Applied Health Economics and Health Policy

, Volume 10, Issue 6, pp 407–415 | Cite as

What Explains Willingness to Pay for Smoking-Cessation Treatments —Addiction Level, Quit-Rate Effectiveness or the Opening Bid?

Past, Present and Future
  • Jan Abel Olsen
  • Ole J. Røgeberg
  • Knut Stavem
Original Research Article


Background: Several countries have now passed laws that place limitations on where smokers may smoke. A range of smoking-cessation treatments have become available, many of which have documented increased quit rates. Population surveys show that most smokers wish to quit, and most nonsmokers would prefer to reduce the prevalence of smoking in society. The strengths of these preferences, however, as measured by their willingness to pay (WTP), have not yet been investigated.

Objective: This study aims to identify variables that explain variations in people’s answers to WTP questions on smoking-cessation treatments.

Methods: A representative sample of the Norwegian population was asked their WTP in terms of an earmarked contribution to a public smokingcessation programme. A sub-group of daily smokers was, in addition, asked about their WTP for a hypothetical treatment that would remove their urge to smoke. The impact of variation in the question format (different opening bids) on stated WTP was compared with that of factors suggested by economic theory, such as quit-rate effectiveness, degree of addiction as measured by the 12-item Cigarette Dependence Scale (CDS-12), and degree of peer group influence as measured by the proportion of one’s friends who smoke.

Results: In both programmes, the most important determinant for explaining variations in WTP was the size of the opening bid. Differences in quit-rate effectiveness did not matter for people’s WTP for the smoking-cessation programme. Addiction, and having a small proportion of friends who smoke, were positively associated with smokers’ WTP to quit smoking.

Conclusion: Variations in WTP were influenced more by how the question was framed in terms of differences in opening bids, than by variables reflecting the quality (effectiveness) and need (addiction level) for the good in question. While the WTP method is theoretically attractive, the findings that outcomes in terms of different quit rates did not affect WTP, and that WTP answers can be manipulated by the chosen opening bid, should raise further doubts on the ability of this method to provide valid and reliable answers that reflect true preferences for health and healthcare.


Discrete Choice Experiment Daily Smoker Addiction Level Cigarette Dependence Scale Hypothetical Good 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank the Foundation for Health Service Research (HELTEF), University of Oslo, University of Tromsø and GlaxoSmithKline for financial support. The study received an unrestricted grant from GlaxoSmithKline for partial funding of this study. The funding agreement assured the authors’ independence in design, analysis, interpretation, writing and publishing of the study.

Authors’ contribution: JAO took the lead in writing the paper, and is the guarantor for the overall content. All three authors contributed jointly to design, statistical analysis and interpretation, and were actively involved in all stages of the work.


  1. 1.
    EPHA. European smoking bans: evolution of the legislation [online]. Available from URL: [Accessed 2012 Aug 13]
  2. 2.
    Xenakis JG, Kinter ET, Ishak KJ, et al. A discrete-event simulation of smoking-cessation strategies based on varenicline pivotal trial data. Pharmacoeconomics 2011; 29: 497–510PubMedCrossRefGoogle Scholar
  3. 3.
    Leu RE. Anti-smoking publicity, taxation, and the demand for cigarettes. J Health Econ 1984; 3: 101–16PubMedCrossRefGoogle Scholar
  4. 4.
    Hammar H, Johansson-Stenman O. The value of risk-free cigarettes: do smokers underestimate the risk? Health Econ 2004; 13: 59–71PubMedCrossRefGoogle Scholar
  5. 5.
    Slovic P. The construction of preferences. Am Psychol 1995; 50: 364–70CrossRefGoogle Scholar
  6. 6.
    Mellers BA, Schwartz A, Cooke ADJ. Judgement and decision making. Annu Rev Psychol 1998; 49: 447–77PubMedCrossRefGoogle Scholar
  7. 7.
    Shiell A, Gold L. If the price is right: vagueness and values clarification in contingent valuation. Health Econ 2003; 12: 909–19PubMedCrossRefGoogle Scholar
  8. 8.
    Lloyd AJ. Threats to the estimation of benefit: are preference elicitation methods accurate? Health Econ 2003; 12: 393–402PubMedCrossRefGoogle Scholar
  9. 9.
    Beattie J, Covey J, Dolan P, et al. On the contingent valuation of safety and the safety of contingent valuation: part 1 — caveat investigator. J Risk Uncertain 1998; 17: 5–25CrossRefGoogle Scholar
  10. 10.
    Mitchell RC, Carson RT. Using surveys to value public goods: the contingent valuation method. Washington DC: Resources for the Future, 1988Google Scholar
  11. 11.
    Herriges JA, Shogren JF. Starting point bias in dichotomous choice valuation with follow-up questioning. J Environ Econ Manage 1996; 30: 112–31CrossRefGoogle Scholar
  12. 12.
    Stalhammar NO. An empirical note on willingness to pay and starting-point bias. Med Decis Making 1996; 16: 242–7PubMedCrossRefGoogle Scholar
  13. 13.
    McNamee P, Ternent L, Gbangou A, et al. A game of two halves? Incentive incompatibility, starting point bias and the bidding game in contingent valuation method. Health Econ 2010; 19: 75–87PubMedGoogle Scholar
  14. 14.
    Ariely D, Loewenstein G, Prelec D. “Coherent arbitrariness”: stable demand curves without stable preferences. Q J Econ 2003; 118: 73–105CrossRefGoogle Scholar
  15. 15.
    Kahneman D. Thinking, fast and slow. London: Allen Lane, Penguin, 2011Google Scholar
  16. 16.
    de Bekker-Grob EW, Ryan M, Gerard K. Discrete choice experiments in health economics: a review of the literature. Health Econ 2012; 21: 145–72PubMedCrossRefGoogle Scholar
  17. 17.
    Bryan S, Dolan P. Discrete choice experiments in health economics: for better or worse? Eur J Health Econ 2004; 3: 199–202CrossRefGoogle Scholar
  18. 18.
    Stavem K. Association of willingness to pay with severity of chronic obstructive pulmonary disease, health status and other preference measures. Int J Tuberc Lung Dis 2002; 6: 542–9PubMedGoogle Scholar
  19. 19.
    Olsen JA, Donaldson C, Pereira J. The insensitivity of ‘willingness-to-pay’ to the size of the good: new evidence for health care. J Econ Psychol 2004; 25: 445–60CrossRefGoogle Scholar
  20. 20.
    Bobinac A, van Exel NJA, Rutten FFH, et al. Get more, pay more? An elaborate test of the validity of willingness to pay per QALY estimates. J Health Econ 2012; 31(1): 158–68PubMedCrossRefGoogle Scholar
  21. 21.
    Westat. Blaise distributions and training [online]. Available from URL: [Accessed 2012 Aug 13]
  22. 22.
    Etter JF, Le Houezec J, Perneger TV. A self-administered questionnaire to measure dependence on cigarettes: the cigarette dependence scale. Neuropsychopharmacology 2003; 28: 359–70PubMedCrossRefGoogle Scholar
  23. 23.
    Stavem K, Rogeberg OJ, Olsen JA, et al. Properties of the Cigarette Dependence Scale and the Fagerstrom Test of Nicotine Dependence in a representative sample of smokers in Norway. Addiction 2008; 103: 1441–9PubMedCrossRefGoogle Scholar
  24. 24.
    Krauth BV. Peer effects and selection effects on smoking among Canadian youth. Can J Econ 2005; 38: 735–57CrossRefGoogle Scholar
  25. 25.
    Jones-Lee MW, Loomes G, Phillips PR. Valuing the prevention of non-fatal road injuries: contingent valuation versus standard gambles. Oxf Econ Pap 1995; 47: 676–95Google Scholar
  26. 26.
    Gyrd-Hansen D, Kjaer T, Nielsen JS. Scope insensitivity in contingent valuation studies of health care services: should we ask twice? Health Econ 2012; 21(2): 101–12PubMedCrossRefGoogle Scholar
  27. 27.
    Diamond PA, Hausman JA. On contingent valuation measurement of nonuse values. In: Hausman JA, editor. Contingent valuation: a critical assessment. North-Holland: Amsterdam, 1993Google Scholar
  28. 28.
    Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science 1981; 211: 453–8PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2012

Authors and Affiliations

  • Jan Abel Olsen
    • 1
  • Ole J. Røgeberg
    • 2
  • Knut Stavem
    • 3
    • 4
    • 5
  1. 1.Institute of Community MedicineUniversity of TromsøTromsøNorway
  2. 2.Ragnar Frisch Centre for Economic ResearchUniversity of OsloOsloNorway
  3. 3.HØHK Research CentreAkershus University HospitalLørenskogNorway
  4. 4.Department of Pulmonary MedicineAkershus University HospitalLørenskogNorway
  5. 5.University of OsloLørenskogNorway

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