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Willingness to Pay for a Treatment for Pain in Multiple Sclerosis

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Abstract

Background: Multiple sclerosis (MS) is a chronic neurological disease that affects 240 per 100 000 Canadians. Of these patients, 10–80% (average 70%) experience pain. Sativex® is a cannabis-based drug recently approved for neuropathic pain.

Objectives: In this study, we determine individuals’ preferences between two treatment options as well as the willingness to pay (WTP) for Sativex®, expressed as the amount they would pay in insurance premiums to have access to that treatment.

Methods: The WTP instrument comprised a decision board as a visual aid, and a questionnaire. A decision board helps clinicians standardize the presentation of treatment information. In this study, the decision board described two treatment options: a three-drug combination (gabapentin, amytriptyline, acetaminophen [paracetamol] {i.e. pills}) and the three-drug combination plus Sativex® (i.e. ‘pills and oral spray’). Information on efficacy and adverse effects was taken from trial data; wording was guided by a panel of neurologists and tested for clarity on lay people. The instrument was administered to 500 participants from Canada’s general population using the bidding game approach. Descriptive statistics were calculated.

Results: Mean (SD) age of participants was 39 (13) years, with a female: male distribution of 56: 44. The decision board was presented in both English (85%) and French (15%). Of 500 interviewees, 253 (50.6%) chose the ‘pills and oral spray’. Mean monthly WTP for the insurance premium for those who chose the ‘pills and oral spray’ was $Can8 (SD ± 15, median 4, range 0–200).

Conclusions: Assuming that 51% of the general population are willing to pay additional premiums as reported in this study, the premiums collected would cover the cost of Sativex® for all Canadian MS patients experiencing pain, with a surplus.

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Notes

  1. The sample size was based on significance and a desired precision level of 5%. The calculation was based on the assumption that equal proportions of participants would select each of the three preference options (i.e. treatment option 1, treatment option 2 and indifferent). Furthermore, we assumed that ≥90% of the data collected would be usable. Therefore, we estimated that the minimum required sample size was 450 participants in total. We ended up collecting data from 500 participants.

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Acknowledgements

The authors would like to acknowledge Dr Amiram Gafni, from McMaster University for scientific input in selected parts of the study, as well as Dr Adriana Costei and Rima Aziziyeh for their technical contribution. The authors would also like to thank Dr Virginia Devonshire from the University of British Columbia, Dr Mark Freedman from the Ottawa Hospital, Dr Allan Gordon from the Wasser Pain Management Centre at the Mount Sinai Hospital in Toronto and Dr Melanie Ursell from St. Michael’s Hospital for their clinical input in developing the decision boards.

This study was sponsored by Bayer Inc., and conducted by PharmIdeas under contract to Bayer Inc. B. Jaszewski is employed by Bayer Inc. Thomas Einarson was, at the time of analysis, a principal of PharmIdeas and has previously consulted with Bayer. Michael Iskedjian is a principal of PharmIdeas.

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Authors and Affiliations

  1. PharmIdeas Research and Consulting Inc., 1175 North Service Road West, Suite 211, Oakville, Ontario, L6M 2W1, Canada

    Michael Iskedjian, Olivier Desjardins, Charles Piwko, Basil Bereza & Thomas R. Einarson

  2. PharmIdeas USA Inc., Buffalo, New York, USA

    Michael Iskedjian

  3. Bayer Healthcare, Toronto, Ontario, Canada

    Barbara Jaszewski

  4. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada

    Thomas R. Einarson

Authors
  1. Michael Iskedjian
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  2. Olivier Desjardins
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  3. Charles Piwko
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  4. Basil Bereza
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  5. Barbara Jaszewski
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  6. Thomas R. Einarson
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Correspondence to Michael Iskedjian.

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Iskedjian, M., Desjardins, O., Piwko, C. et al. Willingness to Pay for a Treatment for Pain in Multiple Sclerosis. Pharmacoeconomics 27, 149–158 (2009). https://doi.org/10.2165/00019053-200927020-00005

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