van den Bosch Jolanda E, Bonsel Gouke J, Moons Karel G, Kalkman Cor J
Division of Perioperative Care and Emergency Medicine and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Anesthesiology. 2006 May;104(5):1033-9. doi: 10.1097/00000542-200605000-00020.
The authors assessed the willingness to pay (WTP) for "perfect" prophylactic antiemetics and analgesics in patients who were scheduled to undergo surgery during general anesthesia. Furthermore, they determined whether postoperative experiences of pain and nausea and vomiting (PONV) changed patients' WTP.
Data were collected alongside a randomized clinical trial that investigated the incidence of PONV in patients anesthetized with either inhalation anesthesia or total intravenous anesthesia. A subset of 808 consecutive patients participating in the trial completed WTP questionnaires 1 day before and 2 weeks after surgery. The outcome measure was the maximum amount of money that patients were willing to pay for "perfect" antiemetics and analgesics. Preoperative WTP and individual WTP changes after surgery were analyzed in relation to baseline characteristics and postoperative pain and PONV experiences.
Prevention of postoperative pain was valued higher than prevention of PONV. The median preoperative WTP for analgesics was US dollar 35 (interquartile range, dolalr 7-69) vs. US dollar 17 (interquartile range, dollar 7-69) for antiemetics. Individual WTP changes for antiemetics were not related to PONV experience, whereas severe postoperative pain (numerical rating score > or = 8) was associated with an increase in the WTP for analgesics.
Severe postoperative pain experiences increased patients' WTP for analgesics, but PONV did not increase WTP for antiemetics. The elicited WTP values were lower than those reported in previous studies, which is possibly related to differences in market culture or patients' attitudes toward postoperative pain, nausea, and vomiting.
作者评估了计划在全身麻醉下接受手术的患者对“完美”预防性止吐药和镇痛药的支付意愿（WTP）。此外，他们还确定了术后疼痛及恶心呕吐（PONV）经历是否会改变患者的支付意愿。
数据收集自一项随机临床试验，该试验调查了接受吸入麻醉或全静脉麻醉的患者中PONV的发生率。参与试验的808例连续患者中的一部分在手术前1天和术后2周完成了支付意愿问卷调查。结果指标是患者愿意为“完美”止吐药和镇痛药支付的最高金额。分析术前支付意愿和术后个体支付意愿的变化与基线特征以及术后疼痛和PONV经历的关系。
预防术后疼痛的价值高于预防PONV。术前镇痛药的支付意愿中位数为35美元（四分位间距为7 - 69美元），而止吐药为17美元（四分位间距为7 - 69美元）。止吐药的个体支付意愿变化与PONV经历无关，而术后严重疼痛（数字评分≥8）与镇痛药支付意愿增加相关。
术后严重疼痛经历增加了患者对镇痛药的支付意愿，但PONV并未增加患者对止吐药的支付意愿。得出的支付意愿值低于先前研究报告的值，这可能与市场文化差异或患者对术后疼痛、恶心和呕吐的态度有关。
