Valuing the Benefit for Cancer Patients of Receiving Blood Transfusions at Home

In the field of health care management, contingent valuation surveys (CV) are used in cost benefit analyses (CBA) to elicit patients' monetary valuation of program benefits. We considered the empirical situation of blood transfusions (BT) in cancer patients. Before planning such a CBA, we had to make sure that the CV approach could be used in a particularly critical clinical situation to estimate the marginal benefit of changing from hospital BT to home BT. The fact that the CV approach is feasible and acceptable to severely ill patients was not taken for granted a priori.We measured patient's willingness-to-pay (WTP) for home BT in a sample of 139 patients who received transfusions either at home or in the hospital. After considering patient's participation to the survey and protest responses, we identified possible determinants of WTP values derived from previous knowledge, then we compared their expected influences to predicted influences resulting from econometric analysis to assess the validity of our results. Participation was high (90%) and few patients gave protest responses. Most patients (65%) had received home care, including 43% BT. The median WTP for home BT was 26.5 per patient.Good consistency was observed between the expected and predicted influences of possible determinants of WTP. The anchoring bias hypothesis was confirmed. The WTP for home BT increased with previous experience of home care, age, living far from the hospital and low quality of life. Our CV approach is thus a first contribution to the debate on the appropriateness of generalizing access to home BT. However, our results would be worth confirming with a formal cost-benefit analysis.