Patient Preference and Adherence (Sep 2021)
Risk Preferences, Rationality of Choices, and Willingness to Pay for Preventive Medicine in Patients with Graves’ Thyrotoxicosis
Abstract
Naoya Emoto,1– 3 Mikiko Okazaki-Hada,1 Yuji Yamaguchi,1 Fumitaka Okajima,1,2 Rei Goto,4 Hitoshi Sugihara1 1Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; 2Department of Diabetes, Endocrinology and Metabolism, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan; 3Diabetes & Thyroid Clinic, Sakura Chuo Hospital, Chiba, Japan; 4Graduate School of Business Administration, Keio University, Tokyo, JapanCorrespondence: Naoya EmotoDiabetes & Thyroid Clinic, Sakura Chuo Hospital, 20-4, Sakaecho, Sakura City, Chiba, 285-0014, JapanTel +81-43-486-1311Fax +81-43-486-1314Email [email protected]: Patients with thyrotoxicosis show neuropsychological changes, and these may damage the quality of informed consent in clinical practice. Therefore, we examined patients’ real-life preferences to assess whether change in risk preferences was dependent on thyroid function state.Patients and Methods: The participants were 86 patients who were newly diagnosed with Graves’ thyrotoxicosis between 1 January and 31 December 2018 (group A), and an additional 33 euthyroid patients diagnosed before 2018 (group B). In a survey conducted via a questionnaire based on the concept of behavioral economics, we sought to determine risk preferences, rationality of choices, and other relevant factors. An identical second survey was completed 6– 12 months later by 36 patients in group A after their thyroid functions had been normalized by treatment, and by 11 euthyroid patients in group B. We performed paired analysis of the first and second surveys in 32 patients of group A and single regression analysis of a total of 140 surveys obtained from 119 patients by combining the first and second surveys of groups A and B with serum level of FT3 as an independent variable.Results: The paired analysis indicated that there was no significant difference in any survey item. The single regression analysis revealed that willingness-to-pay (WTP) for preventive medicine and monthly average out-of-pocket (OOP) expenditure on medical care were both significantly positively associated with serum level of FT3. Patients in the hyperthyroid state tend to have high WTP for preventive medicine, which may be accelerated by the anchoring effect of OOP expenditure.Conclusion: Almost all risk preferences of patients with Graves’ disease are constant, rational, and reproducible in the hyperthyroid and euthyroid states. However, medical professionals should be aware that the willingness of patients with thyrotoxicosis to pay for medical costs may change after the normalization of thyroid function.Keywords: informed consent, behavioral economics, out-of-pocket expenditure, anchoring effects
