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Medical Decision Making
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Eliciting Willingness to Pay: Comparing Closed-Ended with Open-Ended and Payment Scale Formats

Emma J. Frew, MSc

David K. Whynes, MLitt

Jane L. Wolstenholme, PhD

Willingness to pay (WTP) is increasingly being used as a measure of valuation in health technology assessment. A variety of formats for eliciting values are available, although the relative virtues of each remain the subject of methodological controversy. This article compares valuation results obtained using a WTP survey instrument in a closed-ended format with those obtained from instruments using open-ended and payment scale formats. Samples of subjects were drawn from a general population, and all were asked to value the same intervention—alternative methods of screening for colorectal cancer. It was discovered that, whereas the open-ended and payment scale formats produced broadly similar valuations, the closed-ended format produced significantly higher WTP valuations and different justifications for those valuations. It is hypothesized that anchoring and yea-saying effects explain these differences and that the closed-ended format triggers a different response mode in subjects.

Key Words: choice • colorectal cancer • screening • valuation • willingness to pay

Medical Decision Making, Vol. 23, No. 2, 150-159 (2003)
DOI: 10.1177/0272989X03251245
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