OBJECTIVES: Willingness-to-pay (WTP) analysis is a method  for the monetization of a population’s preference for a particular medication and may be determined using a bidding game where participants are asked if they would be willing to pay a particular amount, starting with a pre-determined value and oscillating between a series of new WTP amounts based on their previous answer.  Starting point bias has been previously reported in the literature.  The objective of the present study was to ascertain if any bias was introduced by applying higher or lower starting values to a bidding game.  METHODS: An online survey was presented to members of the general public in Ontario, Canada, who were presented with two treatment delivery options (inhaler vs. injection) for a treatment of pulmonary arterial hypertension. Participants who selected the inhaler were randomly assigned a starting value (CAD$1, $2 or $5) and were asked to identify their WTP in terms of additional monthly insurance premiums. The minimum and maximum bidding game values were set at CAD$0.01 and CAD$50.00; participants who agreed to pay CAD$50.00 were allowed to input a higher WTP explicitly, as desired. The Kruskall-Wallis non-parametric test was applied to explore the differences in mean WTP associated with each starting value. RESULTS: Eighty-six participants reported a mean WTP of CAD$43.15 for the inhaler in additional monthly insurance premium. The mean WTP were CAD$37.55, CAD$49.36 and CAD$40.31 for participants who were assigned to a starting point of CAD$1, $2 or $5, respectively. No significant difference in WTP values was observed between the groups. CONCLUSIONS: The starting value did not appear to introduce a bias in the bidding game.