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Cancer patients’ willingness to pay for blood transfusions at home: results from a contingent valuation study in a French cancer network

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Abstract

Home blood transfusion may be an interesting alternative to hospital transfusion, especially when given with curative or palliative intent or for terminal care in advanced-stage cancer patients. However, there is limited information about patients’ attitude toward this type of care. The purpose of this study was to measure French cancer patients’ willingness to pay (WTP) for home blood transfusion and to analyze determinants of their choice. A contingent valuation survey was administered to 139 patients receiving transfusions in the framework of a regional home care network or in the hospital outpatient department. Participation was high (90%). Most patients (65%) had received home care, including 43% blood transfusions. Just under half of the patients gave a zero WTP, among which we identified 8 protest bidders. The median WTP for home blood transfusion was 26.5 € per patient. In multivariate analysis, long home–hospital distance, poor quality of life, and previous experience of home care were identified as important factors in determining how much more patients would be willing to pay for transfusion at home. These results demonstrate the benefits of developing domiciliary services to improve patient well-being, notably for the weakest among them. The significant impact of previous home care experience on WTP is probably related to the strong involvement of physicians from the blood center and to their active contribution to a high-level homecare network. Some of our findings could be useful for policy decision-making regarding home care.

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Notes

  1. For literature surveys and criticisms, see for example [12–15].

  2. Based on individual criteria (clinical and social), all patients were eligible for BT either at home or in the hospital.

  3. Since transfusions at home are hitherto not very common, it is difficult to obtain, in the international medical literature, real figures on home blood transfusion incidents.

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Acknowledgments

The authors would like to thank the French Ministry of Health (PHRC) for the financial support of this research. They thank also Dr Yves Devaux, Josette Chalencon, and Valerie Kante for their contribution to patient recruitment, Matthias Candusso for data collection, and Marie-Dominique Reynaud for editorial assistance.

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Authors and Affiliations

  1. GATE Lyon-Saint Etienne, University of Lyon, 93 chemin des Mouilles, 69 130, Ecully, France

    Nathalie Havet

  2. GATE Lyon-Saint Etienne, University of Lyon, Léon Bérard Comprehensive Cancer Center, 28 rue Laënnec, 69373, Lyon Cedex 08, France

    Magali Morelle, Raphaël Remonnay & Marie-Odile Carrere

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  1. Nathalie Havet
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  2. Magali Morelle
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  3. Raphaël Remonnay
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  4. Marie-Odile Carrere
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Correspondence to Magali Morelle.

Appendix: Extracts of the questionnaire for patients expressing their WTP for blood transfusion at home

Appendix: Extracts of the questionnaire for patients expressing their WTP for blood transfusion at home

Context

You have agreed to participate in a study comparing the sites of administration of blood transfusion. The aim of our study was to measure the strength (or intensity) of your preference for blood transfusion at home compared with blood transfusion at the hospital. To measure this strength, we use a monetary assessment method. This technique is frequently used in social sciences for the following reason: The main advantage that a patient may withdraw from a new type of care management like home care is better quality of life. It is a very important outcome, but it is very difficult to quantify, unlike for example gain in life expectancy.

It is difficult to compare the benefits of the treatment for a given patient and the amount of additional expenses incurred. To overcome this difficulty, economists have developed a technique called willingness to pay. It is assumed that the benefit derived from a good or a service is related to what people are willing to pay for it. So we try to find a monetary equivalent of this benefit.

In our study, three elements are important and we ask you to keep them in mind when you answer our questions:

  1. 1.

    We seek to measure the strength of your preference for home blood transfusion compared with blood transfusion at the hospital, in other words, you are expected to weigh the advantages of transfusion at home against transfusion in the hospital.

  2. 2.

    The questions that you will be asked will place you in hypothetical situations. We want you to pretend, to imagine the situation that is suggested. Of course, you will not be charged for the transfusion, regardless of your response.

  3. 3.

    It is important that you do not mistake the valuation of your preferences in monetary terms (in euros), and the actual cost of a transfusion, at the hospital or at home. You must set aside the notion of cost in your responses.

Willingness to pay

Hypothetical situation

We ask you to imagine the following situation that is, remember, entirely hypothetical. Remember also that this study aims to measure the strength of your preference for blood transfusion at home compared with blood transfusion at the hospital. We assume that you need to receive another blood transfusion during your treatment but that the only freely available management would be hospital. For example, imagine that the government decides to reduce the number of blood transfusions outside the hospital. In this case, if you still want to receive your blood transfusion at home rather than at the hospital, a certain sum of money may be asked from you. In other words, if you are not ready to pay this contribution, you will undergo the blood transfusion administration at the hospital (which is fully covered by Health Insurance).

The proposition is as follows “If you want your next blood transfusion at home rather than at the hospital, you will have to pay x Euros.” The actual amount will be estimated using an auction-like mechanism. Explanations are illustrated with an example.

Example

The initial bid is 40 €. Would you accept or, conversely, refuse to pay 40 € to be transfused at home rather than at the hospital?

  • If your answer is “yes,” it means that you are willing to pay 40 € or more to be transfused at home. In this case, we will propose another, higher amount and you will be asked the same question again with this higher amount (e.g., 80 €).

  • If your answer is “no,” it means that you do not agree to pay 40 € to be transfused at home. In this case, we will propose another, lower bid and you will be asked the same question again; the procedure will be repeated up to 4 times.

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Havet, N., Morelle, M., Remonnay, R. et al. Cancer patients’ willingness to pay for blood transfusions at home: results from a contingent valuation study in a French cancer network. Eur J Health Econ 13, 289–300 (2012). https://doi.org/10.1007/s10198-011-0328-9

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