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

Awareness of non-communicable diseases in women: a cross-sectional study

Chronic non-communicable diseases (NCD) are the major reason for death, morbidity, loss of independency and public health cost. NCD prevalence could be significantly reduced by adopting a healthy lifestyle. This cross-sectional cohort study (online survey) in 221 women aimed to assess NCD awareness, knowledge about NCD prevention and willingness to adopt a healthier lifestyle in women. Overall, NCD awareness level was quite high with, however, information mainly originating from lay media, probably being one reason for false estimations of age groups mainly affected by NCD, impact of NCD on quality of life, NCD mortalities, and the extent of NCD prevention by lifestyle interventions, respectively. Furthermore, also due to mainly lay media, half of women knew online NCD risk calculators, most of them would like to know their NCD risk, but only few had been offered NCD risk calculation by their physician. The mean threshold for willing to adopt a healthier lifestyle was a roughly calculated 37% 5-10 years risk to develop a certain NCD. Acceptance of non-pharmacological interventions for NCD prevention was high, however, major barriers for not implementing a healthier lifestyle were lack of expert information and lack of time. In conclusion, future public health strategies should focus on distributing better understandable and correct information about NCD as well as meeting the individuals' request for personalized NCD risk calculation. Furthermore, physicians should be better trained for personalized NCD prevention counseling.

Examining Willingness-to-Pay and Zero Valuations for a Health Improvement with Logistic Regression

Study aim was to elicit the Greek general population’s willingness-to-pay (WTP) for a health improvement (recovery to perfect health), examine attitudinal differences between willing- and unwilling-to-pay individuals regarding healthcare services provision, and investigate —using a logistic regression model—demographic/socioeconomic factors impact on their intention to pay for a health improvement. A research tool was developed to conduct a cross-sectional stated-preference telephone-based survey (January-February 2019) and a representative sample (n = 1342) of the Greek general population was queried. The computer-assisted telephone-interview (CATI) method was used to ensure random sampling. WTP was elicited using the iterative bidding technique. Participants’ attitudes toward healthcare services provision were assessed through pre-defined statements. Test-retest reliability of these statements was assessed using intraclass correlation coefficients (ICC). Logistic regression was employed to identify sociodemographic factors’ effect on WTP intention. Differences among individuals’ attitudes were assessed using the chi-square test. All analyses were conducted using the IBM SPSS Software v.25.0. Analysis showed acceptable reliability for WTP estimates (ICC = .67) and good reliability for healthcare services assessment statements (ICC = .83-.94). Mean WTP was estimated at €439.8. Respondents with higher educational level and higher household income were more likely to be willing to pay for a health improvement. On the contrary, older participants were less likely to be willing to pay. Most participants who considered public healthcare services to be of high quality were unwilling to pay. Logistic regression analysis led to the development of an effective predictive model regarding factors affecting individuals’ WTP intention for a health improvement. Further classification of unwilling-to-pay individuals into protest responders and “true” zero valuators showed that protest responders are unlikely to be representative of the population. Hence, study results can be used for debiasing WTP responses, leading to a more accurate use of WTP estimates by policy makers, exploiting WTP values in medical interventions cost-benefit analysis within reimbursement decisions framework.

A Contingent Valuation Study for Eliciting a Monetary Value of a Quality-Adjusted Life-Year in the General Greek Population

OBJECTIVES

To elicit a willingness-to-pay (WTP) per quality-adjusted life-year (QALY) estimate for the general Greek population and assess the impact of individuals' socio-demographic characteristics and motives on this estimate.

METHODS

A telephone-based survey was carried out employing a representative sample of the general Greek population (n = 1342). A computer-assisted telephone-interview method was adopted to ensure random sampling. A total of 528 participants reported a WTP value for a utility improvement from their current health to perfect health. Those individuals' motives were assessed through predefined statements. Test-retest reliability was assessed using intraclass correlation coefficient (ICC). Multiple linear regression (MLR) and one-way analysis of variance (ANOVA) tests were conducted to assess the effect of socioeconomic/demographic determinants and motive statements, respectively, on WTP/QALY. MLR was re-estimated considering as dependent variable the WTP/QALY estimate calculated for participants: (1) stating a WTP value ≤ their household income and (2) presenting higher certainty regarding stated WTP value (sensitivity analysis).

RESULTS

Analysis revealed good reliability for WTP/QALY estimates and motive statements (ICC values > 0.8). Mean WTP/QALY was €26 280. The respective 5% trimmed value was €14 862. Being a student and household income affected WTP/QALY. Sensitivity analysis did not produce markedly different WTP/QALY predictors, implying the robustness of results, irrespective of the participant group considered. Individuals who indicated the inability to cover basic family needs or pay tax claims as motives reported lower WTP/QALY values compared with those not viewing these aspects as motives.

CONCLUSIONS

Findings confirm that the World Health Organization's criterion used currently in Greek cost-effectiveness studies is not unreasonable. Additional research is essential to further explore WTP/QALY estimates in the Greek setting and facilitate informed decision making.