Medical Center, Box3094, Durham, NC 27710, USA. E-mail: gan00001@mc.duke.edu Supported by Aspect Medical System, Inc., Natick, MA. Received for publication July 16, 2002; re- vised manuscript accepted for publication August 19, 2002. How Much Are Patients Willing to Pay to Avoid Intraoperative Awareness? Tong J. Gan, MB, FRCA, FFARCS(I),* Richard J. Ing, MB, ChB, FCA(SA),† Guy de L Dear, MB, FRCA,* David Wright, MB, FRCA,† Habib E. El-Moalem, PhD,§ David A. Lubarsky, MD, MBA Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, 27710 Study Objective: To determine how much patients are willing to pay to avoid intraoperative awareness? Design: Observational study Setting: University-affiliated metropolitan hospital. Patients: 60 patients who completed a questionnaire (39 F, 21 M). The mean age was 43 years and the median household income range of US$45,000 –$60,000. Interventions: Patients completed an interactive computer-generated questionnaire on the value of preventing intraoperative awareness and their willingness to pay for a “depth of anesthesia” monitor. Their willingness to pay for the prevention of postoperative pain, nausea and vomiting, postoperative grogginess, and sleepiness was also determined as a means of comparison. Measurements and Main Results: Patients were willing to pay (WTP) $34, $10 to $42 (median, interquartile range) for a monitor that would assist an anesthesia care provider assess the depth of anesthesia in an effort to avoid awareness. This increased to $43, $20 to $77 (p  0.0,001) (median, interquartile range), if the insurance company was making the payment and the WTP value only decreased minimally to $33 if the incidence of awareness was reduced 10-fold. Conclusion: The incidence of intraoperative awareness and WTP value for monitoring awareness have a nonlinear relationship (a risk averse utility function), which suggests that patients assign an intrinsic base value for a rare or very rare possibility of an event. Other healthcare economic analyses (such as cost effectiveness) do not take this factor into account and assume a linear value relationship (i.e., if something occurs ten times less frequently, it has ten times less value). Implication: The median value for patients’ WTP for a monitor that might prevent awareness under anesthesia was $34 given an incidence of 5/1,000 cases. The incidence of awareness and WTP value have a nonlinear relationship suggesting that patients assign an intrinsic base value for the possibility of awareness. © 2003 by Elsevier Science Inc. Keywords: Cost-benefit analysis; willing to pay (WTP); intraoperative awareness; pain; vomiting; nausea; grogginess. Journal of Clinical Anesthesia 15:108 –112, 2003 © 2003 Elsevier Science Inc. All rights reserved. 0952-8180/03/$–see front matter 655 Avenue of the Americas, New York, NY 10010 doi:10.1016/S0952-8180(03)00507-X