Willingness to pay and accept risks to cure chronic disease.

Measurements of disease burden focus most often on economic outputs--neglecting effects on quality of life. More comprehensive quantification is based on what people would pay or risk to avoid illness. Many, however, find it difficult to respond thoughtfully to hypothetical questions about what they would pay or risk. With response rates frequently under 50 per cent, the practicality of these methods has been of concern. In this study, specially trained interviewers asked 247 subjects with rheumatoid arthritis how much of their income they would pay and how large a mortal risk they would accept to achieve a hypothetical cure. Ninety-eight per cent of the subjects estimated their maximum acceptable risk (MAR) at an average 27 per cent chance of immediate death. Eighty-four per cent gave plausible responses to the willingness-to-pay (WTP) questions, with a mean WTP of 22 per cent of household income. The aspect of disease most strongly associated with WTP was impairment in activities of daily living; measured pain was most associated with MAR. The response rates achieved indicate the overall feasibility of these methods; the associations of WTP and MAR with other variables suggest systematic consideration of personal circumstances.