Cosmesis matters the most in Singapore’s neuroscience outpatient clinics

Neuroscience outpatients put a premium on cosmesis, valuing treatments that improve or restore their physical appearance the most, according to a new Singapore study.

“To the best of our knowledge, this is the first study to investigate willingness to pay (WTP) of neuroscience patients for neurologic treatments targeted to improve three health domains,” said researchers. “In our cohort, the value of cosmesis was highest followed by life extension and advanced restoration of function.”

The WTP of 94 respondents (median age, 39 years; 56 percent female) for each additional year of advanced restored function increased from SGD 10,000 for one additional year to SGD 35,000 for five years. The change did not achieve statistical significance. The median WTP thresholds for 2, 3 and 4 years of additional restored function were SGD 20,000, SGD 20,000 and SGD 30,000, respectively. [Value Health Reg Issues 2019;21:45-52]

In comparison, the median WTP for extending the life of the patient by 1 year was SHD 20,000. More than a fourth (27 percent; n=25) indicated that they were willing to pay SGD 65,000.

The corresponding threshold for cosmesis, particularly for repairing a large defect in the skull, was SGD 35,000. Almost a third (31 percent; n=27) were willing to pay SGD 65,000.

Interdomain comparisons revealed that participants perceived cosmesis to have the highest value. As compared with one additional year of advanced restored function, the WTP for cosmesis was 3.5 times higher, a difference that reached statistical significance (SGD 35,000 vs 10,000; p<0.001). Patients continued to view cosmesis as 1.75 times valuable than two additional years of advanced restored function (SGD 35,000 vs 20,000; p=0.014). The statistical significance was attenuated after 3 years of functional restoration.

Participants likewise thought that cosmesis was 1.75 times more valuable than extending the patient’s life by one more year (SGD 35,000 v SGD 20,000; p=0.035). The WTP differences between life extension and advanced functional restoration were not statistically significant.

Regression analysis found that being of at least university-level education was a significant predictor of placing greater value on a 1-year life extension (B, 0.45, 95 percent CI, 0.12–0.78; p=0.01) and improved cosmesis (B, 0.42, 0.16–0.67; p=0.002). Monthly personal income was the only predictor of WTP for advanced restored function (B, 0.33, 0.04–0.62; p=0.03).

“These findings have policy implications, such as determination of funding for cranioplasty procedures, and help us to better understand patient and caregiver medical decision making,” the researchers said.

“Although there is no limit to what human ingenuity and science can create, the cost of what we create should not be more than what people are willing to pay, and the findings of this study will serve as an important guide to what would be our society’s limit and threshold in value-based pricing for treatment of neurologic disorders,” they added.