Reliability of self-reported willingness-to-pay and annual income in patients treated for toenail onychomycosis

Background: Willingness-to-pay (WTP) is a health economics measure that has recently been used for skin diseases to evaluate patients' quality of life. However, the reliability of this measure has not been investigated in the dermatology literature and is essential in validating its use in health services research. Objectives: This study evaluated the test-retest reliability of self-reported annual income and WTP, a health economics measure of disease impact, in patients with toenail onychomycosis. Methods: Forty-six patients enrolled in a randomized clinical trial comparing two different dosing regimens of terbinafine completed a self-administered questionnaire at baseline and 1 month later. The questionnaire asked: (i) how much patients would be willing to pay for a theoretical treatment with a cure rate of 85% for their current onychomycosis (10 categories: $0-50, $51-100, to > $800); and (ii) annual income (10 categories: $0-10 000 to > $200 000). Results: Forty-four patients reported WTP at both visits, and 55% reported the same WTP. The quadratic-weighted (Fleiss-Cohen) κ statistic indicated moderate agreement (κ = 0·50, 95% confidence interval, CI 0·24-0·75, P < 0·01) as did the Spearman rank-order correlation coefficient (r_s = 0·57, P < 0·01; median difference = 0, P = 0·50). Strong agreement was shown among the 42 patients who reported income at both visits; 71% reported the same annual income category (κ = 0·72, 95% CI 0·47-0·96, P < 0·01; rs = 0·68, P < 0·01; median difference = 0, P = 0·77). Age, disease severity and duration, previous therapy, self-reported annual income, and medication side-effects were not statistically associated with the reliability of WTP. Conclusions: WTP and annual income demonstrated moderate and strong test-retest reliability, respectively. Self-reported WTP can serve as a reliable measure for future health economics research on onychomycosis.