Economic Burden of Gaucher Disease at a Tertiary Care Public Hospital in Mumbai

OBJECTIVES

To estimate the economic burden of patients diagnosed with Gaucher disease at a public hospital from a societal perspective.

METHODS

Data from 30 Gaucher patients visiting the Genetic Clinic of the Department of Pediatrics at the study site in Mumbai was analyzed between January 2019 and January 2021. A cost of illness analysis was undertaken to estimate direct, indirect and intangible costs. Costs in treated and treatment naive groups were compared.

RESULTS

The total cost (direct and indirect) for 30 patients was ₹25,45,74,743/- (3440199.2 USD). Majority of this cost (99.8%) was due to direct costs of which medications [Enzyme replacement therapy (ERT) and Substrate reduction therapy (SRT)] constituted 98.8%. The notional cost was ₹1,43,94,695. Total costs of 14 treated patients were ₹25,29,67,279 and 16 treatment naive patients were ₹16,15,064 with a ratio of 157:1. Direct costs and cost of school absenteeism were significantly higher in the treated subgroup. Overall, direct, total costs and costs of school absenteeism were significantly associated with age and disease duration.

CONCLUSIONS

The economic burden of Gaucher disease is a staggering amount. This is an underestimate, as the expenses are highly subsidized in a public health facility. The highest contributor to cost component was direct costs, especially medication costs. Against the backdrop of the National Policy for Rare Diseases, resource allocation towards Gaucher disease should consider short term measures for judicious funding or reimbursement of disease-specific therapy and long-term cost-effective measures for promoting preventive strategies as the most practically feasible solution to reduce this economic burden.

Neural correlates of willingness to pay for items: A meta-analysis of functional magnetic resonance imaging studies

Willingness to pay (WTP) pervades every marketplace transaction, therefore, understanding how the brain makes bidding decisions is essential in consumer neuroscience. Although some neuroimaging studies have investigated the neural networks of WTP, systematic understanding remains limited. This study identified reliable neural networks activated by the WTP across different reward types and assessed common and distinct neural networks for different reward types (food and other) bids. We conducted an activation likelihood estimation (ALE) meta-analysis on WTP across different reward types (25 studies; 254 foci; 705 participants), and to compared neural representations of WTP for food reward (22 studies; 232 foci; 628 participants) and other rewards (7 studies, 61 foci; 177 participants). The ALE results revealed that the brain centers of WTP for different rewards mainly consist of the bilateral inferior frontal gyrus (IFG), bilateral insula, bilateral anterior cingulate cortex (ACC), along with the left caudate. This suggests that neural networks encoding WTP for different rewards consist of brain regions associated with reward processing, cost-benefit calculations, and goal-directed action activities. In addition, consistent activation of the bilateral IFG and bilateral insula for food but no other rewards bids suggest their involvement in the neural network of appetite. WTP for food and other rewards commonly activated ACC, suggesting a common region encoding bids for different rewards. Our findings provide novel insights into neural networks associated with WTP for food and other rewards bids and the mechanisms underlying WTP across different reward types.

Parental willingness to accept and pay human papillomavirus vaccine for boys aged 9-14 in a metropolis area of China: Evidence for developing a vaccination strategy

BACKGROUND

Increasing countries are expanding the human papillomavirus (HPV) vaccination to men, which has not yet been licensed in China. This study investigated the parental willingness to accept (WTA) and pay (WTP) HPV vaccine for their sons aged 9-14.

METHODS

In Shanghai, a metropolis area of China, parents with boys aged 9-14 were recruited to complete an online questionnaire using a convenience sampling strategy. Parental WTA were determined for parents themselves and for their sons. Parental preference of HPV vaccine was measured using discrete choice experiment in two assumed government subsidy scenarios that referred to HPV vaccination subsidy mechanisms for girls in China. Additionally, parental WTP was estimated using contingent valuation method.

RESULTS

A total of 2493 parents with boys aged 9-14 were included in the study. Majority of mothers (88.99 % and 90.99 %) and fathers (79.57 % and 85.04 %) showed WTA HPV vaccine for themselves and sons, respectively. Parental gender, age, monthly household income, knowledge, and awareness were positively associated with parental WTA for their sons (each P < 0.05). Remarkably, more mothers showed specific preference of HPV vaccine for themselves (53.67 %) and sons (47.78 %), while more fathers showed no preference for themselves (46.76 %) and sons (53.81 %). In the two assumed government subsidy scenarios, parents mostly preferred domestic HPV vaccines for themselves and sons (each P < 0.05). Additionally, mothers had significantly higher WTP for sons (mean value, 2122.75 CNY) than fathers did (1695.40 CNY) (P < 0.001). However, parental WTP was similar between for themselves and for sons, regardless of mothers and fathers (each P > 0.05).

CONCLUSION

Parents have high WTA and WTP HPV vaccine for boys aged 9-14 in Shanghai, which may provide evidence for preparing HPV vaccination strategy. Acceptance of HPV vaccines and roll-out in boys could be enhanced through the availability of government subsidy mechanism and domestic HPV vaccines.

Would manufacturing go for renewable energy? Manufacturers' preference towards sustainability

Malaysia needs to fully utilize its renewable energy resources to meet its goal of installed capacity of 31% of renewable energy in 2025 and 40% in 2035. In order to empower renewable energy sources, the government has established a fund known as the renewable energy fund (RE FUND). In Malaysia, most manufacturing sectors contribute to the RE FUND through their monthly electricity bills due to their electricity consumption exceeding 300kwh per month. As Malaysia's highest electricity consumer, the manufacturing sector needs government investment incentives to switch to renewable energy sources to generate electricity. Therefore, this study was conducted to identify attribute preferences of the manufacturing sector due to investing in renewable energy sources. The Choice Experiment method was employed where the Mixed Logit model was chosen to identify the willingness to pay for the manufacturing sectors based on their preferences among the four attributes: types of renewable energy, project location, annual reduction in GHG emissions, and RE FUND. The study results found that the manufacturing sector places the highest value on the project location, where they prefer to improve the project location from current condition to far location. This study can also help to achieve the Goal 7 in the Sustainable Development Goal (SDG), where investment in renewable energy sources can guarantee that all individuals obtain affordable, reliable, sustainable, and modern electricity in 2030.

Robot-assisted surgery and artificial intelligence-based tumour diagnostics: social preferences with a representative cross-sectional survey

BACKGROUND

The aim of this study was to assess social preferences for two different advanced digital health technologies and investigate the contextual dependency of the preferences.

METHODS

A cross-sectional online survey was performed among the general population of Hungary aged 40 years and over. Participants were asked to imagine that they needed a total hip replacement surgery and to indicate whether they would prefer a traditional or a robot-assisted (RA) hip surgery. To better understand preferences for the chosen method, the willingness to pay (WTP) method was used. The same assessment was conducted for preferences between a radiologist's and AI-based image analysis in establishing the radiological diagnosis of a suspected tumour. Respondents' electronic health literacy was assessed with the eHEALS questionnaire. Descriptive methods were used to assess sample characteristics and differences between subgroups. Associations were investigated with correlation analysis and multiple linear regressions.

RESULTS

Altogether, 1400 individuals (53.7% female) with a mean age of 58.3 (SD = 11.1) years filled in the survey. RA hip surgery was chosen by 762 (54.4%) respondents, but only 470 (33.6%) chose AI-based medical image evaluation. Those who opted for the digital technology had significantly higher educational levels and electronic health literacy (eHEALS). The majority of respondents were willing to pay to secure their preferred surgical (surgeon 67.2%, robot-assisted: 68.8%) and image assessment (radiologist: 70.9%; AI: 77.4%) methods, reporting similar average amounts in the first (p = 0.677), and a significantly higher average amount for radiologist vs. AI in the second task (p = 0.001). The regression showed a significant association between WTP and income, and in the hip surgery task, it also revealed an association with the type of intervention chosen.

CONCLUSIONS

Individuals with higher education levels seem to accept the advanced digital medical technologies more. However, the greater openness for RA surgery than for AI image assessment highlights that social preferences may depend considerably on the medical situation and the type of advanced digital technology. WTP results suggest rather firm preferences in the great majority of the cases. Determinants of preferences and real-world choices of affected patients should be further investigated in future studies.

How negative factors influence youth hostel stay aftermath COVID-19 pandemic

The bookings and revenues of youth hostels have significantly decreased because of the multiple effects of the COVID-19 pandemic. It is necessary to investigate young consumers' perceptions of visiting youth hostels aftermath this pandemic. The current study examines the relationship between multi-dimensions of perceived risk, three types of images, willingness to pay and visit intention. A convenience sampling was developed where 534 questionnaires were received, followed by subsequent empirical testing of the proposed hypotheses using SPSS and AMOS-SEM. Results showed that perceived risk negatively influenced cognitive and affective image, respectively. Cognitive and affective image positively influenced overall image and finally influenced willingness to pay and visit intention separately. In addition, cognitive image positively influenced affective image. The theoretical framework satisfactorily accounted for willingness to pay and intention, and our results help youth hostels practitioners invent efficient strategies to boost young consumers' willingness to pay and intention to visit youth hostels.

A cost-benefit analysis of genetic screening test for breast cancer in Iran

BACKGROUND

This study aimed to evaluate the implementation of the population- and family history (FH) -based screening for BReast CAncer (BRCA) in Iran, a country where less than 10% of breast cancer cases are attributable to a gene mutation.

METHODS

This was an economic evaluation study. The Benefit-Cost Ratio (BCR) for genetic screening test strategies in Iranian women older than 30 was calculated. To this end, the monetary value of the test was estimated using the willingness-to-pay (WTP) approach using the contingent valuation method (CVM) by payment card. From a healthcare perspective, direct medical and non-medical costs were considered and a decision model for the strategies was developed to simulate the costs. A one-way sensitivity analysis assessed the robustness of the analysis. The data were analyzed using Excel 2010.

RESULTS

660 women were included for estimating WTP and 2,176,919 women were considered in the costing model. The cost per genetic screening test for population- and FH-based strategies was $167 and $8, respectively. The monetary value of a genetic screening test was $20 and it was $27 for women with a family history or gene mutation in breast cancer. The BCR for population-based and FH-based screening strategies was 0.12 and 3.37, respectively. Sensitivity analyses confirmed the robustness of the results.

CONCLUSIONS

This study recommends the implementation of a FH-based strategy instead of a population-based genetic screening strategy in Iran, although a cascade genetic screening test strategy should be evaluated in future studies.

Community perception to pay for conservation of Barekese and Owabi watersheds in Ghana

There is growing concern globally to conserve natural systems including watersheds due to increasing forest degradation and deforestation. The Barekese and Owabi watersheds provide several ecosystem services to communities, health facilities and industries. The watersheds are found in a rapidly degrading environment due to increasing anthropogenic activities. This paper addressed the neglected, but critical, question of the importance of watershed ecosystem services. The objective of the study was to determine willingness of households in downstream communities to pay for watershed conservation and the drivers of WTP. Households were willing to pay a mean of $1.5 ± 0.2 additional on their monthly water bills. Quotations for Willingness to pay varied from as low as $0.02 to as high as $ 20.58 per month. Age, household size and years of residence were significantly related with willingness to pay, amount to pay and reasons for protest bids. The younger generations and women were ready to pay extra amount for watershed management. The results indicated that downstream communities are willing to support conservation and that demographic factors influence the amount people are willing to pay. The concept of WTP is useful and applicable to conservation of watersheds in the tropics through the design and implementation of PES schemes. It also provides important information for conservation and development policies related to watershed management in developing countries.

Awareness increases acceptance and willingness to pay for low-carbon fuels amongst marine passengers

One of the main applications discussed in decarbonising the marine sector is via alternative fuels, such as methanol and ammonia, produced from renewable hydrogen. These alternative, low-carbon fuels often come with increased prices and operational expenses for the vessel operators, which are ultimately reflected in the passengers' costs. Therefore, it is important to assess passengers' familiarity with expressions linked to decarbonisation and their willingness to pay this 'green premium' for alternative fuels. To assess these, we ran a survey-based study and collected close to 2000 answers through different channels from marine passengers, specifically from those travelling in the Northern European region on roll-on/roll-off passenger (RoPax) vessels. We found that most of the passengers prioritise environmental friendliness in marine fuels and are concerned about environmental issues. However, there seems to be a lack of knowledge about fuels and fuel technologies. Familiarity with certain alternative fuel-related expressions results in a more positive view of them. The observed willingness to pay is affected by the level of education, income, and place of residence, in addition to the level of concern about environmental issues, frequency of travel and spending on trips. Close to 80% of passengers are willing to increase their spending if the vessel is powered by a low-carbon, alternative fuel. As the results indicate that the more passengers know about alternative fuels and their benefits, the more willing they are to pay for them, it is recommended that RoPax operators invest in educating them.

Sex differences in the relationship between post-vaccination adverse reactions, decision regret, and WTP for the booster dose of COVID-19 vaccine in Taizhou, China

This study investigated sex differences in the relationship between post-vaccination adverse reactions, decision regret, and willingness to pay (WTP) for the booster dose of COVID-19 vaccines. This research carried out an online cross-sectional investigation among healthcare workers (HCWs) in Taizhou, China. In total, 1,054 respondents (165 males and 889 females) have received two-dose COVID-19 vaccination. We performed descriptive analysis, chi-square test, and mediation analysis on the exported data. In this study, 67 (40.6%) males and 429 (48.3%) females had WTP for the booster dose. Our study presented that decision regret mediated the effect of adverse reactions after vaccination on WTP for the booster dose in both male and female groups. In males, decision regret played a completely mediating role, while in females, it acted as a partial mediator. Sex differences in the relationship between post-vaccination side effects, decision regret, and WTP for the third dose were demonstrated in a sample of healthcare workers.

Valuing life over the life cycle

Adjusting the valuation of life along the (i) person-specific (age, health, wealth) and (ii) mortality risk-specific (beneficial or detrimental, temporary or permanent changes) dimensions is relevant in prioritizing healthcare interventions. These adjustments are provided by solving a life cycle model of consumption, leisure and health choices and the associated Hicksian variations for mortality changes. The calibrated model yields plausible Values of Life Year between 154K$ and 200K$ and Values of Statistical Life close to 6.0M$. The willingness to pay (WTP) and to accept (WTA) compensation are equal and symmetric for one-shot beneficial and detrimental changes in mortality risk. However, permanent, and expected longevity changes are both associated with larger willingness for gains, relative to losses, and larger WTA than WTP. Ageing lowers both variations via falling resources and health, lower marginal continuation utility of living and decreasing longevity returns of changes in mortality.

Extending the theory of planned behavior to examine the role of meat-eater identity: The case of dry-aged beef

Dry-aged beef provides superior qualities and a unique taste experience due to its exceptional sensory attributes, including tenderness, juiciness, and flavor, compared to traditional beef. Our study focused on the factors that impact consumers' intention to consume and willingness to pay for dry-aged beef. We implemented an extended version of the Theory of Planned Behavior (TPB) model that contains a measure of meat-eater identity to analyze the intention to consume and the willingness to pay a premium for dry-aged beef steak that has undergone 21-30 days of aging. An online survey was conducted with a stratified sample of Italian respondents (n = 944). The data were analyzed using partial least squares structural equation modeling (PLS-SEM). The TPB's effectiveness was enhanced by adding the meat-eater identity construct to the model. Specifically, it was found that the participants' meat-eater identity significantly influenced their intention to consume. The results also revealed that the most critical impact of identity comes from the mediated influence of attitudes, subjective norms, and perceived behavioral control. Finally, the intention to consume strongly influenced the willingness to pay for a dry-aged beef steak.

Parents' willingness to pay for their children's COVID-19 vaccine in Taiwan, China: A cross-sectional study

Most COVID-19 studies aim to assess factors influencing willingness to pay for vaccines between the public and medical staff. However, few studies focus on parents' willingness to pay for their children's COVID-19 vaccine. The current study aimed to assess parents' willingness to pay for their children's vaccination against COVID-19 and its influencing factors. This population-based cross-sectional study used a self-administered questionnaire. The inclusion criterion was parents with at least one child younger than 18 years. The final analysis included 384 valid data points. A total of 89.1% of the parents indicated that they are willing to pay for their children's vaccination against COVID-19. Among them, both fathers' and mothers' willingness to pay for their children's COVID-19 vaccine was 89.6%. The mean and median willingness to pay were% would pay for their children. Excluding other confounding factors, willingness to pay for the COVID-19 vaccine for themselves and hesitation to vaccinate their children were significantly associated with parents' willingness to pay for their children's COVID-19 vaccine. We found that 89.1% of the parents in Taiwan would pay for their children's COVID-19 vaccine. Parents' willingness to pay for themselves and hesitation to vaccinate their children were associated with willingness to pay. Reducing hesitation about vaccines and developing policies for vaccine payment may have a positive impact on willingness to pay for vaccines and promoting COVID-19 vaccination.

Households' willingness to pay for water for the environment in an urban setting

Continued population growth, and climate change are placing stress on many of the world's water sources and this often manifests in environmental damage to rivers and wetlands. Most of the published literature around allocating more water to the environment considers trade-offs with agriculture. In contrast this study focusses on scenarios for different potable water supplies in cities and thus adds a novel perspective on the value of riverine restoration. This study sheds light on urban households' willingness to pay for more water to be allocated to the environment where it directly competes with their own water demands. The study uses two stated preference techniques (choice modelling and best-worst scaling) to establish the value of environmental water and the motivations for households paying for an increase in environmental water reserves. The study is set in Australia's fastest growing city, Melbourne, although the approach and method have implications for other developed-world settings. The paper also offers practical advice on the management of water allocated for different uses. Overall, the results indicate a positive and significant willingness to pay by households for additional water entitlements. Importantly, this provides a benchmark for contemplating the costs and benefits of activating alternative water supplies, such as desalination, to free up rainwater for environmental purposes.

Resource allocation in public sector programmes: does the value of a life differ between governmental departments?

BACKGROUND

The value of a life is regularly monetised by government departments for informing resource allocation. Guidance documents indicate how economic evaluation should be conducted, often specifying precise values for different impacts. However, we find different values of life and health are used in analyses by departments within the same government despite commonality in desired outcomes. This creates potential inconsistencies in considering trade-offs within a broader public sector spending budget. We provide evidence to better inform the political process and to raise important issues in assessing the value of public expenditure across different sectors.

METHODS

Our document analysis identifies thresholds, explicitly or implicitly, as observed in government-related publications in the following public sectors: health, social care, transport, and environment. We include both demand-side and supply-side thresholds, understood as societies' and governments' willingness to pay for health gains. We look at key countries that introduced formal economic evaluation processes early on and have impacted other countries' policy development: Australia, Canada, Japan, New Zealand, the Netherlands, and the United Kingdom. We also present a framework to consider how governments allocate resources across different public services.

RESULTS

Our analysis supports that identifying and describing the Value of a Life from disparate public sector activities in a manner that facilitates comparison is theoretically meaningful. The optimal allocation of resources across sectors depends on the relative position of benefits across different attributes, weighted by the social value that society puts on them. The value of a Quality-Adjusted Life Year is generally used as a demand-side threshold by Departments of transport and environment. It exceeds those used in health, often by a large enough proportion to be a multiple thereof. Decisions made across departments are generally based on an unspecified rationing rule.

CONCLUSIONS

Comparing government expenditure across different public sector departments, in terms of the value of each department outcome, is not only possible but also desirable. It is essential for an optimal resource allocation to identify the relevant social attributes and to quantify the value of these attributes for each department.

The effect of a One Health message intervention on willingness to pay for antibiotic-free animal foods: A randomized controlled trial among Chinese college students

Routine use of antibiotics in livestock for prophylactic purposes is a main driver of antimicrobial resistance, posing a significant threat to the health of humans, animals, and the environment. Ways to motivate farmers to voluntarily reduce antibiotics use need to be explored. Promoting antibiotic-free animal foods is one of the promising strategies. A three-arm double-blind randomized controlled trial was conducted online to explore the impact of a One Health message intervention on Chinese college students' willingness to pay for antibiotic-free animal foods. A total of 389 individuals participated in this study and were randomly assigned to one of the One Health message group, the food nutrition and safety message group, and the no message group. Each participant read a message from the corresponding group and answered a self-report questionnaire. Participants' willingness to pay (WTP) and willingness to buy (WTB) for antibiotic-free pork, eggs, and milk were measured before and after viewing the One Health message, and the results were compared to the other two groups using the Kruskal-Wallis rank sum test and the Bonferroni correction. In the One Health message group, 30.2% (39/129) reported improved WTP for all three foods, compared to 6.2% (8/130) and 13.6% (17/125) in the food nutrition and safety message group and the no message group, respectively. The One Health message intervention had a significant effect on increasing participants' WTP (p < 0.001) and WTB (p < 0.05) for antibiotic-free pork, eggs, and milk. The One Health message intervention is effective in raising participants' WTP for antibiotic-free animal foods. It is hopeful to motivate farmers and producers to voluntarily reduce prophylactic antibiotic use through market demand and consumer choice, leading to a potential decrease in total antibiotics use in livestock. Additionally, integrated approaches based on One Health principles need to be found in the future.

An examination of willingness to participate and willingness to pay for a universal school food program in the Canadian context

OBJECTIVE

To examine parents'/caregivers' willingness to participate and willingness to pay (WTP) for a cost-shared school food program (SFP) and its associated factors.

DESIGN

A quantitative survey design was used where WTP for a hypothetical SFP was elicited using a double-bounded dichotomous choice elicitation method. We used a double hurdle (logistic and truncated regression) model to examine WTP and positively or negatively associated factors.

SETTING

Saskatoon Public School Division elementary schools situated in high-, mid- or low-median-income neighbourhoods.

PARTICIPANTS

Parents or caregivers of children attending grades 1 to grade 8 in the Saskatoon Public School Division elementary schools.

RESULTS

94 % respondents were willing to participate in a SFP while less than two-thirds of participants were willing to pay for such a program. Over 90 % respondents from all the socio-economic groups were willing to participate. Multiple household income earners, higher household income, higher number of children, household food security status and higher academic attainment of parents'/caregivers predicted greater willingness to pay. Mean willingness to pay was $4·68 (CAN), and households reporting moderate or severe food insecurity were likely to be willing to pay significantly less for a SFP.

CONCLUSION

A cost-shared program might be financially sustainable in Canada if community characteristics such as household food insecurity status, economic participation of women and average household size are kept in mind while determining the price of the program.

How much are patients willing to pay for spine surgery? An evaluation of attitudes toward out-of-pocket expenses and cost-reducing measures

BACKGROUND CONTEXT

With rising healthcare expenditures in the United States, patients and providers are searching to maintain quality while reducing costs.

PURPOSE

The aim of this study was to investigate patient willingness to pay for anterior cervical discectomy and fusion (ACDF), degenerative lumbar spinal fusions (LF), and adult spine deformity (ASD) surgery.

STUDY DESIGN/SETTING

A survey was developed and distributed to anonymous respondents through Amazon Mechanical Turk (MTurk).

METHODS

The survey introduced 3 procedures: ACDF, LF, and ASD surgery. Respondents were asked sequentially if they would pay at each increasing price option. Respondents were then presented with various cost-saving methods and asked to select the options that made them most uncomfortable, even if those would save them out-of-pocket costs.

RESULTS

In total, 979 of 1,172 total responses (84%) were retained for analysis. The average age was 36.2 years and 44% of participants reported a household income of $50,000 to 100,000. A total of 63% used Medicare and 13% used Medicaid. A total of 40% stated they had high levels of financial stress. A total of 30.1% of participants were willing to undergo an ACDF, 30.3% were willing to undergo a LF, and 29.6% were willing to undergo ASD surgery for the cost of $3,000 (p=.98). Regression demonstrated that for ACDF surgery, a $100 increase in price resulted in a 2.1% decrease in willingness to pay. This is comparable to degenerative LF surgery (1.8% decrease), and ASD surgery (2%). When asked which cost-saving measures participants were least comfortable with for ACDF surgery, 60% stated "Use of the older generation implants/devices" (LF: 51%, ASD: 60%,), 61% stated "Having the surgery performed at a community hospital instead of at a major academic center" (LF: 49%, ASD: 56%), and 55% stated "Administration of anesthesia by a nurse anesthetist" (LF: 48.01%, ASD: 55%). Conversely, 36% of ACDF patients were uncomfortable with a "Video/telephone postoperative visit" to cut costs (LF: 51%, ASD: 39%).

CONCLUSIONS

Patients are unwilling to contribute larger copays for adult spinal deformity correction than for ACDF and degenerative lumbar spine surgery, despite significantly higher procedural costs and case complexity/invasiveness. Patients were most uncomfortable forfeiting newer generation implants, receiving the operation at a community rather than an academic center, and receiving care by physician extenders. Conversely, patients were more willing to convert postoperative visits to telehealth and forgo neuromonitoring, indicating a potentially poor understanding of which cost-saving measures may be implemented without increasing the risk of complications.

The Influence of Ambient Weather Conditions on Stated Preferences for Ecosystem Services Management

One of the assumptions in stated preference studies is the stability of respondents' preferences. This assumption might be violated in situations of context dependence, i.e., when the contingent situation influences respondents' choices. Ambient weather conditions (AWCs) are one element of the context that may influence stated preferences. The literature suggests that AWCs affect people's emotions, behaviors, and decision-making processes; however, the potential AWCs impact in environmental preference studies has not yet been investigated. This aspect is of high importance because context-dependent choices return biased willingness to pay estimates and affect the subsequent welfare analysis that informs public policy. To shed light on this important aspect of non-market valuation studies, we explore the effect of AWCs on preferences elicited with a Discrete Choice Experiment for ecosystem services management of a Nature Park. Results of a generalized mixed logit model evidenced a significant effect of AWCs on respondents' choices, with good weather conditions leading to higher preferences and willingness to pay for ecosystem services management. This result, which is consistent with previous psychological studies, raises the issue of sampling design and reveals the importance of a sensitivity analysis of WTP. As this issue is still unexplored in stated preference studies, we also encourage undertaking similar studies to add a priori knowledge for more accurate ex-post calibration of WTP estimates.

Psychological distance and physical distance induced residents' heterogeneous willingness to pay for transboundary watershed ecosystem services in the Wei River Basin, China

Under the framework of payment for transboundary watershed ecosystem services (ESs), identifying midstream and downstream residents' preference and willingness to pay (WTP) for ESs provided by the upstream is crucial for sustainable watershed management. The residents' preferences and WTP are not evenly distributed within the watershed. This study uses a choice experiment assessing the spatial impact of physical distance (including residents' watershed location and distance to waterbody) and psychological distance on residents' preference and WTP for the Wei River Basin ESs. The results showed that midstream and downstream residents' preference and WTP for the ecological attributes have a significant distance-decay effect, either the physical distance to the upstream exit or physical and psychological distance to the waterbody. However, compared with the residents in the midstream, the residents downstream have a stronger preference and WTP for upstream ecological governance. Besides, the distance-decay effect differs between urban and rural residents. There is a psychological distance-decay effect in rural residents' preference for water quality and a physical distance-decay effect in their preference for water quantity, entertainment area, and cost; there is a physical distance decay effect in urban residents' preference for entertainment areas. The above differences lead to heterogeneity in WTP and total economic value (TEV) for ESs. When calculating the TEV of the transboundary watershed ES and charging the public, policymakers should consider the location of the residents, the physical and psychological distance to the water body, and the difference between urban and rural areas.

Factor associated with willingness to pay for prevention of cancer: a study of prostate cancer screening

INTRODUCTION

This study investigates Iranian men's willingness to pay (WTP) for prostate cancer (PCa) screening and influencing factor, along with the impact of information.

METHOD

We assessed preferences for prostate cancer screening in 771 Iranian men aged 40 and above using an internet-based questionnaire survey. Participants received basic and complementary information, and their willingness to pay was determined through a payment card approach. A Wilcoxon test assessed the impact of information. We also analyzed prostate cancer screening demand and employed Heckman's two-step model to evaluate factors influencing the willingness to pay. Additionally, reasons for unwillingness to pay were explored.

RESULTS

Willingness to pay significantly decreased with complementary information relative to basic information (16.3$ vs 17.8$). Heckman model, using WTP based on basic information shows age, education, and monthly household expenditure positively influenced the decision to pay. In contrast, health status, expectations of remaining life and prostate problems history positively affect amount of WTP for PCa screening, and insurance coverage has a negative impact on it. Majority of respondents (91%) supported PCa screening, with 82% expressing a willingness to pay. Common reasons for not paying include seeing screening as a public good (43%), financial constraints (35%), and having insurance (20%). The screening demand is price-sensitive.

CONCLUSION

The basic mindset of Iranian men exaggerates the risk of prostate cancer. Reduced willingness to pay after receiving information reassures the reliability of their financial expectation. Taking into account the factors that influence PCa screening is essential for accurate planning and the successful implementation of this program.

Preference and willingness to pay for reproductive health services among adults in Urban-Rural transition settings of a developing country: evidence from a cross-sectional study in a rural district of Hanoi, Vietnam

BACKGROUND

Since the introduction of fee-for-service models in public hospitals and the legalization of private health services in Vietnam in 1989, the price of reproductive health services has risen. These changes have exacerbated inequities in accessing reproductive health services. This study examines potential disparities in willingness to pay for reproductive health services among adults in a rural district of Hanoi.

METHODS

A cross-sectional study was conducted at 9 communes in Thanh Oai district, a rural district of Hanoi, Vietnam, in July 2019. Face-to-face interviews were conducted using a structured questionnaire to collect self-reported data. The contingent valuation was used to examine willingness to pay for reproductive health services with a starting price of 2 million VND (~ US$86.2, July 2019 exchange rate), which is the average price of all RHS in public facilities in Vietnam. Multiple Logistic regression and Multiple Interval regression models were used to identify factors associated with willingness to pay and the amount that people were willing to pay for reproductive health services.

RESULTS

Among 883 participants, this study found 59.1% of them willing to pay for reproductive health services at an average maximum amount of US$36.2, significantly less than the current average price of US$86.2. Occupation, number of sex partners, perception towards the necessity of reproductive health services, and prior use of reproductive health services were found to significantly influence willingness to pay for reproductive health services, while age, income level, gender, occupation, perception towards the necessity of reproductive health services and prior use of reproductive health services were reportedly correlated with the amount participants were willing to pay for reproductive health services.

CONCLUSION

Lower willingness to pay for reproductive health services compared to the current prices (US$36.2 vs. US$86.2) is likely related to an overall low awareness of the necessity of reproductive health services, and future education campaigns should specifically target those from lower-income backgrounds. Financial subsidization should also be provided, especially for those from the low-income group, to ensure equitable access to reproductive health services. Given the heterogeneity of reproductive health services, further studies should examine the willingness to pay for each type of service independently.

Putting a price on pain: The monetary compensation needed to offset welfare losses due to violence

Efficiency calculations of violence prevention are likely to be severely biased if the hard-to-measure value of utility reductions due to victimization is not included. We measure the monetary compensation needed to offset the welfare loss associated with being subjected to violence, by applying the compensating-income-variation method to data from an Icelandic health-and-lifestyle survey carried out in 2017. We examine differences in the monetary compensation needed by (i) types of violence, (ii) duration since the exposure, and (iii) the relationship with the perpetrator. Our results show that the average compensation needed to offset the welfare loss due to psychological violence is $43,750 per year, $22,202 per year for sexual violence, and $10,938 per year for physical violence. Further, we find that the monetary compensation needed is highest when the perpetrator is a spouse or an ex-spouse, and when the violence happened recently.

Generic ibrutinib a potential cost-effective strategy for the first-line treatment of chronic lymphocytic leukaemia

Though the chronic lymphocytic leukaemia (CLL) management options in India are still limited compared to the novel drug options in resource-rich settings, the availability of less costly generics and the government health insurance scheme has enabled many patients to access the newer drugs in India. The current study compared the cost-effectiveness and cost-utility of existing initial management options for the progression-free survival (PFS) time horizon from the patient's perspective. A two-health-state, PFS and progressive disease, Markov model was assumed for three regimens (generics): ibrutinib monotherapy, bendamustine-rituximab (B-R), and rituximab-chlorambucil (RClb) used as the frontline treatment of CLL patients in India. All costs, utilization of services, and consequences data during the PFS period were collected from interviewing patients during follow-up visits. The transition probability (TP) and average PFS information were obtained from landmark published studies. EQ-5D-5L questionnaires were utilized to assess the quality of life (QoL). Quality-adjusted life years (QALY) were measured during the PFS period. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were studied. Upon analysis, the entire monetary expense during the PFS time was ₹1581964 with ibrutinib, ₹171434 with B-R, and ₹91997 with RClb treatment arm. Pooled PFS and QALY gain was 10.33 and 8.28 years for ibrutinib, 4.08 and 3.53 years for the B-R regimen, and 1.33 and 1.23 years in RClb arms, respectively. Ibrutinib's ICER and ICUR were ₹214587.32 per PFS year gain and ₹282384.86 per QALY gain when assessed against the B-R regimen. Ibrutinib also performed better in ICER and ICUR against the RClb arm with ₹157014.29 per PFS year gain and ₹200413.6 per QALY gain. In conclusion, generic ibrutinib is a cost-effective initial line of management compared to other commonly used treatment regimes in resource-limited settings.

Willingness to pay for medical care and its determinants in private health care facilities among Gondar city residents, Northwest Ethiopia: Cross sectional study

Medical care is a type of health service that mainly consists of investigation and diagnosis, treatment, rehabilitative care, and nursing care for the purpose of maintaining the structure or function of the body. A medical care payment is a sort of payment made for the diagnosis, cure, mitigation, treatment, or prevention of disease, sickness, or damage, which includes checkups and periodic exams. In low-income nations, out-of-pocket expenditures account for 60 % of overall health spending, compared to 20 % in high-income ones. Willingness to pay is perhaps the highest money that a person is willing to provide to ensure that a particular wellbeing care action is undertaken. Previous research works focused mainly on the patients' willingness to pay but not the amount they can afford. The focus of this study is to determine the level of willingness to pay, the mean amount of willingness to pay for medical care, and its major determinants. A community-based cross-section study was carried out among Gondar city residents from February 2022 to March 2022. The study participants were recruited by systematic random sampling. Four data collectors conducted interviews using a questionnaire. For analysis, the dataset was entered into Epi Info version 7 and transferred to STATA version 14. The descriptive part was summarized using summary statistics like mean, median, and standard deviation. Determinants of willingness to pay were identified using a Tobit regression model with a significance of p-value ≤ 0.05 and confidence interval (CI ≠ 0). Finally, the analyzed data was presented using tables and figures accordingly. The study involved 414 participants, with a response rate of 95.8 %. About 53.62 % of the participants were willing to pay for medical care and the average willingness to pay was 24.17 USD per year. They were more willing to pay if they were still working (β = 19.66), currently married (β = 14.49), had a family history of medical care (β = 25.74), had good knowledge (β = 36.16), had a history of medical illness (β = 16.64), lived a long distance from the health facility (β = 1.98), and had a high wealth index (β = 29.51). The willingness to pay for medical care is below the actual cost. Designing a cost-recovery strategy with multi-tiered programs assigned to the most vulnerable individuals, such as the elderly, less educated, or seriously sick, is a strategic approach of the raising demand for service uptake and accessibility.

Assessing farmer willingness to participate in a subsidized veterinary herd health management program

Zoonoses, such as COVID-19, can cause pandemics with many fatalities. Therefore, livestock keepers should attach great importance to livestock disease control. Veterinarians can support farmers in this task through a structured veterinary herd health management (VHHM) program. The dissemination of these programs remained low, and Swiss policy makers planned to launch a subsidy program for VHHM. To inform policy making ex-ante, a survey of 1600 Swiss dairy farmers was conducted to determine whether they are willing to participate and how much they are willing to pay. Contingent evaluation with a discrete choice format elicited willingness to pay (WTP). As a rather high share of farmers who would not participate was expected, a spike model was applied with a single-bounded discrete choice (SBDC) model. Only 47% of the farmers had a positive WTP. Mean WTP in the SBDC was CHF 10.47 per cow and year and in the spike model CHF 57.96. Participation would increase with higher subsidy levels. If the government pays 20% of the costs and farmers pay CHF 96 per cow per year, 23.6% of farms would participate. If the subsidy increases to 80% (CHF 24 for farmers), 40.4% would participate. A logistic regression indicates younger and older farmers, those with lower veterinary costs, and those who consider VHHM relevant only for farms with problems are less likely to participate.

Health-related quality of life and willingness to pay measurement among patients on warfarin in Thailand

BACKGROUND

Complex dosage regimens and the high incidence of adverse events associated with warfarin therapy can affect the health-related quality of life (HRQoL) and willingness to pay (WTP) among patients on warfarin. No such previous study has been conducted to assess the HRQoL and WTP among Thai patients on warfarin; therefore, this study aimed to measure these parameters and identify some sociodemographic factors associated with those aspects among patients on warfarin in Thailand.

METHODS

This cross-sectional survey study involving 260 patients on warfarin between June 2022 and June 2023 used a quantitative method for data collection. Face-to-face interviews with well-trained interviewers were conducted and patients were required to complete the questionnaires of both World Health Organization Quality of Life-BREF (WHOQOL-BREF) and EQ-5D-5L to assess and measure their HRQoL levels. WTP was assessed using a bidding game technique. Descriptive statistics with mean and standard deviations were used to report HRQoL scores and WTP, whereas a generalized linear model was employed to identify factors associated with both HRQoL and WTP.

RESULTS

The mean EQ-5D index and mean EQ-VAS score were 0.89 ± 0.15 and 76.92 ± 15.95, respectively, whereas the mean WHOQOL-BREF domain scores were 59.18 ± 14.13, 68.56 ± 15.47, 59.13 ± 19.64, and 65.23 ± 14.04 for the physical, psychological, social, and environmental domains, respectively. Elderly participants (age > 60 years) and those with comorbidities had lower HRQoL scores than their counterparts. The mean WTP was 22.25 ± 32.19 USD for one patient's visit. The presence of comorbidities was the only factor significantly associated with WTP values.

CONCLUSIONS

Thai patients on warfarin have lower mean EQ-5D indexes and EQ-VAS scores than members of the general Thai population. Patients on warfarin with comorbidities have diminished HRQoL and WTP values. Therefore, all healthcare professionals should pay more attention to this group of patients on warfarin to achieve better outcomes.

Farm impacts of the 2019 Missouri River floods and economic valuation of flood risk reduction

The 2019 Missouri River flood caused billions of dollars in damage to businesses, homes, and public infrastructure. Yet little is known about the farm-level effects of this event and farmers' perceptions of its causes. This study reports on the operational and financial setbacks farmers sustained because of the 2019 floods, as well as on their beliefs on the causes of these floods. It further explores farmers' willingness to pay (WTP) to avoid flood risks and the factors that condition it. The empirical application focuses on a sample of approximately 700 Missouri farmers operating near the Missouri River. Results show that yield loss, loss of growing crops, and inability to plant crops were the three most important consequences of flooding. Nearly 40% of the flood-affected farmers reported financial losses of $100,000 or more. Most respondents identified government decision makers as the cause of the 2019 floods, and many believe that government should prioritize flood control over other benefits (recreation and fish and wildlife habitat) the Missouri River system provides. The WTP results show that less than half of the surveyed farmers were willing to pay to avoid flood risks, with an average WTP estimated at $3 per $10,000 value of agricultural land. Subjective but not objective risk exposure influences WTP for flood risk reduction. Other important determinants of WTP are risk aversion, disutility from flood risks, and respondents' age, income, and education. Directions for policy to improve flood risk management in the Missouri River Basin are discussed.

Awareness and willingness to pay for green roofs in Mediterranean areas

Green roofs have been extensively investigated in recent years, showing that their implementation in urban areas provides multiple benefits (e.g., pluvial flood mitigation, urban heat island reduction, energy saving, increase of biodiversity, CO2 sequestration) and supports sustainable urban development. Although green roof benefits have been widely recognized, the perception that the community has of these nature-based solutions and the willingness to pay for their installation in urban areas is still not clear nor quantified. Societal perception and willingness to pay for green roofs are fundamental for urban planners and decision makers, since they represent the community participation in the sustainable development of urban areas. In this work, we aim to analyze how citizens perceive green roofs and how willing they are to pay for the installation and maintenance of these nature-based solutions. We used an online survey to investigate the perception and the knowledge of green roofs as a potential solution to common environmental issues (i.e., urban flood, increase of temperature, energy consumption, air pollution and lack of green spaces), and the interest and willingness to pay for green roof installation on both public and private roofs. Based on the answers of 389 respondents living in Sardinia (Italy), our analysis revealed that most citizens are aware of what green roofs are, and they are aware that, although these nature-based solutions can not completely solve environmental issues, they can greatly contribute to the mitigation of these phenomena. Results also show a higher interest in the installation of green roofs on public buildings than on private ones, due to the high installation costs. Moreover, for private roofs, the possibility to install photovoltaic panels instead of GRs is generally preferred. Most of the respondents are willing to spend less than 100 € per year for the maintenance of green roofs on public buildings and to invest less than 5000 € for the installation on their own house.

Farmers' valuation and willingness to pay for vaccines to protect livestock resources against priority infectious diseases in Ghana

INTRODUCTION

Livestock vaccination coverage rates remain low in many lower and middle income countries despite effective vaccines being commonly available. Consequently, many preventable infectious livestock diseases remain highly prevalent, causing significant animal mortalities and threatening farmers' livelihood and food security. This study sought to assess farmers' maximum willingness to pay (WTP) for contagious bovine pleuropneumonia (CBPP), and peste-des-petits-ruminants (PPR) vaccination of cattle, and sheep and goats, respectively.

METHODS

Overall, 350 ruminant livestock farmers were randomly selected from three districts located in the northern, middle and southern farming belts of Ghana. We implemented a double-bounded dichotomous contingent valuation experiment, where farmers indicated their WTP for vaccinating each livestock specie(s) owned at randomly assigned price points. WTP responses were analyzed using maximum likelihood estimation, and factors influencing WTP were assessed using censored regression analysis accounting for village-level clustering.

RESULTS

Mean WTP for CBPP vaccination was USD 1.43 or Ghanaian Cedi (GHC) 8.63 (95% CI: GHC 7.08-GHC 10.19) per cattle. Mean WTP for PPR vaccination was USD 1.17 or GHC 7.02 (95% CI: GHC 5.99-GHC 8.05) per sheep, and USD 1.1 or GHC 6.66 (95% CI: GHC 5.89-GHC 7.44) per goat. WTP was positively associated with resilience, limited knowledge about vaccines (assessed prior to WTP experiment), farmland size, and male gender, after adjusting for other covariates. To attain 70% vaccination coverage in Ghana, vaccination costs should be no larger than GHC 5.30 (USD 0.88) for CBPP per cattle and GHC 3.89 (USD 0.65) and GHC 3.67 (USD 0.61), respectively, for PPR vaccines per sheep and goat.

CONCLUSIONS

Ruminant livestock farmers in Ghana value vaccination highly, and are, on average, willing to pay vaccination costs that exceed the prevailing market prices (GHC 6 for CBPP and GHC 5 for PPR vaccination) to protect their livestock resources. To achieve 70% coverage, only minor subsidies would likely be required. These results suggest that effective disease control in these settings should be possible with appropriate distribution strategies.

Positive effects of green practices on the consumers' satisfaction, loyalty, word-of-mouth, and willingness to pay

Concern about green practices by companies and people has grown exponentially worldwide, considering them as a key element sustaining the development of competitive advantages. Given the present competitive, dynamic, and turbulent supermarket environment, managing environmental practices is essential for their survival. This study has two objectives: First, studying the relationship between green practices and customer satisfaction and, second, analyzing the impact of green practices and satisfaction on loyalty, word-of-mouth, and willingness to pay more via a quantitative study on a convenience sample of 458 customers from different Chilean supermarkets. Partial least square regression was used to analyze data. Results show the importance of green practices for developing satisfaction and different customer behaviors such as loyalty, word-of-mouth, and willingness to pay more. In addition, results prove satisfaction's positive impact on loyalty, word-of-mouth, and willingness to pay more. Those results also provide empirical evidence about the effects of green practices on the supermarket industry and, in this way, their advancement toward more sustainable management.

Social incentives as nudges for agricultural knowledge diffusion and willingness to pay for certified seeds: Experimental evidence from Uganda

A transition from low-input subsistence farming in Sub-Saharan Africa will require the use of yield-increasing agricultural technologies. However, in developing countries, most farmers continue to rely heavily on pest-infested and disease-infected recycled seed from own or local sources leading to low yields. This study used a field experiment to examine the effect of a social incentive combined with goal setting on the diffusion of agricultural knowledge and uptake of quality certified seed by farmers. We relaxed the seed access and information/knowledge constraints by introducing improved varieties of sweetpotato in the study villages and providing training to carefully selected progressive farmers who were then linked to co-villagers. We find that social incentives combined with goal setting reduced the likelihood of the trained progressive farmers reaching out to co-villagers to share information and discuss farming. Further, social incentive combined with goal setting had no significant effect on knowledge and experimentation by progressive farmers, and on willingness to pay for improved seed - as elicited through auctions, our proxy for experimentation, by co-villagers. These findings suggest that the combination of goal setting and public recognition acted to crowd-out diffusion effort. We conclude that social incentive combined with goal setting by established progressive farmers already enjoying a certain degree of public recognition is not sufficient to induce effort in learning and experimentation with agricultural innovations. These results have implications for design of policy and extension services to promote adoption of agricultural technologies with proven food and nutrition security benefits in developing countries.

The role of social network embeddedness and collective efficacy in encouraging farmers' participation in water environmental management

Water environmental management (WEM) has a significant influence on the global ecological balance. As an institutional innovation, the River Chief System (RCS) in China has achieved a positive short-term impact on addressing water environmental problems. However, its effects are limited in rural China. As a type of public good, the rural WEM demands the active participation not only of government but also of farmers. Based on the social cognitive and social network theory, this study empirically investigates how rural social networks promote farmers' participation in WEM. Using the survey of 860 farmers in the Yellow and Yangtze River Basin, we employ the double-hurdle model (D-H-M) to craft the primary assessment. The results show that the social network embeddedness facilitates farmers' participation in WEM directly. Collective efficacy plays a full mediation role in the relationship between social network embeddedness and farmers' participation. Moreover, the perceived role of village leaders affects the relationship between social networks and farmers' participation. Our research enriches the application of social network theory in the rural social context and offers an innovative approach to solving farmers' participation problems in WEM.

Consumer willingness to pay more for pro-environmental packages: The moderating role of familiarity

Institutional regulations and market trends are spurring companies to invest more in pro-environmental and sustainable products. Within the pro-environmental offer, there are several packaging alternatives, from sustainably packaged to unpackaged products - so-called bulk - and/or labels, compelling companies into making a complex investment choice. Further, the required higher investments do not always find consumers' approval. Consumers often consider pro-environmental packaging as excessively expensive. Within this context, this study seeks to understand how to exploit the consumers' greater attention to sustainability and well-being to boost consumers' willingness to pay more for pro-environmental products. In doing so, the study compares two packaging options (i.e., sustainably packaged products and bulk products). Additionally, the study assesses differences between highly and slightly familiar consumers, evidencing how to properly encounter the expectations of the two segments. The findings, derived by a multigroup structural equation model conducted on 278 structured questionnaires, reveal that health concern impact is more relevant to highly familiar consumers while environmental concern is for slightly familiar consumers. For the latter, label influence plays a primary role in enhancing their willingness to pay more for pro-environmental products. Overall, sustainably packaged products are preferred to unpackaged products.

Farmers' willingness to pay for metal silo cereal storage technology in northeast Ethiopia

In Ethiopia, cereal crops play a significant role in food security and income for most smallholder farmers. In the Gubalafto district, the environment is ideal for growing vital cereal crops such as sorghum, maize, and teff. However, various factors such as weevils, rodents, mold infestation, and lack of suitable storage materials were blamed for a post-harvest loss of cereal at the storage stage in the district. Hence, this research study was intended to identify factors affecting households' willingness to pay for metal silo cereal storage technology and the maximum willingness to pay for the technology. The study used both primary and secondary sources to gather the data. A total of 385 sample households were selected using a systematic random sampling technique. The semi-structural questionnaire was used to collect the primary data during a face-to-face interview, and double-bounded questions were also followed by open-ended questions. Combinations of data analysis methods such as descriptive, inferential statistics, and econometrics models were used. a binary probit regression model was used to identify factors that influenced farmers' willingness to pay for metal silo cereal storage technology. A bivariate probit regression model was also used to estimate the household's willingness to pay for metal silo cereal storage technology. The survey results showed that the majority (71.69%) of the sample households were willing to pay for metal silo cereal storage technology due to the severity of cereal post-harvest loss. Moreover, the binary probit model results revealed that household educational status, total household annual income, market accessibility, and extension service positively and significantly affected the household's willingness to pay decisions. The mean willingness to pay of households in open-ended and double-bounded methods was 4157 Ethiopian birr and 5147 Ethiopian Birr (ETB), respectively. In general, the result of the study revealed that farmers were more willing to adopt metal silo cereal storage technology due to its high-storage quality. Therefore, as a part of the recommendations, there should be great integration among farmers, metal manufacturing factories, local and regional governments to supply and offer metal silos technology for farmers at a reasonable price and time. Moreover, training should be arranged on how to use the metal silo technology to prevent post-harvesting loss during the storage time.

Influence of survey engagement and multiple-choice heuristics in the estimation of the value of a statistical life

Estimating the value of non-market goods, such as reductions in mortality risks due to traffic accidents or air pollution, is typically done using stated choice (SC) data. However, issues with potential estimation biases due to the hypothetical nature of SC experiments arise, as protest choices are common and survey engagement is not constant across respondents. Further, if respondents choose to use different choice mechanisms and this is not considered, the results may also be biased. We designed an SC experiment to estimate the willingness to pay (WTP) for mortality risk reductions, that allowed us to simultaneously estimate the WTP to reduce the risk of traffic accident deaths and cardiorespiratory deaths due to air pollution. We formulated and estimated a multiple heuristic latent class model that also considered two latent constructs: Institutional Belief, to consider protest responses, and survey Engagement as a class membership covariate. We found, first, that individuals with lower institutional belief gave a higher probability of choice to the status-quo alternative, shying away from programs involving governmental action. Second, that not identifying respondents who do not appropriately engage in the experiment, biased the WTP estimators. In our case WTP decreased up to 26% when two different choice heuristics were allowed for in the model.

Are citizens willing to pay for the ecosystem services supported by Common Agricultural Policy? A non-market valuation by choice experiment

Public attention to the impact of human activities on the environment is growing over time across several sectors, particularly agri-food. In Europe, the agricultural sector's focus on sustainability has influenced EU policies for at least 40 years. The Common Agricultural Policy (CAP) has for years been proposing tools, commitments, and incentives to mitigate the over-use of natural resources and to increase or maintain the flow of ecosystem services (ES) provide by agro-ecosystems. In the latest reform (23-27), the EU strengthens the commitments required of farmers for environmental issues. The role of farmers in natural capital management and ES provision seems to be recognized, EU subsidies for farmers seem to be more related to sustainability and well-being concerns of European citizen. However, it is necessary to understand whether society recognizes these benefits and legitimizes this transfer of public money for these purposes. This study aims to evaluate non-farmers citizen preference through a Choice Experiment for the potential higher flows of ES provided by three of the reformulated and new Good Agricultural Environmental Conditions - GAEC. The case study developed in Italy collected data from 185 citizens of the Po Valley, one of the most intensely cultivated areas in Europe. Analyses demonstrated how society recognizes the benefits provided by more sustainable agricultural systems, showing a preference for higher ES flows. The results show that there is a hypothetical value recognized by society for ES attributable to new GAECs that will be implemented by CAP farmers. In the case study, this value is higher than what farmers currently receive for general environmental purposes through direct payment for the management of arable land. Analysis it could justify that efforts required by the new CAP reform (23-27) to the farmers to achieve sustainable agricultural systems could be compensate and supported by positive citizens valuation.

Willingness to pay premium prices for green buildings: evidence from an emerging economy

The building sector is one of the major contributors to greenhouse gas (GHG) emissions, which may impede the achievement of Malaysia's intended nationally determined contribution (INDC) by 2030. Therefore, this paper is aimed at identifying the underlying factors that affect working adults' willingness to pay (WTP) premium prices for green buildings. Data were collected from a total of 1198 respondents and analyzed using structural equitation modeling partial least square (SEM-PLS) to measure the willingness to pay for green buildings among working adults in Malaysia. The findings reveal that environmental literacy affects environmental belief as well as awareness of consequences among working adults in Malaysia. The findings also reveal that incentives for green building buyers have a significant impact on perceived behavioral control, while awareness of consequences has a significant influence on ascription of responsibility. However, the results reveal that awareness of consequences does not influence buyers' willingness to pay for green buildings. Moreover, the ascription of responsibility and perceived behavioral control have a significant effect on willingness to pay for green buildings. The findings of this study will help the concerned authorities to take appropriate steps to promote willingness to pay for green buildings, which will contribute significantly to the realization of INDC by 2030 as part of the Paris Agreement.

Caretakers' stated willingness to pay for children's spectacles in cross river state, Nigeria and its implication for a cross-subsidisation scheme: a cross-sectional study

BACKGROUND

Understanding caretakers' willingness to pay (WTP) for their children's spectacles is essential to improving the sustainability of refractive error services and spectacle provision. Therefore, we investigated the willingness of caretakers to pay for their children's spectacles in a multi-centre study to develop a spectacle cross-subsidisation scheme in the Cross River State (CRS), Nigeria.

METHODS

We administered the questionnaire to all caretakers whose children were referred from school vision screenings to four eye centres for full refraction assessment and dispensing of corrective spectacles from 9 August to 31 October 2019. We collected information on socio-demography, children's refractive error types, and spectacle prescription and then asked the caretakers about their WTP for the spectacles using a structured questionnaire and bidding format (in the local currency, Naira, ₦).

RESULTS

A total of 137 respondents (response rate = 100%) from four centres were interviewed: with greater proportion of women (n = 92, 67.1%), aged between 41 and 50 years (n = 59, 43.1%), government employees (n = 64, 46.7%) and had acquired college or university education (n = 77, 56.2%). Of the 137 spectacles dispensed to their children, 74 (54.0%) had myopia or myopic astigmatism (equal to or greater than 0.50D). The mean stated WTP for the sample population was ₦3,560 (US$ 8.9) (SD ± ₦1,913.4). Men (p = 0.039), those with higher education (p < 0.001), higher monthly incomes (p = 0.042), and government employees (p = 0.001) were more willing to pay ₦3,600 (US$9.0) or more.

CONCLUSION

Combining our previous findings from marketing analysis, these findings provided a basis to plan for a children's spectacles cross-subsidisation scheme in CRS. Further research will be needed to determine the acceptability of the scheme and the actual WTP.

Economic evaluation of groundwater resource in the Effutu Municipality: An application of the Gisser-Sanchez effect

This study presents an economic valuation of the groundwater resource in the Effutu Municipality. It tests the validity of the Gisser-Sanchez's position that the benefits derived from implementing a groundwater management intervention are insignificantly small compared to when no intervention is made. Hundred groundwater-user households were sampled by quota, convenience, and simple random sampling techniques. Assuming a quantitative approach, a contingent valuation-based willingness to pay questionnaire was used for data collection. Respondents were asked to value groundwater under two regimes based on quality: (1) unmanaged quality and (2) hypothetically-managed quality regimes. Using the Lancaster demand theory, the values assigned under either regime were assumed as the benefits users would derive from using groundwater. The statistical difference between the benefits of the two regimes was established by the Wilcoxon Signed Rank Test. The findings revealed that groundwater users are willing to pay 20 Pesewas (GH₵ 0.2) and 30 Pesewas (GH₵ 0.3), respectively, for a 10 L bucket of groundwater from the unmanaged quality regime and groundwater from the hypothetically-managed quality regime. The study established a statistically significant difference between the economic values of groundwater under either regime, indicating that the Gisser-Sanchez effect does not hold for groundwater used for drinking and domestic purposes in the Effutu Municipality. It has been expressed that improving groundwater quality will significantly increase the economic value of the resource. It has therefore been recommended that efforts should be made to treat groundwater to assume the quality of the Ghana Water Company's pipe-borne water after drilling projects in the Municipality.

Holistic valuation of Nature-Based Solutions accounting for human perceptions and nature benefits

When assessing strategies for implementing Nature-Based Solutions (NBS), it is paramount to identify and quantify all benefits for securing better, informed decisionmaking. Nevertheless, there appears to be a lack of primary data for linking the valuation of NBS sites with the preferences and attitudes of people interacting with them and their connection to supporting efforts to reduce biodiversity loss. This is a critical gap, as the socio-cultural context of NBS has been proven to play a big role in NBS valuation, especially for their non-tangible benefits (e.g. physical and psychological well-being, habitat enhancements, etc.). Consequently, through cocreation with the local government, we co-designed a contingent valuation (CV) survey to explore how the valuation of NBS sites may be shaped by their relationship with the users and the specific respondent and site characteristics. We applied this method to a case study of two distinct areas located in Aarhus, Denmark, with notable differences related to their attributes (e.g. size, location, time passed since construction). The esults obtained from 607 households in Aarhus Municipality show that the personal preferences of the respondent are the most relevant driver of value, surpassing both the perceptions linked to the physical features of the NBS and the socio-economic characteristics of the respondents. Specifically, the respondents attributing most importance to nature benefits were the ones assigning a higher value to the NBS and being willing to pay more for an improvement of the nature quality in the area. These findings highlight the relevance of applying a method assessing the interconnections between human perceptions and nature benefits to ensure a holistic valuation and purposeful design of NBS.

A consumer emotion analysis system based on support vector regression model

The effective means to stimulate economic growth is to enhance consumers' consumption capacity. Because many consumers have different consumption habits, they will pay different attention to products. Even the same consumer will have different shopping experiences when buying the same product at different times. By mining the online comments of consumers on the online fitness platform, we can find the characteristics of fitness projects that consumers care about. Analyzing consumers' emotional tendencies towards the characteristics of fitness programs will help online fitness platforms adjust the quality and service direction of fitness programs in a timely manner. At the same time, it can also provide purchase advice and suggestions for other consumers. Based on this goal, this study uses an optimized support vector regression (SVR) model to build a consumer sentiment analysis system, so as to predict the consumer's willingness to pay. The optimized SVR model uses the region convolution neural network (RCNN) to extract features from the dataset, and uses feature data to train the SVR model. The experimental results show that the SVR model optimized by RCNN is more accurate. The improvement of the accuracy of consumer sentiment analysis can accurately help businesses promote and publicize, and increase sales. On the other hand, the increase in the accuracy of emotion analysis can also help users quickly locate their favorite fitness projects, saving browsing time. To sum up, the emotional analysis system for consumers in this paper has good practical value.

Food safety governance information tool design in trust crisis - Analysis based on consumer trust perspective

In this paper, we use the method of principal-form analysis, based on 836 consumer survey data obtained from mobile Internet, and analyze the trust of current residents' tea consumption behavior on information content, presentation form, subject and other elements of information tools and their influence on the pollution-free certified products with the help of descriptive statistical analysis, KMO test and common factor extraction method. It was found that, firstly, the higher the trust of tea consumers in information content, the higher the additional willingness to pay; secondly, the form trust also significantly affects tea consumers' willingness to pay for pollution-free certified tea, and the specific cognitive information presentation form can effectively enhance tea consumers' willingness to pay; thirdly, there are significant differences in the trust of subjects, and enhancing the trust of industrial subjects helps to improve the pollution-free certified industrial The effect of trust of external subjects is not significant; fourth, the higher the tea consumers' care about the attributes of experienced products, the higher the degree of knowledge about the three products and one standard, and the higher the consumers' education, the higher they are willing to pay higher prices for traceable tea.

The value of treatment for infertility: A systematic literature review of willingness-to-pay thresholds and approaches for determining the cost effectiveness of fertility therapies

Willingness to pay (WTP) for an infertility treatment is the maximum amount of money a patient is willing to pay per treatment, or to achieve a live birth or pregnancy. Such thresholds are important to determine the cost effectiveness of a treatment. A systematic review was conducted to identify and explore the studies that attempt to ascertain WTP for infertility and compare them with the cost-effectiveness studies that claimed to use WTP thresholds. For comparison, all the costs were converted and inflated to 2021 euros. The results demonstrated that there were no standard outcomes or WTP thresholds for an outcome/treatment, and the methodologies used vary. Cost-effectiveness studies either used the incremental cost-effectiveness ratio to imply a WTP threshold, or used thresholds that were previously accepted for a quality-adjusted life year outcome converted, inappropriately, to an infertility outcome. There is a need for further research by health economists to develop a consensus for the meaningful assessment of WTP for ART.

Health utilities and willingness to pay in adult patients with coeliac disease in Hungary

BACKGROUND

Coeliac disease (CD) is a life-long food-related disorder with a global prevalence of approximately 1%. Patients with CD often experience reduced health-related quality of life that could improve with a strict adherence to a gluten-free diet (GFD).

OBJECTIVES

To obtain visual analogue scale (VAS), time trade-off (TTO) and willingness-to-pay (WTP) values amongst patients with CD.

METHODS

In 2020-2021, a cross-sectional online survey was conducted amongst 312 adult CD patients in Hungary. Patients completed the Gastrointestinal Symptom Rating Scale (GSRS) and evaluated their current health and three hypothetical health state vignettes defined based on dietary adherence using VAS, conventional 10-year TTO and WTP. Multivariate regressions were used to explore the effect of patients' demographic and clinical characteristics on utility and WTP values.

RESULTS

Mean VAS values for current health and 'CD with strict adherence to GFD', 'CD with loose adherence to GFD' and 'CD without GFD' hypothetical health states were 79.69 ± 18.52, 85.36 ± 16.18, 62.44 ± 19.91 and 36.69 ± 25.83, respectively. Corresponding mean TTO utilities were: 0.90 ± 0.19, 0.91 ± 0.20, 0.87 ± 0.23 and 0.76 ± 0.29. Mean annual WTP values for returning to full health were: €845 ± 1077, €648 ± 1002, €862 ± 1135 and €1251 ± 1496. Older age at diagnosis, male sex, more severe gastrointestinal symptoms (GSRS) and having comorbidities were associated with lower VAS and TTO or higher WTP values for current own health (p < 0.05).

CONCLUSION

This is the first study to report TTO utilities for CD health states. Strict adherence to the GFD may result in substantial health gains in symptomatic patients. Utilities and WTP results can be used to estimate benefits of GFD in cost-utility and cost-benefit analyses.

Exploring preference and willingness for rural water pollution control: A choice experiment approach incorporating extended theory of planned behaviour

Rural water pollution control (RWPC) is a crucial issue for developing countries, particularly because of its importance for improving ecosystems, promoting sustainable development, and ultimately contributing to the health and well-being of individuals. This study adopted a choice experiment (CE) to explore farmers' preference and willingness for RWPC and to investigate whether socioeconomic and psychosocial factors can explain differences in farmers' preferences and values governing RWPC. The theory of planned behaviour (TPB) and some additional constructs (risk perception, knowledge, moral norms, and subjective norms) were included in an empirical test that predicts stated choices. The Wei River basin, one of the most water-polluted areas in China, was used as the location for our study. From June to July 2022, we collected the questionnaire responses of 427 farmers who live and work in this area. The results suggested that farmers have significant heterogeneity in their preference for RWPC attributes, but the majority highly value improving water quality through water pollution treatment. The inclusion of TPB and additional constructs in our test explained the behaviour of farmers. Those with high scores tended to already perform RWPC and have a willingness to continue to do so. According to the results of a latent class (LC) model, the average willingness to pay (WTP) per farmer for rural water pollution treatment was 254.69 Chinese yuan (CNY) per year. Excluding biodiversity, the average WTP was 241.55 CNY per year. This study provides a new path for developing countries to promote RWPC and improve local rural environments and the well-being of rural residents.

The value of a QALY towards the end of life and its determinants: Experimental evidence

OBJECTIVES

Individual and societal willingness to pay (WTP) for end-of-life medical interventions continue to be subject to considerable uncertainty. This study aims at deriving both types of WTP estimates for an extension of survival time and an improvement of quality of life amounting to a QALY.

METHODS

A discrete choice experiment (DCE) involving a hypothetical novel drug for the treatment of terminal cancer involving 1529 Swiss residents was performed in 2014. In its individual setting, respondents choose between the status quo and a hypothetical drug with varying characteristics and out-of-pocket payments, adopting the perspective of a terminal cancer patient. In the societal setting, participants are asked to choose between the status quo and a social health insurance contract with and without coverage of the novel drug and a varying insurance contribution.

RESULTS

In the individual setting, respondents put a higher value on their quality of life than on their survival time whereas in the societal setting, they put a higher value on extra survival time. The combination of the two extensions results in a mean individual WTP per QALY of CHF 96,150 (1 CHF = 1 USD as of 2014). Mean societal WTP for a QALY even amounts to CHF 213,500 in favor of an adult patient, CHF 255,600 for a child, and CHF 153,600 for a person aged over 70 years, respectively. While estimated societal values consistently exceed their individual counterparts, they vary considerably with respondents' socioeconomic characteristics in both settings.

CONCLUSIONS

This research finds that individual WTP for an extension of survival time to one year is dominated by WTP for health-related quality of life whereas for societal WTP, it is the other way round. Both individual and societal WTP values exhibit a great deal of heterogeneity, with the latter depending on the type of beneficiary.

Will information interventions affect public preferences and willingness to pay for air quality improvement? An empirical study based on deliberative choice experiment

Environmental information is a prerequisite for public participation in air quality improvement, and the choice of such participation behavior is influenced by the intervention of environmental information. Nonetheless, there has been insufficient analysis of how information interventions affect public preferences and willingness to pay for air quality improvement. The combination of deliberative and choice experiment is used to explore the importance of information interventions for public participation in air quality improvement, and the changes in public preferences and willingness to pay for air quality improvement before and after information interventions are compared to analyze the impact of information interventions on evaluation results of air quality value. The results suggest that information interventions do alter the preferences and willingness of the public to pay for air quality improvement, significantly increasing the choice certainty of respondents and decreasing the protest response. In addition, women and high-income groups showed a stronger willingness to improve air quality after the information interventions, with 35.15 CNY, 44.07 CNY and 46.75 CNY increases in willingness to pay for improved urban green coverage rate, fewer haze days and reduced morbidity. The combination of deliberative information interventions and choice experiment will help improve the effectiveness of air quality value evaluation, stimulate public environmental awareness and willingness to participate, and the results will aid government environmental management.

Monetary valuation of COVID-19 informal care: caregivers' willingness to pay and willingness to accept

BACKGROUND

Informal care can reduce hospitalization frequency and time, elevate bed turnover, and increase the health systems' capacity. This type of care has shown meaningful value in managing many cases through the COVID-19 pandemic. The present study aimed to identify determinants of monetary valuation of informal care and the burden of this care on the COVID-19 patients' caregivers.

METHODS

Through a cross-sectional phone survey from June to September 2021 in Sanandaj city, the west of Iran, COVID-19 patients and their caregivers (Each Group No. 425) were separately interviewed. A simple probabilistic sampling method was applied. Two questionnaires were developed and used after validation. Monetary valuation of informal caregivers was done using Willingness to pay (WTP) and willingness to accept (WTA). Double hurdle regressions were used to determine related variables to WTP/WTA. R software was used for the data analysis.

RESULTS

The total mean (Standard Deviation) of WTP and WTA were $12.02(28.73), $10.30(15.43) USD. Most respondents put a zero value on informal care by WTA (243(57.18%) and WTP [263 (61.88%)]. Caregivers' Employment, and being spouse/child of the care recipient increased the probability of reporting a positive value for WTP (p-value < 0.0001, p-value = 0.011 respectively) and WTA (p-value = 0.004, p-value < 0.0001 respectively). An increase in the number of caring days decreased the probability of reporting positive WTA (p-value = 0.001) and increased the mean of lnWTP (p-value = 0.044). Perceived difficulty in doing indoor activities and perceived difficulty in doing outdoor activities decreased lnWTA mean (p-value = 0.002) and lnWTP mean (p-value = 0.043) respectively.

CONCLUSIONS

Increasing caregivers' self-efficacy and facilitating their involvement in the caring process could be facilitated through flexible work status, educational programs, and interventions on decreasing their burnout.

Caregivers' willingness to pay for digital support services: Comparative survey

BACKGROUND

Considering the substantial information needs experienced by informal caregivers, the increased availability of digital support services for caregivers as well as the potential they offer, further understanding of caregivers' willingness to pay for digital support services is needed.

OBJECTIVE

The aim of this study is to identify associations between informal caregiver's characteristics and their willingness to pay for digital support services in two countries: Italy and Sweden.

METHODS

A sample of 378 respondents participated in a cross-sectional survey. Respondents were recruited by the Italian National Institute of Health and Science on Ageing and the Swedish Family Care Competence Centre. A two-part regression model was used. In the first part, logistic regression analysis was applied to investigate the association between willingness to pay and sets of independent variables (caregiver's demographics, caregiver's socioeconomic resources and caregiving context). In the second part, a generalized linear model (log-link and gamma distribution) was applied to determine the adjusted mean willingness to pay.

RESULTS

More than half of the participants from both countries of our study were willing to pay out of pocket for digital support services. A recommendation by a healthcare professional was the top factor that may motivate caregivers' willingness to pay an additional amount for a paid version of a digital support service. In both countries, the majority of the respondents believe that the government should allocate more funds for digital support services and for improving digital infrastructures. Caregiver' s gender, care recipient relationship to the caregiver, care duration, the total household income and the amount spent per month on professional caregiving services are all associated with willingness to pay. For every additional 10 Euro increase in the amount spent per month on professional caregiving services, the odds of willingness to pay an additional Euro for a digital support service increased by 0.60 % in the Italian sample (p= 0.002, 95% CI: 1.002, 1.009) and 0.31% in the Swedish sample (p=0.015, 95% CI: 1.006, 1.057).

CONCLUSIONS

Factors such as demographics, socioeconomic resources and the caregiving context may play a role in caregivers' willingness to pay for digital support services. The digital and social divide may negatively affect caregivers' willingness to pay for digital support services. Policy makers and insurance providers should consider innovative policies to fund digital support services that have been shown to be effective at supporting and improving caregivers' health outcomes via subsidies or other incentives. Future research that evaluates the cost-effectiveness of digital support services is needed in a context of a growing number of informal caregivers and ever scarcer resources.