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Fiala MA. Financial Toxicity and Willingness-to-Pay for Cancer Treatment Among People With Multiple Myeloma. JCO Oncol Pract 2024:OP2400016. [PMID: 38885465 DOI: 10.1200/op.24.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/08/2024] [Accepted: 05/07/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE This study used willingness-to-pay (WTP) exercises to explore the relationships between race, financial toxicity, and treatment decision making among people with cancer. METHODS A convenience sample of people with multiple myeloma who attended an academic medical center in 2022 was surveyed. Financial toxicity was assessed by the Comprehensive Score for financial Toxicity, with scores <26 indicating financial toxicity. WTP was assessed with (1) a discrete choice experiment (DCE), (2) fixed-choice tasks, and (3) a bidding game. RESULTS In total, 156 people were approached, and 130 completed the survey. The majority of the sample was White (n = 99), whereas 24% (n = 31) was African American or Black. Forty-six percent (n = 60) of the sample were experiencing financial toxicity. In the DCE, the relative importance of cost was twice as high for those with financial toxicity (30% compared with 14%; P < .001). In the fixed-choice tasks, they were twice as likely to accept a treatment with shorter progression-free survival but lower costs (adjusted odds ratio [aOR], 2.47; P = .049). In the bidding game, the median monthly WTP of those with financial toxicity was half that of those without ($100 in US dollars [USD] compared with $200 USD; P < .001). Only in the bidding game was race statistically associated with WTP; after controlling for financial toxicity, African American or Black participants were three times as likely (aOR, 3.06; P = .007) to report a lower WTP. CONCLUSION Across all three exercises, participants with financial toxicity reported lower WTP than those without. As financial toxicity disproportionally affects some segments of patients, it is possible that financial toxicity contributes to cancer disparities.
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Affiliation(s)
- Mark A Fiala
- Department of Medicine, Washington University School of Medicine, St Louis, MO
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van der Pol M, Boyers D, Marashdeh MM, Loria-Rebolledo LE. UK general population's willingness to pay for dental check-ups. Community Dent Oral Epidemiol 2024; 52:181-186. [PMID: 37776154 DOI: 10.1111/cdoe.12911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/23/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES Choices about which dental treatments to provide in a publicly funded system should be guided by the value that the general population place on those treatments. The aim of this study was to estimate United Kingdom (UK) general population willingness to pay (WTP) for dental check-ups, and to investigate what factors influence WTP. METHODS WTP was elicited using a hypothetical question in an online survey. The sample consisted of 594 participants, nationally representative of the UK general population in terms of age and gender. Regression analysis was used to examine what factors are associated with WTP. Analyses were conducted including and excluding protest answers. RESULTS The mean WTP for a dental check-up is £31.32 for the full sample and £33.17 excluding protest answers. Respondents on higher incomes and those with higher university education had higher WTP. Respondents in Scotland were WTP less than respondents living in the rest of the UK which may be the result of NHS dental check-ups being free to patients in Scotland. CONCLUSION The general UK population value dental check-ups. This study provides estimates of WTP for dental check-ups which can be used in Cost-Benefit Analyses.
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Affiliation(s)
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Han DH, Kang HY, Ryu JI. The role of income and frequency of dental visits in the relationship between dental sealant use and resin fillings after extended coverage: a retrospective cohort study. BMC Oral Health 2023; 23:807. [PMID: 37891584 PMCID: PMC10612205 DOI: 10.1186/s12903-023-03387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Prevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between implementing the sealant program and resin fillings restoration and to explore the role of income and frequency of dental visits in this relationship. METHODS This retrospective cohort study used the cohort database from the National Health Information Database of the National Health Insurance Service. The study population comprised 494,731 children born in 2007. A logistic regression model for the experience of resin fillings and a linear regression model for weighted utilization of them were used to identify the independent effects of dental sealants, income, and frequency of dental visits. All analyses were conducted using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA). RESULTS The ratio based on income level was almost proportional in all groups except the medical aid group, which had a rate as high as that of the wealthier group. Children without sealants were 1.05 times more likely to have resin fillings than others after adjusting for income level and frequency of visiting dental clinics in the final model. However, an opposite relationship between sealant experiences and resin fillings was observed in the previous model without dental visits. The gap in the weighted resin filling scores according to socioeconomic variables showed a similar tendency. CONCLUSIONS Income and frequency of dental visits might be confounding factors for the relationship between dental sealant and resin fillings. It is necessary to consider the complex relationship between socioeconomic indicators and service use while studying oral health inequality.
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Affiliation(s)
- Dong-Hun Han
- Department of Preventive and Social Dentistry, Seoul National University School of Dentistry, Seoul, Republic of Korea
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hee-Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Jae-In Ryu
- Department of Preventive and Social Dentistry, Kyung Hee University College of Dentistry, Seoul, Republic of Korea.
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Franklin M, Angus C, Welte T, Joos G. How Much Should be Invested in Lung Care Across the WHO European Region? Applying a Monetary Value to Disability-Adjusted Life-Years Within the International Respiratory Coalition's Lung Facts. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:547-558. [PMID: 37039953 DOI: 10.1007/s40258-023-00802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The International Respiratory Coalition's Lung Facts web resource provides the latest data on a range of lung conditions covering the World Health Organization's European Region, informed by the Global Burden of Disease studies: https://international-respiratory-coalition.org/lung-facts/ . Within Lung Facts, disability-adjusted life-years (DALYs) are monetised based on gross domestic product (GDP) per capita. We describe the conceptual and empirical basis for using monetised DALYs to inform negotiations with policymakers to invest in lung care across the World Health Organization European region. METHODS We reflect on the existing debate and research evidence regarding the X value in an X*GDP per capita framework to monetise DALYs, with a focus on if 1*GDP per capita is conceptually and practically appropriate. Using an asthma case study, Global Burden of Disease study 2019 DALY estimates per country are presented. Gross domestic product per capita are converted to international dollars using purchasing power parity (Int$2019). RESULTS Using 1*GDP per capita, the estimated monetised asthma DALY burden, for example, in Kyrgyzstan or Germany is: across the whole population, $44,860,483 or $9,264,767,882, respectively; per 100,000 people, $731,600 or $10,208,317, respectively. CONCLUSIONS Our indicative monetised DALY estimates can enable informed discussions with policy and decision makers, to guide financial investment in alleviating the burden of lung conditions. We suggest 1*GDP per capita as a benchmarked value forms a starting point for negotiation with policymakers for investing in lung care, by scaling the estimated lung condition DALY burden to the resource available in each country to tackle the burden.
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Affiliation(s)
- Matthew Franklin
- Health Economics and Decision Science (HEDS), School of Health and Related Research ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Colin Angus
- Health Economics and Decision Science (HEDS), School of Health and Related Research ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Tobias Welte
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
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Xie Z, Chen J, Or CK. Consumers’ Willingness to Pay for eHealth and Its Influencing Factors: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e25959. [PMID: 36103227 PMCID: PMC9520394 DOI: 10.2196/25959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 06/15/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite the great potential of eHealth, substantial costs are involved in its implementation, and it is essential to know whether these costs can be justified by its benefits. Such needs have led to an increased interest in measuring the benefits of eHealth, especially using the willingness to pay (WTP) metric as an accurate proxy for consumers’ perceived benefits of eHealth. This offered us an opportunity to systematically review and synthesize evidence from the literature to better understand WTP for eHealth and its influencing factors. Objective This study aimed to provide a systematic review of WTP for eHealth and its influencing factors. Methods This study was performed and reported as per the Cochrane Collaboration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, CINAHL Plus, Cochrane Library, EconLit, and PsycINFO databases were searched from their inception to April 19, 2022. We conducted random-effects meta-analyses to calculate WTP values for eHealth (at 2021 US dollar rates) and meta-regression analyses to examine the factors affecting WTP. Results A total of 30 articles representing 35 studies were included in the review. We found that WTP for eHealth varied across studies; when expressed as a 1-time payment, it ranged from US $0.88 to US $191.84, and when expressed as a monthly payment, it ranged from US $5.25 to US $45.64. Meta-regression analyses showed that WTP for eHealth was negatively associated with the percentages of women (β=−.76; P<.001) and positively associated with the percentages of college-educated respondents (β=.63; P<.001) and a country’s gross domestic product per capita (multiples of US $1000; β=.03; P<.001). Compared with eHealth provided through websites, people reported a lower WTP for eHealth provided through asynchronous communication (β=−1.43; P<.001) and a higher WTP for eHealth provided through medical devices (β=.66; P<.001), health apps (β=.25; P=.01), and synchronous communication (β=.58; P<.001). As for the methods used to measure WTP, single-bounded dichotomous choice (β=2.13; P<.001), double-bounded dichotomous choice (β=2.20; P<.001), and payment scale (β=1.11; P<.001) were shown to obtain higher WTP values than the open-ended format. Compared with ex ante evaluations, ex post evaluations were shown to obtain lower WTP values (β=−.37; P<.001). Conclusions WTP for eHealth varied significantly depending on the study population, modality used to provide eHealth, and methods used to measure it. WTP for eHealth was lower among certain population segments, suggesting that these segments may be at a disadvantage in terms of accessing and benefiting from eHealth. We also identified the modalities of eHealth that were highly valued by consumers and offered suggestions for the design of eHealth interventions. In addition, we found that different methods of measuring WTP led to significantly different WTP estimates, highlighting the need to undertake further methodological explorations of approaches to elicit WTP values.
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Affiliation(s)
- Zhenzhen Xie
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Jiayin Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Chen N, Bai J, Nicholas S, Maitland E, Tan J, Wang J. Preferences for private health insurance in China: A discrete choice experiment. Front Public Health 2022; 10:985582. [PMID: 36148354 PMCID: PMC9486459 DOI: 10.3389/fpubh.2022.985582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/08/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction There is limited evidence on the sustainability and optimal design of China's private health insurance market, especially from the demand-side. With the increasing medical cost burden on both patients and the social security system, policy makers need data on potential clients' demand for private health insurance. Methods A discrete choice experiment was conducted to explore potential clients' preferences for a type of government-involved private supplementary health insurance, Huimin Insurance, in China. A mixed logit model was used to evaluated participants' preferences for six attributes. Willingness to pay, subgroup analysis and interaction effects were estimated based on the initial model. Results Among the 947 participants, 883 (93.2%) were aged 18 to 59 years and 578 (61.0%) were female. Participants had a strong preference for government involvement, extensive benefit packages, high reimbursement ratio and compensation for pre-existing conditions. With respect to the attribute of deductible, participants were indifferent between the level of CNY15,000 and CNY18,000 but had strong and significant preference for the level of CNY15,000 than CNY20,000. The premium was significantly correlated with a decline in the utility of PHI. Conclusions All attributes had a significant impact on participants' preference for Huimin Insurance. Providing a reference point for the development of private health insurance in China, our results inform the optimal design of PHI, especially Huimin Insurance's products.
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Affiliation(s)
- Nuo Chen
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China
| | - Jing Bai
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia,Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, United Kingdom
| | - Jialong Tan
- School of Public Health, Wuhan University, Wuhan, China,*Correspondence: Jialong Tan
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China,Center for Health Economics and Management at the School of Economics and Management, Wuhan University, Wuhan, China,Jian Wang
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Hill SR, Bhattarai N, Tolley CL, Slight SP, Vale L. Eliciting willingness-to-pay to prevent hospital medication administration errors in the UK: a contingent valuation survey. BMJ Open 2022; 12:e053115. [PMID: 35105580 PMCID: PMC8808384 DOI: 10.1136/bmjopen-2021-053115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
UNLABELLED Medication errors are common in hospitals. These errors can result in adverse drug events (ADEs), which can reduce the health and well-being of patients', and their relatives and caregivers. Interventions have been developed to reduce medication errors, including those that occur at the administration stage. OBJECTIVE We aimed to elicit willingness-to-pay (WTP) values to prevent hospital medication administration errors. DESIGN AND SETTING An online, contingent valuation (CV) survey was conducted, using the random card-sort elicitation method, to elicit WTP to prevent medication errors. PARTICIPANTS A representative sample of the UK public. METHODS Seven medication error scenarios, varying in the potential for harm and the severity of harm, were valued. Scenarios were developed with input from: clinical experts, focus groups with members of the public and piloting. Mean and median WTP values were calculated, excluding protest responses or those that failed a logic test. A two-part model (logit, generalised linear model) regression analysis was conducted to explore predictive characteristics of WTP. RESULTS Responses were collected from 1001 individuals. The proportion of respondents willing to pay to prevent a medication error increased as the severity of the ADE increased and was highest for scenarios that described actual harm occurring. Mean WTP across the scenarios ranged from £45 (95% CI £36 to £54) to £278 (95% CI £200 to £355). Several factors influenced both the value and likelihood of WTP, such as: income, known experience of medication errors, sex, field of work, marriage status, education level and employment status. Predictors of WTP were not, however, consistent across scenarios. CONCLUSIONS This CV study highlights how the UK public value preventing medication errors. The findings from this study could be used to carry out a cost-benefit analysis which could inform implementation decisions on the use of technology to reduce medication administration errors in UK hospitals.
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Affiliation(s)
- Sarah R Hill
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nawaraj Bhattarai
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Clare L Tolley
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah P Slight
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Saadatfar N, Jadidfard MP. Parents' preferences for preventive and curative dental services: A comparison between fissure sealant and composite filling using willingness-to-pay method. Int J Paediatr Dent 2021; 31:792-800. [PMID: 33548081 DOI: 10.1111/ipd.12778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 01/23/2021] [Accepted: 01/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The early years of life play a significant role in the lifelong health of humans and parents have an important role in healthcare decision making. Thus, it seems necessary for policymakers and clinicians to be aware of how parents value pediatric health services. Willingness to pay (WTP) is a recommended method for measuring the stated utility of health services/goods or health states. AIM This study aimed to elicit and compare parents' WTP for health services such as fissure sealant and composite filling. DESIGN An originally developed questionnaire was used to guide interviews with a sample of 290 parents attending a public pediatric healthcare center. Related-samples Wilcoxon signed-rank test was performed for comparing the difference in absolute WTP amounts between the two services, and linear regression was used to assess the association between WTP and relevant variables using SPSS version 21. RESULTS Mean WTP for fissure sealant and filling was 269 724 and 555 327 Tomans, respectively, and the difference between them was statistically significant (P < .001). Higher WTP amounts found in both services were associated with income levels of 4 and 5 (P < .05). CONCLUSIONS Respondents highly valued the considered services and stated a significantly higher relative preference for filling. Public awareness should be promoted about the importance of prevention of oral health diseases and the attributes of the oral healthcare system services.
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Affiliation(s)
- Navid Saadatfar
- Department of Community Oral Health, School of Dentistry, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Pooyan Jadidfard
- Department of Community Oral Health, School of Dentistry, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
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Rogers HJ, Freitas RD, Beeson MJ, Vernazza CR. Economic evaluations in paediatric dentistry clinical trials. Int J Paediatr Dent 2020; 31 Suppl 1:56-65. [PMID: 33469952 DOI: 10.1111/ipd.12772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022]
Abstract
Economic evaluations play an important role in identifying the cost-effectiveness of alternative healthcare programmes, informing decisions surrounding funding and the allocation of resources. This paper outlines the basic principles of economic evaluation and how it can be conducted alongside a clinical trial. Furthermore, it considers the ways in which evidence from these studies can be used, and the challenges researchers are faced with when conducting economic evaluations in the field of children's oral health.
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Affiliation(s)
| | - Raiza Dias Freitas
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Nosyk B, Min JE, Zang X, Feaster DJ, Metsch L, Marshall BDL, Rio CD, Granich R, Schackman BR, Montaner JSG. Why Maximizing Quality-Adjusted Life Years, rather than Reducing HIV Incidence, Must Remain Our Objective in Addressing the HIV/AIDS Epidemic. J Int Assoc Provid AIDS Care 2020; 18:2325958218821962. [PMID: 30798657 PMCID: PMC6457342 DOI: 10.1177/2325958218821962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
With efficacious behavioral, biomedical, and structural interventions available, combination implementation strategies are being implemented to combat HIV/AIDS across settings internationally. However, priority statements from national and international bodies make it unclear whether the objective should be the reduction in HIV incidence or the maximization of health, most commonly measured with quality-adjusted life years (QALYs). Building off a model-based evaluation of HIV care interventions in British Columbia, Canada, we compare the optimal sets of interventions that would be identified using HIV infections averted, and QALYs as the primary outcome in a cost-effectiveness analysis. We found an explicit focus on averting new infections undervalues the health benefits derived from antiretroviral therapy, resulting in suboptimal and potentially harmful funding recommendations.
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Affiliation(s)
- Bohdan Nosyk
- 1 BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,2 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jeong Eun Min
- 1 BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Xiao Zang
- 1 BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,2 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Daniel J Feaster
- 3 Department of Epidemiology and Public Health, Center for Family Studies, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Lisa Metsch
- 4 Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Brandon D L Marshall
- 5 Department of Epidemiology, Brown School of Public Health, Providence, RI, USA
| | - Carlos Del Rio
- 6 Hubert Department of Global Health, Emory Center for AIDS Research, Rollins School of Public Health of Emory University, Atlanta, GA, USA
| | - Reuben Granich
- 7 Independent Public Health Consultant, Washington, DC, USA
| | | | - Julio S G Montaner
- 1 BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,9 Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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AlShayban DM, Naqvi AA, Islam MA, Almaskeen M, Almulla A, Alali M, AlQaroos A, Raafat M, Iqbal MS, Haseeb A. Patient Satisfaction and Their Willingness to Pay for a Pharmacist Counseling Session in Hospital and Community Pharmacies in Saudi Healthcare Settings. Front Pharmacol 2020; 11:138. [PMID: 32194400 PMCID: PMC7061856 DOI: 10.3389/fphar.2020.00138] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/31/2020] [Indexed: 12/22/2022] Open
Abstract
Objective Patient satisfaction is an indicator for quality of healthcare service and is sometimes linked to patients’ willingness to pay. Willingness to pay is an economic method for estimating patient’s inclination for a service in monetary terms. This study assessed satisfaction of patients from pharmacist counseling service and estimated their willing to pay for the same. Methods A month-long survey was conducted in community and hospital pharmacies located in Khobar, Dammam, and Qatif cities of Saudi Arabia, using Arabic version of Patient Satisfaction Feedback (PSF) questionnaire that measured satisfaction with counseling as well as willingness-to-pay. Convenient sampling method was used, and sample size was calculated based on power analysis. Data was analyzed through SPSS version 23. Chi-square (χ2) test and logistic regression analyses were conducted to report associations between variables and, determinants of satisfaction as well as willingness to pay respectively. The study was approved by concerned ethical committee (IRB-2019-05-020). Results Patients (n = 531) with previous counseling experience were more likely to be satisfied [adjusted odds ratio (AOR) 5.2, p < 0.05]. Patients were more willing to pay if, they had an income above SAR 10,000 i.e., USD 2666.5 (AOR 1.78, p < 0.05), were satisfied with counseling time duration (AOR 4.5) and, were able to get counseling without difficulty (AOR 2.1, p < 0.05). Patients were more likely to be satisfied and were willing to pay if, they received required knowledge/information completely (AOR 2.5, 3.7, and p < 0.05) and found pharmacist helpful (AOR 1, 4.5, and p < 0.05). Most patients (43.9%) were satisfied with pharmacist counseling and average satisfaction rating was 7.87 ± 1.99/10. Conclusion Patients considered counseling as an important service and were satisfied from it. Less than a third of patients were willing to pay for the service. Knowledge and helpfulness of pharmacist were identified as two major determinants that could not only satisfy and but also promote willingness to pay for the service. A pharmacist with skills in pharmaceutical care and counseling could be useful in promoting the service and making it profitable for pharmacy business.
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Affiliation(s)
- Dhfer Mahdi AlShayban
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Atta Abbas Naqvi
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Md Ashraful Islam
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Almaskeen
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ali Almulla
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhab Alali
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah AlQaroos
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohamed Raafat
- Department of Pharmacology & Toxicology, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdul Aziz University, Alkharj, Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
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Harris R, Vernazza C, Laverty L, Lowers V, Burnside G, Brown S, Higham S, Ternent L. Presenting patients with information on their oral health risk: the PREFER three-arm RCT and ethnography. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
A new NHS dental practice contract is being tested using a traffic light (TL) system that categorises patients as being at red (high), amber (medium) or green (low) risk of poor oral health. This is intended to increase the emphasis on preventative dentistry, including giving advice on ways patients can improve their oral health. Quantitative Light-Induced Fluorescence (QLF™) cameras (Inspektor Research Systems BV, Amsterdam, the Netherlands) also potentially offer a vivid portrayal of information on patients’ oral health.
Methods
Systematic review – objective: to investigate how patients value and respond to different forms of information on health risks. Methods: electronic searches of nine databases, hand-searching of eight specialist journals and backwards and forwards citation-chasing followed by duplicate title, abstract- and paper-screening and data-extraction. Inclusion criteria limited studies to personalised information on risk given to patients as part of their health care. Randomised controlled trial (RCT) – setting: NHS dental practice. Objective: to investigate patients’ preferences for and response to different forms of information about risk given at check-ups. Design: a pragmatic, multicentred, three-arm, parallel-group, patient RCT. Participants: adults with a high/medium risk of poor oral health attending NHS dental practices. Interventions: (1) information given verbally supported by a card showing the patient’s TL risk category; (2) information given verbally supported by a QLF photograph of the patient’s mouth. The control was verbal information only (usual care). Main outcome measures: primary outcome – median valuation for the three forms of information measured by willingness to pay (WTP). Secondary outcomes included toothbrushing frequency and duration, dietary sugar intake, smoking status, self-rated oral health, a basic periodontal examination, Plaque Percentage Index and the number of tooth surfaces affected by caries (as measured by QLF). Qualitative study – an ethnography involving observations of 368 dental appointments and interviews with patients and dental teams.
Results
Systematic review – the review identified 12 papers (nine of which were RCTs). Eight studies involved the use of computerised risk assessments in primary care. Intervention effects were generally modest, even with respect to modifying risk perceptions rather than altering behaviour or clinical outcomes. RCT – the trial found that 51% of patients identified verbal information as their most preferred form, 35% identified QLF as most preferred and 14% identified TL information as most preferred. The median WTP for TL was about half that for verbal information alone. Although at 6 and 12 months patients reported taking less sugar in drinks, and at 12 months patients reported longer toothbrushing, there was no difference by information group. Qualitative study – there was very little explicit risk talk. Lifestyle discussions were often cursory to avoid causing shame or embarrassment to patients.
Limitations
Only 45% of patients were retained in the trial at 6 months and 31% were retained at 12 months. The trial was conducted in four dental practices, and five dental practices were involved in the qualitative work.
Conclusions
Patients prefer personal, detailed verbal advice on oral health at their check-up. A new NHS dental practice contract using TL categorisation might make this less likely.
Future work
Research on how to deliver, within time constraints, effective advice to patients on preventing poor oral health. More research on ‘risk work’ in wider clinical settings is also needed.
Trial registration
Current Controlled Trials ISRCTN71242343.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rebecca Harris
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | | | - Louise Laverty
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Victoria Lowers
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Girvan Burnside
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Stephen Brown
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Susan Higham
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Laura Ternent
- Institute of Health and Social Care, Newcastle University, Newcastle upon Tyne, UK
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Azimatun Noor A, Saperi S, Aljunid SM. The Malaysian community's acceptance and willingness to pay for a National Health Financing Scheme. Public Health 2019; 175:129-137. [PMID: 31473369 DOI: 10.1016/j.puhe.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/27/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Currently, Malaysia faces great challenges in allocating adequate resources for healthcare services using a tax-based system. Therefore, Malaysia has no choice but to reform its healthcare financing system. The objective of this study is to assess Malaysian household willingness to pay and acceptance levels to the proposed National Health Financing Scheme. STUDY DESIGN This is a cross-sectional study. METHODS In total, 774 households from four states in Malaysia completed face-to-face interviews. A validated structured questionnaire was used, which was composed of a combination of open-ended questions, bidding games and contingent valuation methods regarding the participants' willingness to pay. RESULTS The study found that the majority of households supported the establishment of the National Health Financing Scheme, and half proposed that a government body should manage the scheme. Most (87.5%) of the households were willing to contribute 0.5-1% of their salaries to the scheme through monthly deductions. Over three-quarters (76.6%) were willing to contribute to a higher level scheme (1-2%) to gain access to both public and private healthcare basic services. Willingness to pay for the National Health Financing Scheme was significantly higher among younger persons, females, those located in rural areas, those with a higher income and those with an illness. CONCLUSION There is a high level of acceptance for the National Health Financing Scheme in the Malaysian community, and they are willing to pay for a scheme organised by a government body. However, acceptance and willingness to pay are strongly linked to household socio-economic status. Policymakers should initiate plans to establish the National Health Financing Scheme to provide the necessary financing for a sustainable health system.
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Affiliation(s)
- A Azimatun Noor
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia; International Centre for Casemix & Clinical Coding, Universiti Kebangsaan Malaysia Medical Centre, Malaysia.
| | - S Saperi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia
| | - S M Aljunid
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia; International Centre for Casemix & Clinical Coding, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
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Vernazza CR, Carr K, Wildman J, Gray J, Holmes RD, Exley C, Smith RA, Donaldson C. Resource allocation in NHS dentistry: recognition of societal preferences (RAINDROP): study protocol. BMC Health Serv Res 2018; 18:487. [PMID: 29929516 PMCID: PMC6013861 DOI: 10.1186/s12913-018-3302-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/15/2018] [Indexed: 01/16/2023] Open
Abstract
Background Resources in any healthcare systems are scarce relative to need and therefore choices need to be made which often involve difficult decisions about the best allocation of these resources. One pragmatic and robust tool to aid resource allocation is Programme Budgeting and Marginal Analysis (PBMA), but there is mixed evidence on its uptake and effectiveness. Furthermore, there is also no evidence on the incorporation of the preferences of a large and representative sample of the general public into such a process. The study therefore aims to undertake, evaluate and refine a PBMA process within the exemplar of NHS dentistry in England whilst also using an established methodology (Willingness to Pay (WTP)) to systematically gather views from a representative sample of the public. Methods Stakeholders including service buyers (commissioners), dentists, dental public health representatives and patient representatives will be recruited to participate in a PBMA process involving defining current spend, agreeing criteria to judge services/interventions, defining areas for investment and disinvestment, rating these areas against the criteria and making final recommendations. The process will be refined based on participatory action research principles and evaluated through semi-structured interviews, focus groups and observation of the process by the research team. In parallel a representative sample of English adults will be recruited to complete a series of four surveys including WTP valuations of programmes being considered by the PBMA panel. In addition a methodological experiment comparing two ways of eliciting WTP will be undertaken. Discussion The project will allow the PBMA process and particularly the use of WTP within it to be investigated and developed. There will be challenges around engagement with the task by the panel undertaking it and with the outputs by stakeholders but careful relationship building will help to mitigate this. The large volume of data will be managed through careful segmenting of the analysis and the use of the well-established Framework approach to qualitative data analysis. WTP has various potential biases but the elicitation will be carefully designed to minimise these and some methodological investigation will take place. Electronic supplementary material The online version of this article (10.1186/s12913-018-3302-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher R Vernazza
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK.
| | - Katherine Carr
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK
| | - John Wildman
- Newcastle University Business School, Newcastle University, Room 7.20, 7th Floor, 5 Barrack Road, Newcastle upon Tyne, NE1 4SE, UK
| | - Joanne Gray
- Nursing, Midwifery & Health, Northumbria University, Sutherland Building, Newcastle-upon-Tyne, NE1 8ST, UK
| | - Richard D Holmes
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK
| | - Catherine Exley
- Faculty of Health and Life Sciences, Northumbria University, NB266, 2nd Floor, Northumberland Building, Newcastle upon Tyne, NE1 8ST, UK
| | - Robert A Smith
- ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, M201, George Moore Building, Glasgow, G4 0BA, UK
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Baik S, Davis AL, Morgan MG. Assessing the Cost of Large-Scale Power Outages to Residential Customers. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:283-296. [PMID: 28661084 DOI: 10.1111/risa.12842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Residents in developed economies depend heavily on electric services. While distributed resources and a variety of new smart technologies can increase the reliability of that service, adopting them involves costs, necessitating tradeoffs between cost and reliability. An important input to making such tradeoffs is an estimate of the value customers place on reliable electric services. We develop an elicitation framework that helps individuals think systematically about the value they attach to reliable electric service. Our approach employs a detailed and realistic blackout scenario, full or partial (20 A) backup service, questions about willingness to pay (WTP) using a multiple bounded discrete choice method, information regarding inconveniences and economic losses, and checks for bias and consistency. We applied this method to a convenience sample of residents in Allegheny County, Pennsylvania, finding that respondents valued a kWh for backup services they assessed to be high priority more than services that were seen as low priority ($0.75/kWh vs. $0.51/kWh). As more information about the consequences of a blackout was provided, this difference increased ($1.2/kWh vs. $0.35/kWh), and respondents' uncertainty about the backup services decreased (Full: $11 to $9.0, Partial: $13 to $11). There was no evidence that the respondents were anchored by their previous WTP statements, but they demonstrated only weak scope sensitivity. In sum, the consumer surplus associated with providing a partial electric backup service during a blackout may justify the costs of such service, but measurement of that surplus depends on the public having accurate information about blackouts and their consequences.
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Affiliation(s)
- Sunhee Baik
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Alexander L Davis
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - M Granger Morgan
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
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Kaambwa B, Bryan S, Frew E, Bray E, Greenfield S, McManus RJ. What Drives Responses to Willingness-to-pay Questions? A Methodological Inquiry in the Context of Hypertension Self-management. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2016; 4:158-171. [PMID: 37661949 PMCID: PMC10471407 DOI: 10.36469/9818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background: The use of economic evaluation to determine the cost-effectiveness of health interventions is recommended by decision-making bodies internationally. Understanding factors that explain variations in costs and benefits is important for policy makers. Objective: This work aimed to test a priori hypotheses defining the relationship between benefits of using self-management equipment (measured using the willingness-to-pay (WTP) approach) and a number of demographic and other patient factors. Methods: Data for this study were collected as part of the first major randomised controlled trial of self-monitoring combined with self-titration in hypertension (TASMINH2). A contingent valuation framework was used with patients asked to indicate how much they were willing to pay for equipment used for self-managing hypertension. Descriptive statistics, simple statistical tests of differences and multivariate regression were used to test six a priori hypotheses. Results: 393 hypertensive patients (204 in the intervention and 189 in the control) were willing to pay for self-management equipment and 85% of these (335) provided positive WTP values. Three hypotheses were accepted: higher WTP values were associated with being male, higher household incomes and satisfaction with the equipment. Prior experiences of using this equipment, age and changes in blood pressure were not significantly related to WTP. Conclusion: The majority of hypertensive patients who had taken part in a self-management study were prepared to purchase the self-monitoring equipment using their own funds, more so for men, those with higher incomes and those with greater satisfaction. Further research based on bigger and more diverse populations is recommended.
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Affiliation(s)
- Billingsley Kaambwa
- Flinders Health Economics Group, School of Medicine Flinders University, Repatriation General Hospital, Daw Park, SA, Australia
| | - Stirling Bryan
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute and School of Population & Public Health University of British Columbia, Vancouver, BC, Canada
| | - Emma Frew
- Health Economics Unit, Institute of Applied Health Research University of Birmingham, Edgbaston, Birmingham, UK
| | - Emma Bray
- School of Psychology University of Central Lancashire, Preston, Lancashire, UK
| | - Sheila Greenfield
- Primary Care Clinical Sciences, Institute of Applied Health Research University of Birmingham, Edgbaston, Birmingham, UK
| | - Richard J McManus
- Primary Care Health Sciences, NIHR School for Primary Care Research University of Oxford, Oxford, UK
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Economic evaluation of integrated new technologies for health and social care: Suggestions for policy makers, users and evaluators. Soc Sci Med 2016; 169:141-148. [PMID: 27721138 DOI: 10.1016/j.socscimed.2016.09.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 08/16/2016] [Accepted: 09/23/2016] [Indexed: 11/20/2022]
Abstract
With an ageing population there is a move towards the use of assisted living technologies (ALTs) to provide social care and health care services, and to improve service processes. These technologies are at the forefront of the integration of health and social care. However, economic evaluations of ALTs, and indeed economic evaluations of any interventions providing both health benefits and benefits beyond health are complex. This paper considers the challenges faced by evaluators and presents a method of economic evaluation for use with interventions where traditional methods may not be suitable for informing funders and decision makers. We propose a method, combining economic evaluation techniques, that can accommodate health outcomes and outcomes beyond health through the use of a common numeraire. Such economic evaluations can benefit both the public and private sector, firstly by ensuring the efficient allocation of resources. And secondly, by providing information for individuals who, in the market for ALTs, face consumption decisions that are infrequent and for which there may be no other sources of information. We consider these issues in the welfarist, extra-welfarist and capabilities frameworks, which we link to attributes in an individual production model. This approach allows for the valuation of the health component of any such intervention and the valuation of key social care attributes and processes. Finally, we present a set of considerations for evaluators highlighting the key issues that need to be considered in this type of economic evaluation.
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Tilling C, Krol M, Attema AE, Tsuchiya A, Brazier J, van Exel J, Brouwer W. Exploring a new method for deriving the monetary value of a QALY. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:801-9. [PMID: 26289341 DOI: 10.1007/s10198-015-0722-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 08/05/2015] [Indexed: 05/07/2023]
Abstract
Several studies have sought to determine the monetary value of health gains expressed as quality adjusted life years (QALYs) gained, predominantly using willingness to pay approaches. However, willingness to pay has a number of recognized problems, most notably its insensitivity to scope. This paper presents an alternative approach to estimate the monetary value of a QALY, which is based on the time trade-off method. Moreover, it presents the results of an online study conducted in the Netherlands exploring the feasibility of this novel approach. The results seem promising, but also highlight a number of methodological problems with this approach, most notably nontrading and the elicitation of negative values. Additional research is necessary to try to overcome these problems and to determine the potential of this new approach.
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Affiliation(s)
- Carl Tilling
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Marieke Krol
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
- Department of Health Policy and Management, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Arthur E Attema
- Department of Health Policy and Management, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Aki Tsuchiya
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Department of Economics, University of Sheffield, Sheffield, UK
| | - John Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Job van Exel
- Department of Health Policy and Management, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Werner Brouwer
- Department of Health Policy and Management, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
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Tuominen S, Leino M, Pirilä L, Tuominen R. Measuring the economic value of morning stiffness: consistency over 1 year. Scand J Rheumatol 2015; 45:294-8. [PMID: 26681432 DOI: 10.3109/03009742.2015.1107912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aims of this study were to determine the within-patient variation in the duration of morning stiffness (MS) over 1 year and the corresponding monetary equivalents assigned to its changes using the willingness-to-pay (WTP) methodology. METHOD A sample of 100 patients with rheumatoid arthritis (RA) was drawn from the register of the Hospital District of Southwest Finland. Subjects were interviewed by telephone on recruitment and 1 year later, using the same structured questionnaire. The subjects were asked to estimate in minutes the typical duration of their MS during the previous week. Sociodemographic background data and subjects' WTP for a 25, 50, 75, and 100% reduction in MS duration were requested, and years with RA diagnosis and serological data were obtained from hospital records. RESULTS After 1 year, there was a reduction in average MS duration from 44.7 min to 39.0 min (ns); duration was reduced in 35% of patients, unchanged in 35%, and prolonged in 30%. Changes in MS duration were reflected by within-patient variation in WTP estimates. In linear regression models, change in duration of MS significantly (p < 0.03) explained the variation in change of WTP for symptom reduction. CONCLUSIONS WTP methodology produces consistent monetary values to assess the relative values patients with RA place on reduction in duration of MS.
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Affiliation(s)
- S Tuominen
- a Department of Medicine, Rheumatology Unit , Turku University Hospital , Turku , Finland.,b Department of Public Health , University of Turku , Turku , Finland
| | - M Leino
- a Department of Medicine, Rheumatology Unit , Turku University Hospital , Turku , Finland.,b Department of Public Health , University of Turku , Turku , Finland
| | - L Pirilä
- a Department of Medicine, Rheumatology Unit , Turku University Hospital , Turku , Finland
| | - R Tuominen
- b Department of Public Health , University of Turku , Turku , Finland.,c Hospital District of Southwest Finland , Turku , Finland
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Predictors of willingness to pay for physical activity of socially vulnerable groups in community-based programs. SPRINGERPLUS 2015; 4:527. [PMID: 26405646 PMCID: PMC4575679 DOI: 10.1186/s40064-015-1336-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 09/10/2015] [Indexed: 12/02/2022]
Abstract
Willingness to pay (WTP) is used to assess individuals’ value attribution to health-related quality of life interventions. Little is known about predictors of WTP for sport and physical activity in socially vulnerable groups in community-based physical activity (CBHEPA) programs. This study addresses the questions: What is the WTP for sport and physical activity of participants in CBHEPA programs, expressed in WTPmoney and WTPtime? Which factors predict WTPmoney and WTPtime? From the literature, predictors for WTP for sport and physical activity were identified: (1) personal and socio-economic predictors: income, education, age, and ethnic origin, (2) health-related predictors: perceived health, life satisfaction, sense of coherence, self-efficacy, (3) sport and physical activity-related predictors: duration and frequency of participation, leisure-time sport or physical activity, sport club membership, enjoyment, and membership fee. Data were gathered for WTPmoney and WTPtime (n = 268) in 19 groups in an evaluation study of CBHEPA programs. Ordered probit was used for analyses. WTPmoney was a monthly average of €9.6. WTPtime was on average 17.6 min travel time. Income was found as predictor for both WTPmoney and WTPtime. Other predictors for WTPmoney were: duration and frequency of program participation, enjoyment, and (former) sport club membership. Low income and younger age were found as predictors for WTPtime. Predictors for WTPmoney are related to income and sport and physical activity experiences, for WTPtime to income and age. Short-term program satisfaction is probably more decisive for WTPmoney than long-term perspectives of improving health-related quality of life.
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Factors affecting patient valuations of caries prevention: Using and validating the willingness to pay method. J Dent 2015; 43:981-8. [PMID: 26054234 DOI: 10.1016/j.jdent.2015.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Determining the value of, or strength of preference for health care interventions is useful for policy makers in planning health care services. Willingness to pay (WTP) is an established economic technique to determine the strength of preferences for interventions by eliciting monetary valuations from individuals in hypothetical situations. The objective of this study was to elicit WTP values for a dental preventive intervention and to analyze the factors affecting these as well as investigating the validity of the WTP method. METHODS Patients aged 40 years plus attending dental practices in the UK and Germany were recruited on a consecutive basis over one month. Participants received information about a novel root caries prevention intervention. They then completed a questionnaire including a WTP task. Where the coating was indicated, patients were offered this for a payment and acceptance was recorded. Analysis included econometric modelling and comparison of expected (based on stated WTP) versus actual behaviour. RESULTS The mean WTP for the coating was £96.41 (standard deviation 60.61). Econometric models showed that no demographic or dental history factors were significant predictors of WTP. 63% of the sample behaved as expected when using stated WTP to predict whether they would buy the coating. The remainder were split almost equally between those expected to pay but who did not and those who were expected to refuse but paid. CONCLUSIONS Values for a caries preventive intervention had a large and unpredictable variance. In comparing hypothetical versus real preferences both under- and over-valuation occurs. CLINICAL SIGNIFICANCE Wide and unpredictable variation in valuations for prevention may mean that there are difficult policy questions around what resource should be allocated to dental prevention and how to target this resource.
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Nimdet K, Chaiyakunapruk N, Vichansavakul K, Ngorsuraches S. A systematic review of studies eliciting willingness-to-pay per quality-adjusted life year: does it justify CE threshold? PLoS One 2015; 10:e0122760. [PMID: 25855971 PMCID: PMC4391853 DOI: 10.1371/journal.pone.0122760] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A number of studies have been conducted to estimate willingness to pay (WTP) per quality-adjusted life years (QALY) in patients or general population for various diseases. However, there has not been any systematic review summarizing the relationship between WTP per QALY and cost-effectiveness (CE) threshold based on World Health Organization (WHO) recommendation. OBJECTIVE To systematically review willingness-to-pay per quality-adjusted-life-year (WTP per QALY) literature, to compare WTP per QALY with Cost-effectiveness (CE) threshold recommended by WHO, and to determine potential influencing factors. METHODS We searched MEDLINE, EMBASE, Psyinfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Center of Research Dissemination (CRD), and EconLit from inception through 15 July 2014. To be included, studies have to estimate WTP per QALY in health-related issues using stated preference method. Two investigators independently reviewed each abstract, completed full-text reviews, and extracted information for included studies. We compared WTP per QALY to GDP per capita, analyzed, and summarized potential influencing factors. RESULTS Out of 3,914 articles founded, 14 studies were included. Most studies (92.85%) used contingent valuation method, while only one study used discrete choice experiments. Sample size varied from 104 to 21,896 persons. The ratio between WTP per QALY and GDP per capita varied widely from 0.05 to 5.40, depending on scenario outcomes (e.g., whether it extended/saved life or improved quality of life), severity of hypothetical scenarios, duration of scenario, and source of funding. The average ratio of WTP per QALY and GDP per capita for extending life or saving life (2.03) was significantly higher than the average for improving quality of life (0.59) with the mean difference of 1.43 (95% CI, 1.81 to 1.06). CONCLUSION This systematic review provides an overview summary of all studies estimating WTP per QALY studies. The variation of ratio of WTP per QALY and GDP per capita depended on several factors may prompt discussions on the CE threshold policy. Our research work provides a foundation for defining future direction of decision criteria for an evidence-informed decision making system.
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Affiliation(s)
- Khachapon Nimdet
- Faculty of Pharmaceutical Sciences, Prince Songkla University, Hatyai, Thailand
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- School of Pharmacy, University of Wisconsin, Madison, United States of America
- School of Population Health, University of Queensland, Brisbane, Australia
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Pavel MS, Chakrabarty S, Gow J. Assessing willingness to pay for health care quality improvements. BMC Health Serv Res 2015; 15:43. [PMID: 25638204 PMCID: PMC4332931 DOI: 10.1186/s12913-015-0678-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 01/05/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Contingent valuation (CV) is used to estimate the willingness to pay (WTP) of consumers for specific attributes to improve the quality of health care they received in three hospitals in Bangladesh. METHODS Random sample of 252 patients were interviewed to measure their willingness to pay for seven specified improvements in the quality of delivered medical care. Partial tobit regression and corresponding marginal effects analysis were used to analyze the data and obtain WTP estimates. RESULTS Patients are willing to pay more if their satisfaction with three attributes of care are increased. These are: a closer doctor-patient relationship, increased drug availability and increased chances of recovery. The doctor patient relationship is considered most important by patients and exhibited the highest willingness to pay. CONCLUSIONS This study provides important information to policy makers about the monetary valuation of patients for improvements in certain attributes of health care in Bangladesh.
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Affiliation(s)
- Md Sadik Pavel
- Department of Economics, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh.
| | - Sayan Chakrabarty
- Department of Economics, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh.
- Australian Digital Futures Institute (ADFI), University of Southern Queensland, Toowoomba, QLD, 4350, Australia.
- Australian Centre for Sustainable Business and Development, University of Southern Queensland, Springfield, QLD, 4300, Australia.
| | - Jeff Gow
- School of Commerce, University of Southern Queensland, Toowoomba, QLD, 4350, Australia.
- Research Associate, Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Durban, South Africa.
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Vernazza CR, Steele JG, Whitworth JM, Wildman JR, Donaldson C. Factors affecting direction and strength of patient preferences for treatment of molar teeth with nonvital pulps. Int Endod J 2014; 48:1137-46. [PMID: 25400281 DOI: 10.1111/iej.12413] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 11/12/2014] [Indexed: 11/29/2022]
Abstract
AIM To elicit the factors affecting willingness to pay (WTP) values for the preferred options of participants for dealing with a molar tooth with a nonvital pulp, a common but difficult problem. METHODOLOGY A total of 503 patients were recruited from dental practices in the North East of England and interviewed. Their preferred treatment option for a molar tooth with a nonvital pulp (endodontics, extraction and various prosthetic restorative options) and WTP for this preferred option were elicited. Factors affecting preferred option and WTP were analysed using econometric modelling. RESULTS Overall, 53% of the sample wished to save the tooth with a mean WTP of £373. The variance in WTP was high. Of those opting for extraction, the majority chose to leave a gap or have an implant. The preferred option was influenced by previous treatment experience. WTP was only influenced by having a low income. CONCLUSIONS The high level of variance in WTP and its relatively unpredictable nature pose difficult questions for policy makers trying to ensure the delivery of an equitable service. For dentists, it is important not to make assumptions about patient preference and strength of preference when making decisions. Ideally, WTP values should be considered alongside effectiveness data, and those on costs, in policy making.
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Affiliation(s)
- C R Vernazza
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - J G Steele
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - J M Whitworth
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - J R Wildman
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - C Donaldson
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
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Alayli-Goebbels AFG, van Exel J, Ament AJHA, de Vries NK, Bot SDM, Severens JL. Consumer willingness to invest money and time for benefits of lifestyle behaviour change: an application of the contingent valuation method. Health Expect 2014; 18:2252-65. [PMID: 25135005 DOI: 10.1111/hex.12195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To use contingent valuation (CV) to derive individual consumer values for both health and broader benefits of a public-health intervention directed at lifestyle behaviour change (LBC) and to examine the feasibility and validity of the method. METHOD Participants of a lifestyle intervention trial (n = 515) were invited to complete an online CV survey. Respondents (n = 312) expressed willingness to invest money and time for changes in life expectancy, health-related quality of life (HRQOL) and broader quality of life aspects. Internal validity was tested for by exploring associations between explanatory variables (i.e. income, paid work, experience and risk factors for cardiovascular diseases) and willingness to invest, and by examining ordering effects and respondents' sensitivity to the scope of the benefits. RESULTS The majority of respondents (94.3%) attached value to benefits of LBC, and 87.4% were willing to invest both money and time. Respondents were willing to invest more for improvements in HRQOL (€42/month; 3 h/week) and broader quality of life aspects (€40/month; 2.6 h/week) than for improvements in life expectancy (€24/month; 2 h/week). Protest answers were limited (3%) and findings regarding internal validity were mixed. CONCLUSION The importance of broader quality of life outcomes to consumers suggests that these outcomes are relevant to be considered in the decision making. Our research showed that CV is a feasible method to value both health and broader outcomes of LBC, but generalizability to other areas of public health still needs to be examined. Mixed evidence regarding internal validity pleads for caution to use CV as only the base for decision making.
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Affiliation(s)
- Adrienne F G Alayli-Goebbels
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Job van Exel
- Institute of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - André J H A Ament
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Nanne K de Vries
- Department of Health Promotion, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Sandra D M Bot
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Johan L Severens
- Institute of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.,Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
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De Steur H, Feng S, Xiaoping S, Gellynck X. Consumer preferences for micronutrient strategies in China. A comparison between folic acid supplementation and folate biofortification. Public Health Nutr 2014; 17:1410-20. [PMID: 23507512 PMCID: PMC10282357 DOI: 10.1017/s1368980013000682] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 01/28/2013] [Accepted: 01/30/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Despite public health efforts, folate deficiency is still largely prevalent in poor, rural populations and continues to cause a large burden of disease. The present paper determines and compares consumer preferences for two folate strategies: folic acid supplementation v. folate biofortification, i.e. the enhancement of the folate content in staple crops. DESIGN Experimental auctions with non-repeated information rounds are applied to rice in order to obtain willingness-to-pay for folate products. Thereby, GM or non-GM folate-biofortified rice (FBR) is auctioned together with rice that is supplemented with free folic acid pills (FAR). SETTING Shanxi Province (China) as a high-risk region of folate deficiency. SUBJECTS One hundred and twenty-six women of childbearing age, divided into a school (n 60) and market sample (n 66). RESULTS Despite differences according to the targeted sample, a general preference for folate biofortification is observed, regardless of the applied breeding technology. Premiums vary between 33·9 % (GM FBR), 36·5 % (non-GM FBR) and 19·0 % (FAR). Zero bidding behaviour as well as the product choice question, respectively, support and validate these findings. The targeted sample, the timing of the auction, the intention to consume GM food and the responsibility for rice purchases are considered key determinants of product choice. A novel ex-post negative valuation procedure shows low consistency in zero bidding. CONCLUSIONS While the low attractiveness of FAR provides an additional argument for the limited effectiveness of past folic acid supplementation programmes, the positive reactions towards GM FBR further support its potential as a possible complementary micronutrient intervention.
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Affiliation(s)
- Hans De Steur
- Department of Agricultural Economics, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium
| | - Shuyi Feng
- College of Public Administration, Nanjing Agricultural University, Nanjing, People's Republic of China
| | - Shi Xiaoping
- College of Public Administration, Nanjing Agricultural University, Nanjing, People's Republic of China
| | - Xavier Gellynck
- Department of Agricultural Economics, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium
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Shono A, Kondo M, Ohmae H, Okubo I. Willingness to pay for public health services in rural Central Java, Indonesia: methodological considerations when using the contingent valuation method. Soc Sci Med 2014; 110:31-40. [PMID: 24713191 DOI: 10.1016/j.socscimed.2014.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 03/10/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
In the health sectors of low- and middle-income countries, contingent valuation method (CVM) studies on willingness to pay (WTP) have been used to gather information on demand variation or financial perspectives alongside price setting, such as the introduction of user fees and valuation of quality improvements. However, WTP found in most CVM studies have only explored the preferences that consumers express through their WTP without exploring whether they are actually able to pay for it. Therefore, this study examines the issues pertaining to WTP estimation for health services using the conventional CVM. We conducted 202 household interviews in 2008, in which we asked respondents about three types of public health services in Indonesia and assessed WTP estimated by the conventional CVM as well as in the scenario of "resorting to debt" to recognize their budget constraints. We find that all the demand curves for both WTP scenarios show gaps. Furthermore, the gap for midwife services is negatively affected by household income and is larger for the poor. These results prove that CVM studies on WTP do not always reveal WTP in the latter scenario. Those findings suggest that WTP elicited by the conventional CVM is different to that from the maximum price that prevents respondents from resorting to debt as their WTP. In order to bridge this gap in the body of knowledge on this topic, studies should improve the scenarios that CVM analyses use to explore WTP. Furthermore, because valuing or pricing health services based on the results of CVM studies on WTP alone can exacerbate the inequity of access to these services, information provided by such studies requires careful interpretation when used for this purpose, especially for the poor and vulnerable sections of society.
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Affiliation(s)
- Aiko Shono
- Department of Health Care Policy and Management, Doctoral Program in Human Care Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan; Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Japan.
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroshi Ohmae
- Department of Parasitology, National Institute of Infectious Diseases, Japan
| | - Ichiro Okubo
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Japan
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Fleurbaey M, Luchini S, Muller C, Schokkaert E. Equivalent income and fair evaluation of health care. HEALTH ECONOMICS 2013; 22:711-729. [PMID: 22767541 DOI: 10.1002/hec.2859] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 05/27/2012] [Accepted: 06/06/2012] [Indexed: 06/01/2023]
Abstract
We argue that the economic evaluation of health care (cost-benefit analysis) should respect individual preferences and should incorporate distributional considerations. Relying on individual preferences does not imply subjective welfarism. We propose a particular non-welfarist approach, based on the concept of equivalent income, and show how it helps to define distributional weights. We illustrate the feasibility of our approach with empirical results from a pilot survey.
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Havet N, Morelle M, Remonnay R, Carrere MO. Cancer patients' willingness to pay for blood transfusions at home: results from a contingent valuation study in a French cancer network. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2012; 13:289-300. [PMID: 21660563 DOI: 10.1007/s10198-011-0328-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 05/25/2011] [Indexed: 05/30/2023]
Abstract
Home blood transfusion may be an interesting alternative to hospital transfusion, especially when given with curative or palliative intent or for terminal care in advanced-stage cancer patients. However, there is limited information about patients' attitude toward this type of care. The purpose of this study was to measure French cancer patients' willingness to pay (WTP) for home blood transfusion and to analyze determinants of their choice. A contingent valuation survey was administered to 139 patients receiving transfusions in the framework of a regional home care network or in the hospital outpatient department. Participation was high (90%). Most patients (65%) had received home care, including 43% blood transfusions. Just under half of the patients gave a zero WTP, among which we identified 8 protest bidders. The median WTP for home blood transfusion was 26.5 <euro> per patient. In multivariate analysis, long home-hospital distance, poor quality of life, and previous experience of home care were identified as important factors in determining how much more patients would be willing to pay for transfusion at home. These results demonstrate the benefits of developing domiciliary services to improve patient well-being, notably for the weakest among them. The significant impact of previous home care experience on WTP is probably related to the strong involvement of physicians from the blood center and to their active contribution to a high-level homecare network. Some of our findings could be useful for policy decision-making regarding home care.
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Affiliation(s)
- Nathalie Havet
- GATE Lyon-Saint Etienne, University of Lyon, 93 chemin des Mouilles, 69 130 Ecully, France.
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Abstract
OBJECTIVE The aim of this study is to determine Swedish parents' willingness to pay (WTP) for coeliac disease (CD) screening of their child. SUBJECTS AND METHODS CD screening was undertaken involving 10,041 12-year-old children, with 7567 (75%) agreeing to participate. Blood samples from the children were analysed for CD serological markers. Parents received a questionnaire including a scenario describing the health-related risks of having CD and screening and diagnostic procedures. Parents were also asked whether they were willing to pay for CD screening, should this not be offered free of charge, and, if so, what their maximum WTP would be. Their WTP was compared with the average cost per child for the screening and case ascertainment procedures. RESULTS The questionnaire was answered by 6524 parents, and of 6057 valid responses 63% stated that they were willing to pay something. The mean WTP was 79 EUR and the median 10 EUR. The average cost per child for the screening and case ascertainment procedures was 47 EUR, which 23% of the parents stated they were willing to pay. Parents' WTP increased with higher education and income, and with child symptoms that may indicate CD. CONCLUSIONS Swedish parents' WTP for school-based CD screening of their child was higher than the average cost per child; however, only a minority of the parents were willing to pay that amount.
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Gold L, Norman R, Devine A, Feder G, Taft AJ, Hegarty KL. Cost-Effectiveness of Health Care Interventions to Address Intimate Partner Violence: What Do We Know and What Else Should We Look for? Violence Against Women 2011; 17:389-403. [PMID: 21343165 DOI: 10.1177/1077801211398639] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intimate partner violence (IPV) creates a substantial burden of disease and significant costs to families, communities, and governments. Building the evidence for effective interventions to reduce violence and its sequelae requires increased use of economic evaluation to inform policy through the analysis of costs and potential savings of interventions. The authors review existing economic evaluations and present case studies of current research from the United Kingdom and Australia to illustrate the strengths and limitations of two approaches to generating economic evidence: economic evaluation alongside randomized controlled trials and economic modeling. Economic evaluation should always be considered in the design of IPV intervention research.
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Affiliation(s)
- Lisa Gold
- Deakin University, Burwood, Victoria, Australia,
| | - Richard Norman
- University of Technology, Sydney, New South Wales, Australia
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What needs to be done in contingent valuation: have Smith and Sach missed the boat? HEALTH ECONOMICS POLICY AND LAW 2010; 5:113-21. [PMID: 20050223 DOI: 10.1017/s174413310999003x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ternent L, McNamee P, Newlands D, Belemsaga D, Gbangou A, Cross S. Willingness to pay for maternal health outcomes: are women willing to pay more than men? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2010; 8:99-109. [PMID: 20067333 DOI: 10.2165/11313960-000000000-00000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Only a limited number of studies have specifically sought to analyse and try to understand sex differences in willingness to pay (WTP). OBJECTIVE To identify the role of sex in determining monetary values placed upon improvements in maternal health in Burkina Faso, West Africa. METHODS A contingent valuation survey using the bidding game method was conducted in the district of Nouna in 2005; a sample of 409 male heads of households and their spouses were asked their WTP for a reduction in the number of maternal deaths in the Nouna area. Ordinary least squares regression analysis was employed to examine the determinants of WTP. RESULTS Men were willing to pay significantly more than women (3127 vs 2273 West African francs), although this represented a significantly smaller proportion of their annual income (4% vs 11%). In the multivariate analyses of all respondents there was a significant positive relationship between WTP values and both starting bid and whether there had been a previous maternal complication in the respondent's household. However, there was a significant negative relationship between WTP and female sex. Once interactions between sex and income were taken into account, income did affect valuations, with a positive relationship between higher-income women and WTP values. CONCLUSION In absolute terms, men were willing to pay more than women, while women were willing to pay a greater proportion of their income. Differences between men and women in their WTP, both in absolute terms and in terms of proportion of income, can be explained by a household effect. Future studies should distinguish between individual income and command over decision making with respect to use of individual and household income, and gain further insight into the strategies used by respondents in answering bidding game questions.
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Affiliation(s)
- Laura Ternent
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
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Guimarães C, Marra CA, Colley L, Gill S, Simpson S, Meneilly G, Queiroz RHC, Lynd LD. Socioeconomic differences in preferences and willingness-to-pay for insulin delivery systems in type 1 and type 2 diabetes. Diabetes Technol Ther 2009; 11:567-73. [PMID: 19764835 DOI: 10.1089/dia.2009.0034] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND An evaluation of patients' preferences is necessary to understand the demand for different insulin delivery systems. The aim of this study was to investigate the association between socioeconomic status (SES) and patients' preferences and willingness to pay (WTP) for various attributes of insulin administration for diabetes management. METHODS We conducted a discrete choice experiment (DCE) to determine patients; preferences and their WTP for hypothetical insulin treatments. Both self-reported annual household income and education completed were used to explore differences in treatment preferences and WTP for different attributes of treatment across different levels of SES. RESULTS The DCE questionnaire was successfully completed by 274 patients. Overall, glucose control was the most valued attribute by all socioeconomic groups, while route of insulin delivery was not as important. Patients with higher incomes were willing to pay significantly more for better glucose control and to avoid adverse events compared to lower income groups. In addition, they were willing to pay more for an oral short-acting insulin ($Can 71.65 [95% confidence interval, $40.68, $102.62]) compared to the low income group ($Can 9.85 [95% confidence interval, 14.86, 34.56; P < 0.01]). Conversely, there were no differences in preferences when the sample was stratified by level of education. CONCLUSIONS This study revealed that preferences and WTP for insulin therapy are influenced by income but not by level of education. Specifically, the higher the income, the greater desire for an oral insulin delivery system, whereas an inhaled route becomes less important for patients.
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Explicit incorporation of equity considerations into economic evaluation of public health interventions. HEALTH ECONOMICS POLICY AND LAW 2009; 4:231-45. [DOI: 10.1017/s1744133109004903] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractHealth equity is one of the main avowed objectives of public health policy across the world. Yet economic evaluations in public health (like those in health care more generally) continue to focus on maximizing health gain. Health equity considerations are rarely mentioned. Health economists rely on the quasi-egalitarian value judgment that ‘a QALY is a QALY’ – that is QALYs are equally weighted and the same health outcome is worth the same no matter how it is achieved or to whom it accrues. This value judgment is questionable in many important circumstances in public health. For example, policy-makers may place rather little value on health outcomes achieved by infringing individual liberties or by discriminating on the basis of age, sex, or race. Furthermore, there is evidence that a majority of the general public wish to give greater weight to health gains accruing to children, the severely ill, and, to a lesser extent, the socio-economically disadvantaged. This paper outlines four approaches to explicit incorporation of equity considerations into economic evaluation in public health: (i) review of background information on equity, (ii) health inequality impact assessment, (iii) analysis of the opportunity cost of equity, and (iv) equity weighting of health outcomes. The first three approaches can readily be applied using standard methods of health technology assessment, where suitable data are available; whereas approaches for generating equity weights remain experimental. The potential benefits of considering equity are likely to be largest in cases involving: (a) interventions that target disadvantaged individuals or communities and are also relatively cost-ineffective and (b) interventions to encourage lifestyle change, which may be relatively ineffective among ‘hard-to-reach’ disadvantaged groups and hence may require re-design to avoid increasing health inequalities.
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Borghi J. Aggregation rules for cost-benefit analysis: a health economics perspective. HEALTH ECONOMICS 2008; 17:863-875. [PMID: 17992709 DOI: 10.1002/hec.1304] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Few willingness-to-pay (WTP) studies in the health sector have used their results within a cost-benefit analysis (CBA), an essential step to informing resource allocation decisions. This paper provides an overview of aggregation methods, reviews current evidence of practice in the health sector, and presents estimates of the total economic value of a women's group programme to improve mother and newborn health using different aggregation rules. A contingent valuation survey was conducted with 93 women's group members, 70 female non-members and 33 husbands. Aggregation was conducted with and without the values of non-users, and with different units of aggregation. The unadjusted mean, median and a weighted mean transfer were used to aggregate values. Equity weights were introduced to adjust WTP for income. Total WTP more than doubled when the values of husbands were added to that of women, and increased over 10-fold when the values of women who were not members of the group were added. The inclusion of non-use values, and the unit of aggregation, had the greatest effect on results. Researchers must reach agreement on the most acceptable method of aggregating WTP values to promote the use of WTP in resource allocation decisions in the health sector.
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An alternative approach for eliciting willingness-to-pay: A randomized Internet trial. JUDGMENT AND DECISION MAKING 2007. [DOI: 10.1017/s1930297500000073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractOpen-ended methods that elicit willingness-to-pay (WTP) in terms of absolute dollars often result in high rates of questionable and highly skewed responses, insensitivity to changes in health state, and raise an ethical issue related to its association with personal income. We conducted a 2x2 randomized trial over the Internet to test 4 WTP formats: 1) WTP in dollars; 2) WTP as a percentage of financial resources; 3) WTP in terms of monthly payments; and 4) WTP as a single lump-sum amount. WTP as a percentage of financial resources generated fewer questionable values, had better distribution properties, greater sensitivity to severity of health states, and was not associated with income. WTP elicited on a monthly basis also showed promise.
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Mataria A, Giacaman R, Khatib R, Moatti JP. Impoverishment and patients' "willingness" and "ability" to pay for improving the quality of health care in Palestine: an assessment using the contingent valuation method. Health Policy 2006; 75:312-28. [PMID: 15869821 DOI: 10.1016/j.healthpol.2005.03.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Accepted: 03/28/2005] [Indexed: 11/23/2022]
Abstract
This paper examines the impact of impoverishment on patients' preferences with respect to improving the quality of health care, by focusing on the sudden impoverishment experience that affected the Occupied Palestinian Territory (OPT) since the beginning of the second Palestinian Uprising of September 2000. Two random samples of patients (352 and 353 individuals, respectively) were interviewed about their willingness to pay for improving a set of quality attributes in delivery of primary health care, prior and after the occurrence of this crisis situation, using a contingent valuation questionnaire. Impoverishment did not seem to affect the structure of patients' preferences vis-à-vis some essential quality attributes such as "doctor-patient relationship" and "drug availability". However, preferences toward "luxury" quality attributes, e.g., "geographical proximity" and "waiting time", suffered from both income-dependent and income-independent negative impoverishment effects. We conclude that impoverishment might not only affect individuals' availability of resources but also the ability of certain groups of patients, notably women, villagers and the elderly, to adequately express their preferences toward improving the quality of health care delivery. The issue of how willingness to pay results should be interpreted in the light of our study for policy implications was discussed. The study raises strong doubts about the current policy of introducing patients' cost recovery schemes for funding primary health care in the current crisis situation of the OPT.
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Affiliation(s)
- Awad Mataria
- French National Institute of Medical Research, Unit 379 & Regional Center for Disease Control of South-Eastern France (INSERM U379/ORS), Marseille, France.
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Onwujekwe O, Malik EFM, Mustafa SH, Mnzava A. Socio-economic inequity in demand for insecticide-treated nets, in-door residual house spraying, larviciding and fogging in Sudan. Malar J 2005; 4:62. [PMID: 16356177 PMCID: PMC1334196 DOI: 10.1186/1475-2875-4-62] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 12/15/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In order to optimally prioritize and use public and private budgets for equitable malaria vector control, there is a need to determine the level and determinants of consumer demand for different vector control tools. OBJECTIVES To determine the demand from people of different socio-economic groups for indoor residual house-spraying (IRHS), insecticide-treated nets (ITNs), larviciding with chemicals (LWC), and space spraying/fogging (SS) and the disease control implications of the result. METHODS Ratings and levels of willingness-to-pay (WTP) for the vector control tools were determined using a random cross-sectional sample of 720 householdes drawn from two states. WTP was elicited using the bidding game. An asset-based socio-economic status (SES) index was used to explore whether WTP was related to SES of the respondents. RESULTS IRHS received the highest proportion of highest preferred rating (41.0%) followed by ITNs (23.1%). However, ITNs had the highest mean WTP followed by IRHS, while LWC had the least. The regression analysis showed that SES was positively and statistically significantly related to WTP across the four vector control tools and that the respondents' rating of IRHS and ITNs significantly explained their levels of WTP for the two tools. CONCLUSION People were willing to pay for all the vector-control tools, but the demand for the vector control tools was related to the SES of the respondents. Hence, it is vital that there are public policies and financing mechanisms to ensure equitable provision and utilisation of vector control tools, as well as protecting the poor from cost-sharing arrangements.
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Affiliation(s)
- Obinna Onwujekwe
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | | | | | - Abraham Mnzava
- World Health Organization, Eastern Mediterranean Regional Office (EMRO), Cairo, Egypt
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Whynes DK, Frew EJ, Wolstenholme JL. Willingness-to-Pay and Demand Curves: A Comparison of Results Obtained Using Different Elicitation Formats. ACTA ACUST UNITED AC 2005; 5:369-86. [PMID: 16378240 DOI: 10.1007/s10754-005-4014-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Health economists use "willingness-to-pay" to assess the prospective value of novel interventions. The technique remains controversial, not least with respect to the formats under which values are elicited. The paper analyses the results of a series of studies of the same intervention valued by the same population, in which different elicitation formats were employed. The findings support the hypothesis that data collected using different formats give rise to different demand curves, from which different inferences about demand elasticity, profitability and consumer surplus will be derived. Judgements as to the relative merits of rival interventions depend crucially upon whichever format has been used to evaluate each intervention.
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Affiliation(s)
- David K Whynes
- Health Economics, School of Economics, University of Nottingham, UK.
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Smith RD. Sensitivity to scale in contingent valuation: the importance of the budget constraint. JOURNAL OF HEALTH ECONOMICS 2005; 24:515-529. [PMID: 15811541 DOI: 10.1016/j.jhealeco.2004.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2003] [Revised: 04/05/2004] [Accepted: 08/05/2004] [Indexed: 05/24/2023]
Abstract
The possible insensitivity of willingness-to-pay (WTP) values to changes in scale continues to cause concern within the contingent valuation (CV) literature. Although several reasons for this phenomenon have been suggested, empirical evidence both supports and refutes insensitivity. This paper presents data that suggest that insensitivity may be significantly determined by the individual's budget constraint: the higher the proportion of income the expressed WTP represents, the greater the insensitivity of that WTP to changes in the scale of the good, irrespective of changes in underlying marginal utility. The methodological implication for CV studies in health care is outlined.
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Affiliation(s)
- Richard D Smith
- Health Economics Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK.
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Mataria A, Donaldson C, Luchini S, Moatti JP. A stated preference approach to assessing health care-quality improvements in Palestine: from theoretical validity to policy implications. JOURNAL OF HEALTH ECONOMICS 2004; 23:1285-1311. [PMID: 15556246 DOI: 10.1016/j.jhealeco.2004.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2002] [Revised: 10/01/2003] [Accepted: 05/19/2004] [Indexed: 05/24/2023]
Abstract
User fees have been promoted as a potential complementary funding mechanism for health care in developing countries. In this paper, we appraise the use of contingent valuation (CV) as a tool to help develop user fees schemes that could be used to assist in allocating, and partially fund, health care. A random sample of 499 patients seeking care in primary health care centers, in Palestine, were asked to reveal their willingness to pay values for specified improvements in the quality of delivered medical care. Empirical analysis suggests that, in this context, CV can lead to internally consistent results and useful policy implications.
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Affiliation(s)
- Awad Mataria
- French National Institute of Medical Research, Unit 379, Regional Center for Disease Control of South-Eastern France (INSERM U379/ORS), Marseille, France.
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Abstract
In health economics, contingent valuation is a method that elicits an individual's monetary valuations of health programmes or health states. This article reviews the theory and conduct of contingent valuation studies, with suggestions for improving the future measurement of contingent valuation for health economics applications. Contingent valuation questions can be targeted to any of the following groups: the general population, to value health insurance premiums for programmes; users of a health programme, to value the associated programme costs; or individuals with a disease, to evaluate health states. The questions can be framed to ask individuals how much they would pay to obtain positive changes in health status or avoid negative changes in health status ('willingness to pay'; WTP) or how much they would need to be paid to compensate for a decrease in health status or for foregoing an improvement in heath status ('willingness to accept'; WTA). In general WTP questions yield more accurate and precise valuations than WTA questions. Payment card techniques, with follow-up bidding using direct interviews with visual aids, are well suited for small contingent valuation studies. Several biases may be operative when assessing contingent valuation, including biases in the way participants are selected, the way in which the questions are posed, the way in which individuals interpret probabilities and value gains relative to losses, and the way in which missing or extreme responses are interpreted. An important aspect of all contingent valuation studies is an assessment of respondents' understanding of the evaluation method and the valuation task. Contingent valuation studies should measure the potential influence of biases, the validity of contingent valuation tests as measures of QOL, and the reliability and responsiveness of responses. Future research should address equity concerns associated with using contingent valuation and explore contingent valuation as a measure of utility for health states, particularly those that are minor or temporary.
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Affiliation(s)
- Ahmed M Bayoumi
- Inner City Health Research Unit, St Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada.
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Meenan RT, Vuckovic N. On the Integration of Complementary and Conventional Medicine Within Health Maintenance Organizations. J Ambul Care Manage 2004; 27:43-52. [PMID: 14717463 DOI: 10.1097/00004479-200401000-00006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The integration of complementary and alternative medicine (CAM) with conventional medicine continues across practice settings and modalities. Managed care is of particular interest to practitioners, policy makers, and researchers concerned with the evolution of CAM integration. Within health maintenance organizations (HMOs), availability, coverage, and support of CAM are variable. We present an organizational model within which we identify factors that influence the degree of CAM integration within HMOs. We describe avenues through which CAM is currently available within the Northwest Region of Kaiser Permanente (KPNW). We also describe research methods applicable to the study of CAM integration within HMOs.
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Affiliation(s)
- Richard T Meenan
- Science Programs Department, Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA.
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Whynes DK, Frew E, Wolstenholme JL. A comparison of two methods for eliciting contingent valuations of colorectal cancer screening. JOURNAL OF HEALTH ECONOMICS 2003; 22:555-574. [PMID: 12842315 DOI: 10.1016/s0167-6296(03)00006-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Willingness-to-pay (WTP) is being used increasingly in health technology assessment, although a number of methodological issues remain unresolved. Using data obtained from a randomised questionnaire survey, we investigated the metrical properties of two WTP formats, the open-ended question versus the payment scale, in the context of screening for colorectal cancer. Approximately, 2800 responses were analysed. Household income, attitudes toward health promotion and personal risk perceptions were the principal determinants of the nature and value of response. In comparison with the open-ended format, the payment scale achieved a higher completion rate and generated higher valuations. We believe that a framing effect is the most plausible explanation for these differences in performance. In contrast to previous findings, we do not find subjects' perceptions of the resource cost of interventions to be a convincing explanation for either their WTP values or inconsistencies between values and preferences. Although a proportion of respondents protested at the notion of valuation, the majority offer positive valuations, although typically of a lower value that non-protesters.
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Affiliation(s)
- David K Whynes
- School of Economics, University of Nottingham, Nottingham NG7 2RD, UK.
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Dixon S, Shackley P. The use of willingness to pay to assess public preferences towards the fortification of foodstuffs with folic acid. Health Expect 2003; 6:140-8. [PMID: 12752742 PMCID: PMC5060174 DOI: 10.1046/j.1369-6513.2003.00219.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To assess public attitudes towards the fortification of flour with folic acid, and quantify their intensity of preference towards the proposed policy. DESIGN Structured interviews describing the proposed policy of fortification followed by questions about the respondent's preferences towards fortification. SETTING AND PARTICIPANTS A United Kingdom community sample of 76 people interviewed at home. MAIN VARIABLES STUDIED Direction of preference towards fortification, willingness to pay (WTP) for the preferred course of action, and the reasons behind their preferences. RESULTS Responses showed that 51 (67%) were in favour of fortification, 15 (20%) were opposed, while the remaining 10 (13%) were either indifferent or were unsure. Those in favour of fortification tended to be younger and poorer than those opposed to it. Willingness to pay estimates show that those in favour of food fortification had more intense preferences, with mean and median WTP around twice as great. Reasons for being willing to pay were centred on the health benefits, with particular reference being made to the intervention saving lives and it being preventative. Those opposed tended to believe that there was insufficient evidence. CONCLUSIONS The combination of a policy vote, WTP and qualitative data, allow us to assess the direction, intensity and motivations behind people's preferences. Further work needs to be undertaken to gather more robust estimates of public preferences for fortification, and to better understand attitudes towards public health interventions more generally.
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Affiliation(s)
- Simon Dixon
- University of Sheffield, School of Health and Related Research, Regent Court, Sheffield, UK.
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Birch S, Donaldson C. Valuing the benefits and costs of health care programmes: where's the 'extra' in extra-welfarism? Soc Sci Med 2003; 56:1121-33. [PMID: 12593883 DOI: 10.1016/s0277-9536(02)00101-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The application of Sen's notion of capabilities to problems of the allocation of resources to health in the form of an extra-welfarist framework underlies the justification of quality adjusted life years (QALYs) as the method for valuing the benefits of health care. In this paper we critically appraise this application from both conceptual and empirical perspectives. We show that the alleged limitations of the welfarist approach are essentially limitations in its application, not in the capacity of the approach to accommodate the concerns of extra-welfarists. Moreover, the arguments used to justify the application of the extra-welfarist framework are essentially welfarist. We demonstrate that the methods used to measure QALYs share their basic theoretical roots with welfarist valuation methods, such as willingness to pay (WTP). Although QALYs and WTP share many challenges, we argue that WTP provides a method which performs better with respect to those challenges. In the context of evaluating alternative allocations of health care resources we are left asking what is 'extra' in extra-welfarism?
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Affiliation(s)
- Stephen Birch
- Centre for Health Economics and Policy Analysis, Department Clinical Epidemiology and Biostatistics, 1200 Main Street West Hamilton, McMaster University, Hamilton, L8N 3Z5, Ontario, Canada.
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Shackley P, Donaldson C. Should we use willingness to pay to elicit community preferences for health care? New evidence from using a 'marginal' approach. JOURNAL OF HEALTH ECONOMICS 2002; 21:971-991. [PMID: 12475121 DOI: 10.1016/s0167-6296(02)00052-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We describe a willingness to pay (WTP) survey in which values were elicited from the public for three disparate health care programmes. Previous applications of WTP in this context have revealed a high proportion of preference reversals between WTP values and ordinal ranking of the programmes. In view of the doubts these findings raise over the use of WTP in this context, our aim was to develop a method of eliciting WTP values which we considered would improve consistency between respondents' explicit ranking of the programmes and their WTP values. Compared to the standard approach, the structure of the new design (the marginal approach) reduced the number of possible preference reversals, thus encouraging a degree of consistency among respondents. Despite this, the marginal approach did not result in fewer preference reversal being observed in actuality, thus casting doubt on the application of WTP in this context.
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Affiliation(s)
- Phil Shackley
- Sheffield Health Economics Group, School of Health and Related Research, University of Sheffield, UK.
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Oliver A, Healey A, Donaldson C. Choosing the method to match the perspective: economic assessment and its implications for health-services efficiency. Lancet 2002; 359:1771-4. [PMID: 12049884 DOI: 10.1016/s0140-6736(02)08664-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Adam Oliver
- LSE Health and Social Care, London School of Economics and Political Science, London WC2A 2AE, UK.
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Sairam K, Kulinskaya E, Hanbury D, Boustead G, McNicholas T. Oral sildenafil (Viagra) in male erectile dysfunction: use, efficacy and safety profile in an unselected cohort presenting to a British district general hospital. BMC Urol 2002; 2:4. [PMID: 12006106 PMCID: PMC111060 DOI: 10.1186/1471-2490-2-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2002] [Accepted: 04/18/2002] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Sildenafil (Viagra) is one of the drugs used in the first line therapy of male erectile dysfunction (MED). We have recorded outcomes, adverse events and acceptability of Sildenafil (Viagra) therapy in an unselected group of men presenting with ED to a British district general hospital. METHODS In this prospective observational study, 147 men with ED were seen since Oct 1999. Study patients were reviewed at 4, 12 and 52 weeks. All the patients filled the International Index of Erectile Function (IIEF) questionnaire and were asked about their willingness to pay (WTP) for treatment. RESULTS All suitable men accepted Viagra as first line therapy. 91% of our patients found sildenafil treatment successful. 80% of these patients were willing to continue with sildenafil therapy. Side effect profile of sildenafil was different in this study with much higher incidence of headache, dyspepsia, flushing and abnormal vision. 92% of men with ED expect to be treated by the NHS. Of those men eligible for treatment in the NHS, 30% qualify under the clinical categories and 18% under the 'distress' category. Only 55% of those with cardiovascular risk factors qualify for NHS treatment. CONCLUSIONS Sildenafil is widely accepted as first line therapy among British men with ED and has a success rate of 91%. Nearly half of men with ED qualify for NHS treatment. Nearly half of those with vascular risk factors do not qualify for NHS treatment. Most men with ED could possibly be managed in primary care.
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Affiliation(s)
| | - Elena Kulinskaya
- Reader in Medical Statistics, Health Reasearch & Development Support Unit (HRDSU) Faculty of Health & Human Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Damian Hanbury
- Department of Urology, Lister Hospital Coreys Mill Lane, Stevenage SG1 4AB, UK
| | - Gregory Boustead
- Department of Urology, Lister Hospital Coreys Mill Lane, Stevenage SG1 4AB, UK
| | - Thomas McNicholas
- Department of Urology, Lister Hospital Coreys Mill Lane, Stevenage SG1 4AB, UK
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