How Much Are Patients Willing to Pay to Avoid Postoperative Nausea and Vomiting?

Abstract

Postoperative nausea and vomiting (PONV) are unpleasant experiences. However, there is no drug that is completely effective in preventing PONV. Whereas cost effectiveness analyses rely on specific health outcomes (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 general anesthesia participated in the study. After their recovery 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 willing 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 vomiting (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 (> or = 50 mm on a 0--100-mm visual analog scale). Nausea or vomiting in the postanesthetic care unit, greater patient income, previous history of PONV, more importance placed on avoiding nausea and vomiting, increasing 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.

The Steroid Controversy: Where Are We?

“…The incidence of PONV is noted to be independent of the dissection technique, and has been reported to occur in more than 70% of children who do not receive prophylactic antiemetics [17]. PONV may necessitate overnight hospital admission for intravenous hydration and pain control, and leads to increased costs and decreased patient satisfaction [18,19,20]. A single dose of intraoperative dexamethasone has been clearly demonstrated to have potent antiemetic effects in the perioperative setting [5,8,9,11,12,13,14,21,22,23].…”

Premedication with H1 and H2 blocking agents reduces the incidence of postoperative nausea and vomiting

“…Thus a safe and effective treatment to prevent PONV would benefit patients. Indeed patients would even pay the costs from their own pockets for a guaranteed PONV free anaesthesia [2,8].…”

Postoperative �belkeit und Erbrechen

“…Dabei sollte nicht vergessen werden, dass eine Prophylaxe bei Risikopatienten nicht nur kosteneffektiv ist [36], sondern auch die Patientenzufriedenheit verbessern kann [56], zumal Patienten selbst den Wert einer effektiven Prophylaxe mit ca. 50 € beziffern[30].…”