Comparison of four contingent valuation methods to estimate the economic value of a pneumococcal vaccine in Bangladesh

Do pregnant persons want influenza vaccines? Knowledge, attitudes, perceptions, and practices toward influenza vaccines in 8 low- and middle-income countries

BACKGROUND

While vaccination is the most effective way to prevent influenza infection and adverse outcomes, and despite WHO recommendations to vaccinate pregnant persons, access to seasonal influenza vaccines remains low. We explored knowledge, attitudes, and practices of pregnant persons about seasonal influenza vaccines to inform actions to improve vaccine uptake among this priority population.

METHODS

We pooled individual-level data from cross-sectional surveys assessing pregnant persons' attitudes toward seasonal influenza vaccines in eight low- and middle-income countries during 2018-2019. The eight countries used a standard protocol and questionnaire to measure attitudes and intents toward influenza vaccination. We stratified by country-level (presence/absence of a national influenza vaccination program, country income group, geographic region) and individual-level factors.

FINDINGS

Our analysis included 8,556 pregnant persons from eight low- and middle-income countries with and without seasonal influenza vaccination programs. Most pregnant persons (6,323, 74%) were willing to receive influenza vaccine if it was offered for free. Willingness differed by presence of an existing influenza vaccination program; acceptance was higher in countries without influenza vaccination programs (2,383, 89%) than in those with such programs (3,940, 67%, p < 0.001).

INTERPRETATION

Most pregnant persons in middle-income countries, regardless of influenza vaccination program status, were willing to be vaccinated against influenza if the vaccine was provided free of charge. National investments in influenza vaccination programs may be well-received by pregnant persons, leading to averted illness both in pregnant persons themselves and in their newborn babies.

FUNDING

US Centers for Disease Control and Prevention.

Willingness to pay for hepatitis B virus vaccine and associated factors among households in Bahir Dar City, northwest Ethiopia: using contingent valuation method

Background

The prevention of disease burden and death through vaccination is one of the most cost-effective methods. Even though the Hepatitis B Virus (HBV) has significant public health problems in Ethiopia, there is no compulsory HBV vaccination program for adults and the vaccine's market value was not yet estimated in the Ethiopia context. Therefore, this study aimed to assess the willingness to pay (WTP) for the HBV vaccine and its associated factors among households in Bahir Dar City, northwest Ethiopia.

Methods

A cross-sectional study was conducted among 620 households from March 1 to 30, 2020. A systematic random sampling technique was employed to select the required number of households. An interviewer-administered questionnaire was used to collect the necessary information. The contingent valuation method was conducted to measure WTP for the HBV vaccine. A Tobit regression model was employed to investigate significantly associated factors, and variables with a p-value of <0.05 were considered statistically significant.

Results

In this study, 62.17% of households were willing to pay for the HBV vaccine with an average cost of ETB174.24 (US$5.25). Male household heads (P = 0.014), favorable attitude (P = 0.017), and good knowledge (P < 0.001) toward the vaccine were positively associated with WTP, whereas age (P < 0.001), single marital status (P = 0.012) and divorced/widowed (P = 0.018) marital status were negatively associated with WTP.

Conclusions

Overall, most households were willing to pay for the HBV vaccine with an average demand of ETB174.24 (US$5.25). Therefore, a national-level HBV vaccine strategy should be designed considering the households' willingness to pay. In addition, working on attitudes and knowledge toward the vaccine could potentially increase the household's willingness to pay for the HBV vaccine.

Application of the double bounded dichotomous choice model to the estimation of parent's willingness to pay for the hand foot mouth disease vaccination: A survey in Selangor, Malaysia

Hand foot and mouth disease (HFMD) is a notifiable viral disease in Malaysia, and is transmitted primarily among young children. Although vaccines for enteroviruses 71 (EV-71) were approved in China against HFMD, the availability and the acceptance of the vaccine in the Malaysia are unknown. This study investigated and ascertained the determinants of willingness-to-pay (WTP) for HFMD vaccination in Selangor Malaysia. This study adopted a cross-sectional, contingent valuation method involving 390 parents of young children aged six and below. The double bounded dichotomous choice (DBDC) approach was employed to assess the WTP for HFMD vaccine among respondents. A bivariate probit model was used to assess the key determinants of WTP for HFMD vaccine, while the mean WTP was measured using the Krinsky and Robb procedure. We found that 279 (71.5%) of parents were willing to pay for the HFMD vaccination. The estimated single bounded mean WTP was MYR460.23 (equivalent to US$ 102.17) for two doses of HFMD vaccination. The double bounded analysis revealed that the vaccine's price, poor education background and lower income were the key factors that significantly affected the WTP, with the estimated mean WTP being MYR394.00 (US$ 87.47). In conclusion, most Malaysian parents are willing to pay for the HFMD vaccination. The estimated WTP identifies the optimal price point for HFMD vaccination in Malaysia. Furthermore, the government should focus on an awareness programme for the HFMD vaccination among parents who have lower income or education level.

A Roadmap for Increasing the Usefulness and Impact of Patient-Preference Studies in Decision Making in Health: A Good Practices Report of an ISPOR Task Force

Many qualitative and quantitative methods are readily available to study patient preferences in health. These methods are now being used to inform a wide variety of decisions, and there is a growing body of evidence showing studies of patient preferences can be used for decision making in a wide variety of contexts. This ISPOR Task Force report synthesizes current good practices for increasing the usefulness and impact of patient-preference studies in decision making. We provide the ISPOR Roadmap for Patient Preferences in Decision Making that invites patient-preference researchers to work with decision makers, patients and patient groups, and other stakeholders to ensure that studies are useful and impactful. The ISPOR Roadmap consists of 5 key elements: (1) context, (2) purpose, (3) population, (4) method, and (5) impact. In this report, we define these 5 elements and provide good practices on how patient-preference researchers and others can actively contribute to increasing the usefulness and impact of patient-preference studies in decision making. We also present a set of key questions that can support researchers and other stakeholders (eg, funders, reviewers, readers) to assess efforts that promote the ongoing impact (both intended and unintended) of a particular preference study and additional studies in the future.

Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania

Background

Globally, approximately 19.7 million children remain under-vaccinated; many more receive delayed vaccinations. Sustained progress towards global vaccination targets requires overcoming, or compensating for, incrementally greater barriers to vaccinating hard-to-reach and hard-to-vaccinate children. We prospectively assessed pregnant women's valuations of routine childhood vaccinations and preferences for alternative incentives to inform interventions aiming to increase vaccination coverage and timeliness in southern Tanzania.

Methods

Between August and December 2017, 406 women in their last trimester of pregnancy were enrolled from health facilities and communities in the Mtwara region of Tanzania and asked contingent valuation questions about their willingness to vaccinate their child if they were (a) given an incentive, or (b) facing a cost for each vaccination. Interval censored regressions assessed correlates of women's willingness to pay (WTP) for timely vaccinations. Participants were asked to rank monetary and non-monetary incentive options for the timely vaccination of their children.

Findings

All women expected to get their children vaccinated according to the recommended schedule, even without incentives. Nearly all women (393; 96.8 %) were willing to pay for vaccinations. The average WTP was Tanzania Shilling (Tsh) 3,066 (95 % confidence interval Tsh 2,523-3,610; 1 USD ∼ Tsh 2,200) for each vaccination. Women's valuations of timely vaccinations varied significantly with vaccine-related knowledge and attitudes, economic status, and rural vs urban residence. Women tended to prefer non-monetary over monetary incentives for the timely vaccination of their children.

Interpretation

Women placed a high value on timely childhood vaccinations, suggesting that unexpected system-level barriers rather than individual-level demand factors are likely to be the primary drivers of missed vaccinations. Systematic variation in the value of vaccinations across women reflects variation in perceived benefits and opportunity costs. In this setting, nonmonetary incentives and other interventions to increase demand and compensate for system-level barriers hold significant potential for improving vaccination coverage and timeliness.

ClinicalTrialsgov Protocol

NCT03252288.

Willingness to pay for HPV vaccine among female health care workers in a Chinese nationwide survey

Background

Payment methods for human papillomavirus (HPV) vaccine could substantially influence vaccination behavior. In China, HPV vaccination uptake remains currently low. This study aims to determine willingness to pay (WTP) for HPV vaccines among Chinese female health care workers under different payment scenarios.

Methods

This is a nationwide online survey recruiting female health care workers aged 18–45 years from 31 provinces throughout China. We collected the respondents’ vaccination status of HPV vaccines and their sociodemographics. Two WTPs were defined and estimated in the study. A general WTP for HPV vaccination was determined using the contingent valuation method with double dichotomous choice bidding. A WTP out-of-pocket was estimated for each HPV vaccine under two scenarios, including partial coverage by governmental subsidy or partial incorporation in basic medical insurance. Accordingly, a multivariable linear regression model was employed to determine the association between sociodemographis and general WTP. Then the maximum WTP out-of-pocket was compared among the respondents’ attitude shift towards HPV vaccination, payment scenarios, and levels of vaccine attributes, using non-parametric Kruskal-Wallis test.

Results

A total of 15,969 respondents were included in the study. The median general WTP was 2000 CNY (interquartile range, 1000–3200 CNY), positively associated with younger age, unmarried status, higher monthly income, fewer children, more positive vaccination behavior, working in tertiary hospital, higher local GDP and HDI (each P < 0.05). Moreover, the median WTP out-of-pocket was 1250 CNY (540–2000 CNY). It was significantly higher for vaccines partly covered by governmental subsidy (median, 1250 CNY; interquartile range, 560–2000 CNY), imported vaccines (1260 CNY; 630–1960 CNY), and 9-valent vaccines (1400 CNY; 750–2240 CNY) (each P < 0.001). Additionally, majority of respondents did not change their attitude towards HPV vaccination between two payment scenarios; those remaining with more expensive HPV vaccines (51.1%) had higher WTP out-of-pocket (1400 CNY; 560–2250 CNY) than those with cheaper vaccines (39.0%) (1120 CNY; 490–1960 CNY) (P < 0.001).

Conclusion

Chinese female health care workers have high WTP for HPV vaccines. A direct public funding for HPV vaccination is more preferable. Our findings may facilitate the adjustment of HPV vaccination strategy and payment mechanism in China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08716-6.

Scope Issue in Contingent Valuation Studies of the COVID-19 Vaccine: The Case of China

BACKGROUND

Assessing the public's willingness to pay (WTP) for the coronavirus disease 2019 (COVID-19) vaccine by the contingent valuation (CV) method can provide a relevant basis for government pricing. However, the scope issue of the CV method can seriously affect the validity and reliability of the estimation results.

AIM

To examine whether there are scope issues in respondents' WTP for the COVID-19 vaccine and to further verify the validity and reliability of the CV estimate results.

METHOD

In this study, nine different CV double-bounded dichotomous choices (DBDC) hypothetical COVID-19 vaccine scenarios were designed using an orthogonal experimental design based on the vaccine's attributes. A total of 2450 samples from 31 provinces in Mainland China were collected to independently estimate the public's WTP in these nine scenarios with logistic, normal, log-logistic and log-normal parameter models. Based on this estimation, several external scope tests were designed to verify the validity and reliability of the CV estimate results.

RESULTS

In the 20 pairs of COVID-19 vaccine scenarios, 6 pairs of scenarios were classified as negative scope issues, therefore not passing the external scope test. Of the remaining 14 pairs of scenarios, only four pairs of scenarios completely passed the external scope test, and one pair of scenarios partially passed the external scope test. Significant negative scope and scope insensitivity issues were revealed.

CONCLUSION

In the context of a dynamic pandemic environment, the findings of this study reveal that the CV method may face difficulty in effectively estimating respondents' WTP for the COVID-19 vaccine. We suggest that future studies be cautious in applying the CV method to estimate the public's WTP for the COVID-19 vaccine.

Determinants of vaccine uptake in HIV-affected families from West Bengal

Children living with Human Immunodeficiency virus (HIV; CLH) have special vaccine needs. Determinants of household-level uptake of vaccines need to be examined in high-risk families with CLH. We previously conducted a study on the impact of Haemophilus influenzae type b conjugate vaccine and pneumococcal conjugate vaccine (PCV-13) in 125 HIV-affected families and 47 HIV-unaffected families in West Bengal. We then interviewed 99 of these 172 families who had participated in the study to understand the household-level factors that determine vaccine uptake. Sixty-four of the 99 families had one or more CLH. Within these 64 families, 30% of CLH had missed vaccines under the universal immunization program (UIP), compared to only 6% of HIV-uninfected children (HUC) (p = .001). Maternal HIV positivity in a family increased risk of missing UIP vaccines nearly five times (4.82, p = .001). Almost all families accessed UIP vaccines at local primary vaccination centers, but 14% of families experienced stigma due to HIV and avoided getting one or more vaccine doses. In contrast, in our study, 100% of HIV-affected families actively sought PCV-13 and HibCV, despite having to travel. Factors that influenced uptake included awareness generation and activation by an outreach worker and availability of vaccines on pick-up days for anti-retroviral therapy. Eighty-six percent of families strongly recommended PCV-13 to other families. To conclude, while we found that CLH have barriers to getting vaccinations, a program designed to take into consideration the obstacles that HIV-affected families face showed a high rate of vaccine uptake.

Willingness to Pay for a Hypothetical COVID-19 Vaccine in the United States: A Contingent Valuation Approach

Our objective was to estimate the individual willingness to pay (WTP) for a COVID-19 vaccine and evaluate its predictors in the United States. A double-bounded dichotomous choice contingent valuation with open-ended question technique was implemented based on the responses to a national survey administered during the first week of November 2020. The final sample size was 1285. The results showed that individual WTP values increased with income, whether a household member had any pre-existing condition, and perceived threat of the virus. The vaccine efficacy rate and duration of protection were found to be important factors for the respondents. The mean WTP for a vaccine with a 95 percent efficacy rate and 3-year protection (US$318.76) was approximately 35 percent greater than the vaccine with a 50 percent efficacy rate and 1-year protection (US$236.85). The initial aggregate direct benefit of the current vaccination program was estimated to be between 20 and 35.6 billion US dollars depending on the vaccine protection duration.

House Prices in the Peripheries of Mass Rapid Transit Stations Using the Contingent Valuation Method

With the implementation of growth management planning in urban areas and the realization of sustainable development visions, transit-oriented development has become a form of mainstream urban development. Relevant studies have verified that the market prices of houses in the peripheries of public transit stations are higher than those of regular houses. However, when buying a house, people make price decisions on the basis of their levels of identification with the amenities and environmental qualities of residential locations. The question arises whether current housing price levels in the peripheries of public transit stations properly reflect or over-reflect this consideration. To clarify this, this study selected the peripheries of mass rapid transit (MRT) stations in the Taipei metropolitan area in Taiwan as the research area and designed a willingness-to-pay questionnaire for houses in the peripheries of MRT stations by using the contingent valuation method. Subsequently, a Tobit regression model was established to estimate the prices that people are willing to pay for such houses. The results revealed that after the respondents had considered the advantages and disadvantages of the amenities and environmental qualities of the peripheries of MRT stations, they were willing to pay higher prices for a house in those areas than for a regular house. For houses in the peripheries of elevated stations, the respondents were willing to pay approximately 7.89% more than the average market price of the entire administrative district per square meter. For houses in the peripheries of underground stations, the respondents were willing to pay approximately 5.9% more than the average market price of the entire administrative district per square meter. However, in the peripheries of both elevated and underground stations, the current market house prices are higher than the price levels the respondents were willing to pay. In the peripheries of elevated stations, the market house prices are 33.55% higher, and those in the peripheries of underground stations are 14.82% higher than what the respondents were willing to pay.

Incentive mechanism to promote corn stalk return sustainably in Henan, China

Corn stalk return (CSR) can manage agricultural residues on the spot to avoid field open burning and protect the environment. However, the implementation of this measure encounters reluctance from farmers which hinders its sustainability. This study combined the economic (cost) and technical (return amount, crushing quality, and decomposition of corn stalk) aspects to examine the factors affecting farmers' willingness to participate in the CSR by using a logistic regression model. The level of willingness to accept (WTA) compensation and its determinants were analyzed by using a tobit model. Based on the survey of 925 farmers, this study found the likelihood of farmers' participation in CSR will be decreased when CSR has high machinery cost, an excessive amount of stalk, poor quality of crushing, and slow decomposing rate. The farmers' WTA for CSR was estimated at about 711 Chinese Yuan (RMB) per ha annually, much higher than the current compensation level of 75-225 RMB per ha in Henan. Farmers were willing to be compensated more because of the high cost and slow decomposing rate. The issues in economic and technical sides should attract more attention, and the compensation should be increased and the technical problems should be solved to stimulate farmers' willingness of CSR. By providing a fuller understanding of farmers' CSR behavior, this study can serve as a reference for the Chinese government to develop and implement better policies.

Willingness to pay for oral cholera vaccines in urban Bangladesh

Introduction

Cholera is a highly infectious disease and remains a serious public health burden in Bangladesh. The objective of the study was to measure the private demand for oral cholera vaccines (OCV) in Bangladesh and to investigate the key determinants of this demand, reflected in the household’s willingness to pay (WTP) for oral cholera vaccine.

Methods

A contingent valuation method was employed in an urban setting of Bangladesh during December 2015 to January 2016. All respondents (N = 1051) received a description of World Health Organization (WHO) prequalified OCV, Shanchol^™. Interviews were conducted with either the head of households or their spouse or a major economic contributor of the households. Respondents were asked about how much at maximum they were willing to pay for OCV for their own and their household members’ protection. Results are presented as the average and median of the reported maximum WTP of the respondents with standard deviations and 95% confidence interval. Natural log-linear regression model was employed to examine the factors influencing participants’ WTP for OCV.

Results

About 99% of the respondents expressed WTP for OCV with a maximum mean and median WTP per vaccination (2 doses) of US$ 2.23 and US$ 1.92 respectively. On the household level with an average number of 4.62 members, the estimated mean WTP was US$ 10 (median: US$ 7.69) which represents the perceived demand for OCV of a household to vaccinate against cholera.

Conclusions

The demand of vaccination further indicates that there is a potential scope for recovering a certain portion of the expenditure of immunization program by introducing direct user fees for future cholera vaccination in Bangladesh. Findings from this study will be useful for the policy-makers to make decision on cost-recovery in future oral cholera vaccination programs in Bangladesh and in similar countries.

Smallholder farmers' knowledge and willingness to pay for insect-based feeds in Kenya

Edible insects are increasingly being considered as sustainable alternatives to fish and soybean meals in animal feed because of their high nutritional quality and environmental benefits. However, successful introduction of a new product to the market depends on the target user’s acceptance. Thus, evaluating the potential demand of insect-based feeds would provide relevant information for policy development. The present study assessed farmers’ knowledge on edible insects as feed, their acceptance of integrating insect meals in animal feeds and willingness to pay (WTP) for insect-based feed (IBF) using a contingent valuation method. A household survey was conducted among 957 randomly selected farmers including: 409 poultry, 241 fish and 307 pig farmers in four counties in Kenya. Results of the study reveal that over 70 and 80% of poultry and fish farmers, respectively, are aware that insects can be used as a feed ingredient. In addition, over 60 and 75% of poultry and fish farmers, respectively, consider insects as a good component of feed. Poultry, pig and fish farmers interviewed accepted and showed willingness to pay for IBF. Regression analysis indicated that age, gender, education, marital status, distance to feed trader, awareness of insects as feed, attitude towards insects, acceptance of insect species, availability of agricultural inputs, use of commercial feeds, availability of training and market information had a significant influence on the WTP for IBF. Therefore, increased extension services to educate famers on the nutritional benefits of insect meals in animal feeds and existing market opportunities are expected to improve farmers’ attitude towards utilization and consequently enhance WTP for IBF, which in return would significantly reduce the existing pressure on conventional fishmeal feed resources. Our findings provide the first insights into the market opportunities of including insect meals in the animal feed value chain in Kenya.

Assessing societal and offender perspectives on the value of offender healthcare: a stated preference research protocol

INTRODUCTION

The increasing burden that offenders place on justice and health budgets necessitates better methods to determine the benefits of and value society places on offender programmes to guide policy regarding resource allocation. The aim of this paper is to demonstrate how economic methods will be used to determine the strength of preferences and value of violent offender treatment programmes from the perspectives of offenders, their families and the general population.

METHODS AND ANALYSIS

Two stated preference economic methods, discrete choice experiment (DCE) and contingent valuation (CV), will be used to assess society's and offenders' value of treatment programmes. The mixed methods process involves a literature review and qualitative methods to derive attributes and levels for the DCE and payment card values for the CV. Consensus building approaches of voting, ranking and the Delphi method will be used to further refine the findings from the qualitative phase. Attributes and their levels will be used in a D-efficient Bayesian experimental design to derive choice scenarios for the development of a questionnaire that will also include CV questions. Finally, quantitative surveys to assess societal preferences and value in terms of willingness to pay will be conducted.

ETHICS AND DISSEMINATION

Ethics approval for this study was obtained from the University of New South Wales (UNSW) Human Research Ethics Committee, Corrective Services New South Wales Ethics Committee and the Aboriginal Health and Medical Research Council ethics committee. The findings will be made available on the Kirby Institute UNSW website, published in peer-reviewed journals and presented at national and international conferences.

Older Adults' Preferences for Discussing Long-Term Life Expectancy: Results From a National Survey

PURPOSE

Clinical practice guidelines recommend incorporating long-term life expectancy to inform a number of decisions in primary care. We aimed to examine older adults' preferences for discussing life expectancy in a national sample.

METHODS

We invited 1,272 older adults (aged 65 or older) from a national, probability-based online panel to participate in 2016. We presented a hypothetical patient with limited life expectancy who was not imminently dying. We asked participants if they were that patient, whether they would like to talk with the doctor about how long they may live, whether it was acceptable for the doctor to offer this discussion, whether they want the doctor to discuss life expectancy with family or friends, and when it should be discussed.

RESULTS

The 878 participants (69.0% participation rate) had a mean age of 73.4 years. The majority, 59.4%, did not want to discuss how long they might live in the presented scenario. Within this group, 59.9% also did not think that the doctor should offer the discussion, and 87.7% also did not want the doctor to discuss life expectancy with family or friends. Fully 55.8% wanted to discuss life expectancy only if it were less than 2 years. Factors positively associated with wanting to have the discussion included higher educational level, believing that doctors can accurately predict life expectancy, and past experience with either a life-threatening illness or having discussed life expectancy of a loved one. Reporting that religion is important was negatively associated.

CONCLUSIONS

The majority of older adults did not wish to discuss life expectancy when we depicted a hypothetical patient with limited life expectancy. Many also did not want to be offered discussion, raising a dilemma for how clinicians may identify patients' preferences regarding this sensitive topic.

Valuing a Lifestyle Intervention for Middle Eastern Immigrants at Risk of Diabetes

Willingness-to-pay (WTP) techniques are increasingly being used in the healthcare sector for assessing the value of interventions. The objective of this study was to estimate WTP and its predictors in a randomized controlled trial of a lifestyle intervention exclusively targeting Middle Eastern immigrants living in Malmö, Sweden, who are at high risk of type 2 diabetes. We used the contingent valuation method to evaluate WTP. The questionnaire was designed following the payment-scale approach, and administered at the end of the trial, giving an ex-post perspective. We performed logistic regression and linear regression techniques to identify the factors associated with zero WTP value and positive WTP values. The intervention group had significantly higher average WTP than the control group (216 SEK vs. 127 SEK; p = 0.035; 1 U.S.$ = 8.52 SEK, 2015 price year) per month. The regression models demonstrated that being in the intervention group, acculturation, and self-employment were significant factors associated with positive WTP values. Male participants and lower-educated participants had a significantly higher likelihood of zero WTP. In this era of increased migration, our findings can help policy makers to take informed decisions to implement lifestyle interventions for immigrant populations.

Comparing the validity of the payment card and structured haggling willingness to pay methods: The case of a diabetes prevention program in rural Kenya

BACKGROUND

The objective of this study was to compare the theoretical validity of two willingness-to-pay (WTP) methods, the commonly used payment card (PC) and the recently developed structured haggling (SH), for estimating the potential benefits of a diabetes prevention program in rural Kenya.

METHODS

A convenience sample of adult residents from a rural county in Kenya (Kiambu), with no history of diabetes, was randomly assigned to one of two WTP methods, PC or SH, using structured face-to-face interviews from December 2011 to February 2012.

RESULTS

A total of 376 respondents completed the interviews using PC (n = 185) or SH (n = 191). More than 95% of respondents were willing to pay something for program access. The study showed that both methods were feasible in rural Kenya. SH resulted in a higher annual mean WTP than PC, Ksh504.05 (US$7.25) versus Ksh619.95 (US$5.90), respectively (p < 0.01). Based on theory, it was hypothesized that certain predisposing factors would result in greater WTP. Greater socio-economic status (measured using income proxies) resulted in greater unconditional WTP for both the PC and SH groups (t-tests and bivariate correlations) and conditional WTP (GLM models). GLM for PC showed being male, employed and having distant relatives with diabetes were significant predictors for WTP, while for SH being educated, employed and owning a vehicle were significant predictors.

CONCLUSION

Both PC and SH showed theoretical validity in rural Kenya. However, the use of SH over PC in rural Kenya may be the better choice given that SH more closely mirrors marketplace transactions in this setting and the use of SH resulted in more significant variables in the GLM models.

Implementing the Contingent Valuation Method for supporting decision making in the waste management sector

This study presents an application of the Contingent Valuation Method (CVM) for valuing the environmental impacts associated with the operation of landfills for residues following waste treatment and depicts how the results of the analysis can be used for decision making in the field of waste management. The survey was conducted in Ikaria, Greece, a medium-sized island in the northern Aegean Sea, with a view to estimate the amount of compensatory benefits that are socially acceptable to be attributed to the hosting community of a new landfill for residues. The results showed that the mean willingness to pay per household to create a fund for financing social and environmental programs in the community that will host the landfill in question was estimated at €6.5-6.7 per 2-month and household taking into account all households of the sample. This estimate is at the same order of magnitude but at the lower band compared to the results of other relevant studies showing that the public in Ikaria is aware for the relatively limited environmental burdens associated with the operation of landfills for residues following an integrated waste management treatment.

Consumer willingness to invest money and time for benefits of lifestyle behaviour change: an application of the contingent valuation method

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.

Cost-effectiveness and economic benefits of vaccines in low- and middle-income countries: a systematic review

BACKGROUND

Public health interventions that prevent mortality and morbidity have greatly increased over the past decade. Immunization is one of these preventive interventions, with a potential to bring economic benefits beyond just health benefits. While vaccines are considered to be a cost-effective public health intervention, implementation has become increasingly challenging. As vaccine costs rise and competing priorities increase, economic evidence is likely to play an increasingly important role in vaccination decisions.

METHODS

To assist policy decisions today and potential investments in the future, we provide a systematic review of the literature on the cost-effectiveness and economic benefits of vaccines in low- and middle-income countries from 2000 to 2010. The review identified 108 relevant articles from 51 countries spanning 23 vaccines from three major electronic databases (Pubmed, Embase and Econlit).

RESULTS

Among the 44 articles that reported costs per disability-adjusted life year (DALY) averted, vaccines cost less than or equal to $100 per DALY averted in 23 articles (52%). Vaccines cost less than $500 per DALY averted in 34 articles (77%), and less than $1000 per DALY averted in 38 articles (86%) in one of the scenarios. 24 articles (22%) examined broad level economic benefits of vaccines such as greater future wage-earning capacity and cost savings from averting disease outbreaks. 60 articles (56%) gathered data from a primary source. There were little data on long-term and societal economic benefits such as morbidity-related productivity gains, averting catastrophic health expenditures, growth in gross domestic product (GDP), and economic implications of demographic changes resulting from vaccination.

CONCLUSIONS

This review documents the available evidence and shows that vaccination in low- and middle-income countries brings important economic benefits. The cost-effectiveness studies reviewed suggest to policy makers that vaccines are an efficient investment. This review further highlights key gaps in the available literature that would benefit from additional research, especially in the area of evaluating the broader economic benefits of vaccination in the developing world.

Assessing households' willingness to pay for an immediate pandemic influenza vaccination programme

AIMS

This study sought to contribute to the existing literature on pandemic influenza vaccination studies by providing additional evidences of households' willingness to pay (WTP) for protection against influenza during a pandemic situation from North America.

METHODS

A standard dichotomous-choice contingent valuation survey was designed and completed in a sample of 306 individuals living in the Greater Toronto Area, Ontario, Canada.

RESULTS

This study shows that, on average, households are willing to pay $417.35 for immediate pandemic influenza (H1N1) vaccination. Results show that the vaccine price, age, gender, occupation, organisation, annual family income, receiving annual flu shot, having additional insurance, having someone with a serious illness in the house, knowledge about pandemics, trusting official information on pandemics, supporting government expenditure, and rating government pandemic planning have significant effects on the decision to accept the vaccine bids.

CONCLUSIONS

The results reconfirm the findings of similar studies that influenza vaccine programmes are highly cost-effective despite the high programme cost, because people's WTP (benefits) for this programme is much higher than the actual costs. Pandemic influenza vaccination programmes should consider the demographic and economic status of the target population as such characteristics have significant impacts on the benefits that people place on such programmes.

Risk perception and priority setting for intervention among hepatitis C virus and environmental risks: a cross-sectional survey in the Cairo community

Background

Hepatitis C virus (HCV) recently emerged as a major public health hazard in Egypt. However, dramatic healthcare budget constraints limit access to the costly treatment. We assessed risk perception and priority setting for intervention among HCV, unsafe water, and outdoor air pollution in Cairo city.

Methods

A survey was conducted in the homes of a representative sample of household heads in Cairo city. Risk perception was assessed using the "psychometric paradigm" where health hazards are evaluated according to several attributes and then summarized by principal component analysis. Priority setting was assessed by individual ranking of interventions reducing health hazards by 50% over five years. The Condorcet method was used to aggregate individual rankings of the three interventions (main study) or two of three interventions (validation study). Explanatory factors of priority setting were explored in multivariate generalized logistic models.

Results

HCV was perceived as having the most severe consequences in terms of illness and out-of-pocket costs, while outdoor air pollution was perceived as the most uncontrollable risk. In the main study (n = 2,603), improved water supply received higher priority than both improved outdoor air quality (60.1%, P < .0001) and screening and treatment of chronic hepatitis C (66.3%, P < .0001), as confirmed in the validation study (n = 1,019). Higher education, report of HCV-related diseases in the household, and perception of HCV as the most severe risk were significantly associated to setting HCV treatment as the first priority.

Conclusions

The Cairo community prefers to further improving water supply as compared to improved outdoor air quality and screening and treatment of chronic hepatitis C.

The effect of protest zeros on estimates of willingness to pay in healthcare contingent valuation analysis

'Protest zeros' occur when respondents reject some aspect of the contingent valuation (CV) market scenario by reporting a zero value even though they place a positive value on the amenity being valued. This is inevitable even in the best-designed CV study, and, when excluded on an ad hoc basis, may cause a selection bias problem. This could affect the reliability of the willingness to pay (WTP) estimates obtained for preference assessment. Treatment of 'protest zeros' in general, and particularly in the context of developing countries, has been rather unsatisfactory. Most case studies employ the Heckman 2-step approach, which is much less robust to co-linearity problems than the Full Information Maximum Likelihood (FIML) estimator. The main objective of this article is to illustrate a sequential procedure to simultaneously deal with co-linearity and selectivity bias resulting from excluding 'protest zeros' in CV analysis. The sequential procedure involves different levels of estimation and diagnostics with the 2-step and FIML estimators; the duration of the procedure depends on the diagnostic test results at each stage of the estimations. The data used for the analysis were elicited using the conventional dichotomous choice buttressed with an open-ended follow-up question. The survey was designed to elicit households' WTP for a proposed community-based malaria control scheme in rural Cameroon. In the application context, we found that the different levels of estimation and diagnostics resulted in reliable WTP estimates from the FIML approach, which would obviously have been overlooked in the absence of such diagnostics.

Willingness to pay for zinc treatment of childhood diarrhoea in a rural population of Bangladesh

INTRODUCTION

Young children in the developing world continue to experience a median of between two and four episodes of diarrhoea each year. To better understand adherence to the WHO/UNICEF-recommended diarrhoea management guidelines, which now include zinc, this study aimed to determine how much caregivers were willing to pay for zinc treatment and to explore the characteristics of actual users of zinc in a rural community of Bangladesh.

METHODS

Initially we conducted a contingent valuation survey among primary caregivers of children aged 6-36 months. We assessed their willingness-to-pay (WTP) for 10 days of zinc treatment per diarrhoea episode at Tk.15 (US$0.26) and at Tk.20 (US$0.34), followed by an open question on the highest WTP amount. Next we conducted a cross-sectional survey in the same area to identify households with children who had received zinc during their most recent diarrhoea episode within the previous 3 months.

RESULTS

Field workers interviewed 111 primary caregivers to explore WTP for zinc in childhood diarrhoea. Of these, 92% were willing to pay US$0.26 and 85% of these positive respondents were also willing to pay US$0.34. The mean WTP was US$0.50. We found that higher socio-economic status, better educated fathers and lower mother's age positively influenced the expressed WTP. Actual users, the 51 households whose child received zinc in their most recent diarrhoea episode, were more likely to have educated parents, higher socio-economic status and to have sought care from qualified providers for diarrhoeal illness.

CONCLUSION

The expressed WTP results indicate a high demand for zinc in childhood diarrhoea management in this rural community of Bangladesh. Safety net measures and targeted communication activities specifically aimed at the poor and less educated population could be beneficial to achieve more equitable use of zinc as part of the standard treatment with oral rehydration solution in childhood diarrhoea management.

Perception of the economic value of primary care services: a Willingness to Pay study

OBJECTIVE

Identify the economic value the user attributes to the visit to the family physician, in a setting of a National Health System, by the Willingness to Pay (WTP) expressed.

METHODS

Economic evaluation study, by the contingent valuation method. Questions were asked about WTP using a payment card format. Interviews were conducted with 451 subjects, in areas with different socioeconomic characteristics. An ordered probit was used to evaluate model's validity.

RESULTS

Median WTP expressed was euro18 (interquartile range euro8-28), not including "zero-answers" of thirty-four subjects (7.5%). This value represents 2% of average adjusted family incomes. Patients with higher incomes or with chronic illnesses presented a probability of 5-14 percentage points of expressing a high WTP. For every point of increase of patient satisfaction, the probability of presenting a WTP in the lowest range decreases 7.0 percentage points. Subjects with a low education level and those older than 65 expressed a lower WTP. Accessibility, risk perception, nationality and having private insurance were not related to the WTP expressed.

CONCLUSIONS

Users of primary care have a clear perception of the economic value of care received from the family physician, even in a framework of providing services financed by taxes and without cost at the moment of use. This value increases in subjects with higher incomes, with greater need for care, or more satisfied.