Willingness to pay for an mRNA-based anti-cancer treatment: results from a contingent valuation study in Israel

BACKGROUND

mRNA technology is currently being investigated for a range of oncology indications. We assessed the willingness to pay (WTP) of the general population in Israel for a hypothetical novel mRNA-based treatment for oncology indications.

METHODS

We used a contingent valuation methodology to elicit WTP using a web-based questionnaire. A sample of adult participants were presented with a hypothetical scenario in which an mRNA-based intervention increased the likelihood of a cure for various cancer types from 20% to 40% (half of the sample), or 60% (the other half of the sample).

RESULTS

531 respondents completed the questionnaire. The mean, median and mode WTP for the proposed hypothetical treatment in both scenarios were ILS65,000 (± ILS114,000), ILS20,000 and ILS50,000, respectively (1USD = 3.4ILS). The WTP was skewed towards zero, and 9.6% of the respondents were not willing to pay any amount. WTP higher amounts was significantly associated with higher income (p < 0.01), self-reported good health (p < 0.05), supplementary health insurance (p < 0.05), Jews compared to other populations (p < 0.01), interest in technology (p < 0.001) and a tendency to adopt medical innovations (p < 0.001). No statistical difference between the 40% vs. the 60% potential cure scenarios was found. Logistic and OLS regressions indicated that age, religion, income, and interest in adopting medical innovations were the best predictors of respondents' WTP.

CONCLUSION

Despite the scientific breakthroughs in oncology treatment over the last few decades, many types of cancer are still incurable. Given the expected development of innovative mRNA-based treatments for cancer, these results should inform policymakers, the pharmaceutical industry and other stakeholders on the future coverage and reimbursement of these technologies incorporating patients' and societal views. To date, WTP considerations have not been given much weight in prioritization of drug reimbursement processes, neither in Israel nor in other countries. As a pioneer in adoption of the mRNA technology, Israel can also lead the incorporation of WTP considerations in this field.

Preference of consumers for higher-grade energy-saving appliances in hierarchical Chinese cities

Promotion of energy-saving household appliances (ESHAs) potentially contributes to optimizing both the total quantity and efficiency of household energy consumption. Differences in urban consumers' preference for higher-grade ESHAs as well as its influencing factors in cities with hierarchical socioeconomic levels remain elusive. Targeting 55 Chinese cities pertaining to three levels of socioeconomic development, we distribute questionnaires designed to cover both demographic and consciousness factors. By combining Contingent Valuation Method and multiple linear regression, the extra willingness to pay (WTP) for Grade-1/2 appliances compared with Grade-3 appliances is measured, and the influence factors on the WTP as well as consumers with highest WTP are identified. The extra WTP for Grade-1 appliances in First-, Second- and Third-level cities is 44.1%, 42.3% and 32.7%, respectively. The influences of age, household income, having children or not and monthly electricity bill parallel the socioeconomic level, while gender and schooling affect differently across socioeconomic levels. Consumers in less developed cities focus more on their affordability for the ESHAs, and in more developed cities have better environmental consciousness. Subsidies for consumers, such as those having master degree or above in First-level and Second-level cities, and having children in Third-level cities will increase their WTP. The findings provide insights for policy interventions aimed at boosting the purchase behavior for ESHAs according to local conditions for control of both household energy consumption and carbon emissions.

Subjective valuation of Iranian women for screening for gene-related diseases: a case of breast cancer

BACKGROUND

About 5-10% of breast cancer cases are attributed to a gene mutation. To perform preventive interventions for women with a gene mutation, genetic screening BRCA tests have recently been implemented in Iran. The present study aimed to determine Iranian women's subjective valuation for screening BRCA tests for early detection of breast cancer to help policymakers to make decisions about genetic screening tests for breast cancer and to know the applicants.

METHODS

An online survey was completed by women older than 30 years old in Tehran, the capital of Iran in 2021. A hypothetical scenario about genetic screening tests for breast cancer was defined. The subjective valuation for the tests was assessed by a willingness to pay (WTP) using the contingent valuation method (CVM) by payment card. Demographics, history of breast cancers, knowledge, and physiological variables were considered as independent variables, and a logistic regression model assessed the relationship between WTP and the variables.

RESULTS

660 women were included. 88% of participants intended to participate in BRCA genetic screening for breast cancer if it were free. The mean WTP for the tests was about $ 20. Based on the logistic regression, income, family history of breast or ovarian cancer, and positive attitude were associated with WTP.

CONCLUSIONS

Iranian women were willing to intend for genetic screening BRCA tests and pay for them as well. The result of the present study is of great importance for policy makers when it comes to funding and determining co-payments for BRCA genetic screening tests. To achieve a high participation rate of women in breast cancer screening plans, a positive attitude should be promoted as a psychological factor. Educational and informative programs can help.

How livelihood capital affects farmers' willingness to pay for farmland non-market value? Evidence from Jianghan Plain, China

Farmland not only provides human being with food and industrial materials, but also has non-market value. However, few studies have explored the impact of livelihood capital configuration and their willingness to pay (WTP) for the farmland non-market value, from farmers' perspective. Based on the field survey data of 434 households in Jianghan Plain, China, this paper divided the research process into two stages to explore the impact of farmers' livelihood capital on their WTP by using binary logistics model and qualitative comparative analysis method of fuzzy sets (fsQCA). The results show that (1) The total livelihood capital of farmers was 2.667, with psychological capital 0.649, natural capital 0.621, social capital 0.127. 79.49% of the households were willing to pay for the farmland non-market value, and the most concentrated range of it is 50-200 yuan/hm². (2) Both social capital and psychological capital had positive impacts on farmers' WTP for the non-market value of farmland protection. (3) There were two livelihood capital configurations that could improve the WTP of farmers. When lacking of human capital, physical capital and psychological capital, the improvement in farmers' financial capital and social capital will improve farmers' WTP. When the natural, financial, and psychological capital are poor, the rich human capital, physical capital and social capital will also increase farmers' WTP. In view of the results, policy implications on livelihood capital structure optimization and ecological compensation system differentiation were proposed.

Environmental benefits of blue ecosystem services and residents' willingness to pay in Khulna city, Bangladesh

Nature-based solutions for urban problems gaining popularity globally. The well-functioning ecosystem could offer a nature-based solution to many urban problems including water, drainage and flooding problems. Therefore, conservation and restoration of urban blue ecosystem components such as pond scape are crucial. This research taking Khulna city of Bangladesh as a case has examined the low-income fringe community's willingness to pay (WTP) for conservation and restoration of pond scape/blue ecosystem service (BES) in their locality from where they benefit. The various types of ecosystem services enjoyed by the local community were identified. To assess the community's WTP for conservation and restoration of pond scape, the payment card approach of the Contingent Valuation Method (CVM) was used. Three environmental attributes were considered to assess the existing condition of the blue ecosystem services in the study area. Findings show that 54% of respondents are not satisfied with the existing conditions of the ecosystem services resulting from the pond scape. Respondent's WTP for eleven types of service facilities was calculated. Results show that only 65.20% are eager to pay an amount of 38 Tk to 138 Tk per month for different service facilities. It means about one-third of the community people want to be free riders. The influences of different attributes of the respondents on their WTP were also analyzed. Education, income, and house-ownership appear to have a positive significant influence on WTP for conservation and restoration of pond scape in the study area. In line with the findings if policy measures are taken without further delay it would help conserve the remaining pond scape.

Willingness to pay for construction and demolition waste from buildings in Chile

In order to encourage increased rates in respect of sorting, recycling and the diversion of construction and demolition waste (C&DW), the world's more advanced economies have developed innovative new technologies and studies to improve the creation of sustainable societies. To achieve this, it is important to dedicate greater efforts to the elaboration of tariff schemes and studies to determine society's disposition to improve the management of C&DW. This study analyzes willingness of construction companies in Chile to pay (WTP) to improve the C&DW management, through the contingent valuation method (CVM). This aims to provide analytical background and market information to circular business models and, in turn, provide information which can be used to define public policies governing the subject, as a contribution to future regulatory developments. The Chilean construction industry was surveyed and a total of 57 valid questionnaires were collected. The results show that the average WTP for inert C&DW, non-inert C&DW, mixed C&DW with a greater quantity of inert waste and mixed C&DW with a greater quantity of non-inert waste was 8.77 (US $/ton), 7.73 (US $/ton), 7.98 (US $/ton) and 8.22 (US $/ton), respectively. Additionally, the cost of waste removal and disposal had an average value of 9.68 (US $/ton). Through multiple regression analysis, it was discovered that the variables related to knowledge about circular economy, state actions, management of C&DW and productivity have a significant effect on WTP. These results provide new evidence for the development of appropriate public policies to address the problem of C&DW and improve management in Chile.

Identifying the status and differences between urban and rural residents' behaviors and attitudes toward express packaging waste management in Guangdong Province, China

With the rapid development of the express delivery industry, the environmental issues of express packaging waste (EPW) have gradually attracted public attention worldwide. As important participants, consumers' behaviors and attitudes will play a vital role in solving the problem. This study uses the conditional value method (CVM) to evaluate the differences in the attitudes and willingness to pay of urban and rural residents toward EPW in Guangdong Province, China. The results show that the respondents have limited knowledge of the recycling situation, relevant policies and environmental impacts of express delivery packaging, although more than 60% of respondents do think that there is a problem with excessive packaging. The low recycling rate for packaging materials is mainly attributed to the lack of recycling facilities and publicity on environmental issues. The differences between urban and rural residents are mainly over disposal methods, the views on excessive packaging and willingness to pay (WTP) for EPW. Finally, the WTP values of urban and rural residents choosing a "deposit" system are 1.58 ($0.24) and 1.79 yuan ($0.28) per piece, respectively, while the WTP values (for increased fees) are 0.64 yuan ($0.10) and 0.60 yuan ($0.09) per piece, respectively. The obtained results may serve as a reference for different regional responses to the promotion and improvement of EPW management in the future.

Is there any demand for improved cooking stoves? Evidence from Bangladesh

Despite the multifarious benefits of improved cooking stoves (ICSs) over traditional biomass stoves, the ICSs adoption rate in rural Bangladesh remains nominal. This paper provides evidence that there is a growing demand for this environmentally friendly and less-hazardous stove. Using a discrete choice experiment (DCE) technique, we surveyed 259 sample households in the south-western region of Bangladesh. The results from the mixed logit model suggest that households are willing to pay (WTP) about $7 on average for a 'realistic' (i.e., one unit or 25 %) reduction in fuel consumption and smoke emission. Moreover, we found that a one-unit (33 %) reduction of cooking time and maintenance frequency increases households' WTP by about $3 and $5 respectively. Finally, this study underscores that extensive promotion, lower installation costs and higher social awareness about health risks and environmental degradation are likely to promote ICSs adoption.

Meta-analysis of consumers' willingness to pay for sustainable food products

There is a continuous increase in the number of studies dealing with consumers' willingness to pay (WTP) price premiums for sustainable food products. This research focused on a broad area of sustainable food products, including different sustainable attributes using a meta-analysis of 80 worldwide studies. The publication bias was verified using the funnel plot and Egger's test. In addition, the subgroup analysis and meta-regression were applied to classify the source of heterogeneity. The results suggest that the overall WTP premium for sustainability (in percentage terms) is 29.5% on average. Furthermore, gender, region, sustainable attributes and food categories influence the average WTP estimates and their heterogeneity. Results also indicate that the WTP estimate conducted by hypothetical approach (choice experiment and contingent valuation method) is higher than non-hypothetical one due to hypothetical bias. In addition, the WTP estimate from the CVM is higher than that from the CE. Additionally, the WTP value of organic attribute is higher than the other sustainable attributes. The subgroup analysis indicates that the fruit &vegetable category has the highest WTP estimate while the seafood receives the lowest one. Results also highlight that Asian WTP estimates, in percentage terms, are higher than those obtained in North America and similar to those from Europe. In addition, positive WTP estimates are shown independent of the food categories, region or methods, denoting the presence of great market potential for sustainable products worldwide. The findings of this research can be used as a guide by food producers, marketers and policymakers when making decisions related to the sustainability of food products.

Valuing inland blue space: A contingent valuation study of two large freshwater lakes

Water bodies, or blue spaces, offer a range of health and well-being benefits. Many of these benefits occur in waterside spaces and do not require direct water contact. For example, non-water based physical activity (e.g. walking and running) and reduced stress as a result of viewing water from a distance. However, research dedicated to understanding the economic impact of changes to freshwater ecosystems predominantly focuses on water-based recreation and water quality. As a result, the economic impacts of changes to waterside space are often overlooked. This study used the contingent valuation method to determine public preference for the protection of lakeside quality, in terms of lake views, path quality and lakeside access, at two large freshwater lakes in Scotland (Loch Lomond and Loch Leven). The aim of the study was to estimate willingness to pay among a sample of adults in Scotland (n = 1056) for the protection of lakeside quality. Results indicate that the majority of respondents are willing to pay for the preservation of lakeside quality at each lake. Based upon the most conservative estimates obtained, mean willingness to pay for the protection of lakeside quality was £12.06 per household per year at Loch Lomond and £8.44 at Loch Leven. These findings provide valuable economic data and suggest that changes to waterside space at destination water bodies have nationally important economic impacts. Greater consideration of the economic impact of changes to lakeside space is recommended in order to develop cost-effective and socially optimal water resource management policies at large freshwater lakes.

Uncovering residents' behaviors, attitudes, and WTP for recycling e-waste: a case study of Zhuhai city, China

China is among the countries facing the most serious pollution effects of e-waste. Many studies have focused on e-waste recycling laws and regulations, recycling technologies, and the pollution situation in China. However, there is a lack of case studies from the perspective of the residents' attitudes and opinions about e-waste recycling. Based on 474 families surveyed by questionnaire, this study, taking Zhuhai City as one example, investigated residents' behaviors and attitudes toward e-waste disposal, and their willingness to pay (WTP) for e-waste recycling. A majority (76.4%) of respondents realized that the improper treatment of e-waste would cause serious threats to the environment and human health. Only 38.2% of respondents were willing to pay for e-waste recycling. Most respondents believed that the fee should be borne by government and manufacturers. These results imply that income level and satisfaction with management will promote WTP significantly, whereas the recovery price is a negative influence on the respondents' WTP. The WTP values were positively correlated with environmental awareness and income at 5% and 10%, respectively. Finally, the estimated average monthly WTP value per household in Zhuhai City is 10.2 RMB ($1.6).

Valuation of ecosystem services using choice experiment with preference heterogeneity: A benefit transfer analysis across inland river basin

River ecosystem services offer a variety of benefits to the inhabitants of inland areas. For the valuation of environmental goods and services in the context of attaining a better environmental status across Heihe River basin (HRB), Northwest of China by 2020, a survey was conducted employing choice experiment approach across the entire river basin. The selected ecological attributes were defined in combination with ecological improvements in the three sub-basins namely upper, middle and lower sub-basins. For estimating spatial preference heterogeneity, the benefits for the inhabitants were estimated by conditional logit and mixed logit models. Results indicated that the willingness to pay (WTP) estimates for river water quality, farmland irrigation, sandstorm days, lake area, biodiversity, landscape and leisure & entertainment were significantly different across sub-basins. The WTP for water quality in upper basin was RMB 126.6 per year, while in middle and lower sub-basin was RMB 97.1 and 66.4 per year respectively. The estimates of mixed logit model indicated the reduced transfer errors with the insertion of taste heterogeneity. However, transferring benefits from middle sub-basin to upper sub-basin the estimated transfer errors were 27.3%, from lower to middle the transfer errors were 23.4% and from upper to lower the transfer errors were 14.1%. Our obtained results recommend the transferability of non-market benefits among sub-basins.

Spatial heterogeneity of ecosystem services: a distance decay approach to quantify willingness to pay for improvements in Heihe River Basin ecosystems

The growing appreciation of distance decay as an important parameter necessary for estimating willingness to pay (WTP) is hugely recognized in the literature. In this paper, we estimated the extent to which distance decay and individual's socioeconomic characteristics influence the WTP for restoration of environmental quality attributes in the Heihe River Basin. A choice experiment technique was used to evaluate the household's WTP for the improvements in local environmental attributes. The results of mixed logit model significant impact of distance on the individual's WTP for the improvements in environmental attributes. Findings of the study revealed that people living within 25 km from the river are willing to pay more for an increase in the river water quality level, a reduction in sandstorm days, and an increase in the area of the east Juyan Lake than the people living within the range of 50 km and much more compared to 50 km away from the river. Based on the socioeconomic characteristics, it is concluded that the level of education, age, household's annual income, and household size have a significant effect on the WTP. Results of the implicit prices for each attribute showed the preferences of the inhabitants for every attribute, where the highest WTP in pooled data was recorded for river water quality level (i.e., RMB 124.81/year) and the lowest for leisure and entertainment (i.e., RMB 0.40/year). The highest WTP for water quality suggests that water quality level was the most favored attribute compared to others, subject to the given conditions of water quality and the river basin.

Exploring the spatial heterogeneity of individual preferences for integrated river basin management: an example of Heihe river basin

This study mainly focuses on welfare impacts from improving considerably degraded river stretches of Heihe river basin and to determine the impact of spatial heterogeneity on willingness-to-pay (WTP) for integrated river basin management (IRBM). The significant WTP values for ecological attributes improvement revealed that the respondents of Heihe river basin significantly support the integrated ecological restoration program. However, socioeconomic characteristics and residential location have a significant impact on WTP values for different ecological attributes. The results demonstrate that water quality is the most preferred variable among all the river attributes in the study area. For example, in Zhangye, Gaotai, Ejinaqi, Minle, and Sunan the respondents were willing to pay 90.6, 160.44, 377.15, 65.40, and 139.21 Yuan per year, respectively, for a one-grade improvement in current water quality. Our findings also show that all the major counties of the basin concern more about water quality representing the relative importance of river water and express the maximum WTP for its improvement, while all major counties also share a low WTP for improvements in conditions of the leisure and entertainment. The differences in socioeconomic characteristics and ecological status of the respondents partially explain the disparity in utility from IRBM. In conclusion, the results based on only specific sub-basin of river basin may over or underestimate the welfare estimate.

The acceptance and willingness to pay (WTP) for hypothetical dengue vaccine in Penang, Malaysia: a contingent valuation study

BACKGROUND

Malaysia has been experiencing an escalation in dengue cases since the past 5 years. As the dengue vaccine pipeline continues to develop steadily with strong public interests, this study had been sought to elicit the acceptance and the willingness to pay (WTP) for hypothetical dengue vaccine in Malaysia.

METHODS

This study adopted the cross-sectional, contingent valuation study that involved 400 respondents in Penang, Malaysia. The double-bounded dichotomous choice via bidding game approach was employed to elicit the WTP value for two hypothetical 3-doses dengue vaccines (Vaccines A and B with 5- and 10-years' protection, respectively against dengue). A univariate logistic regression model was employed to assess the key determinants of vaccine acceptance, while the mean WTP value and its associated factors were measured by using the parametric two-part model (TPM).

RESULTS

Dengue vaccine appeared to be highly acceptable (88.4%) among the population in Penang, Malaysia. Respondents who were of Chinese ethnicity (OR 0.36, p = 0.017), with higher dengue knowledge score (OR 1.43, p = 0.016), and higher vaccination attitude score (OR 1.91, p < 0.001) were more likely to accept the vaccine. The first step logit estimation from TPM displayed that pensioners (OR 2.37, p = 0.036), respondents who were self-employed or working in the private sector (OR 1.21, p = 0.002), respondents with higher education level (OR 2.09-3.29, p < 0.05), and those who accepted the vaccine (OR 3.23, p = 0.001) were more likely to pay for the vaccine. The adjusted mean WTP value for the vaccine was MYR39.21 (USD9.45) per dose. Next, the second-stage regression from TPM revealed the key factors that significantly affected the WTP value, which were composed of age, gender, occupation, household income, dengue prevention practice, and protection duration of the vaccine. The pensioners and those with better dengue prevention practice were willing to pay more for the vaccines. Additionally, all the respondents elicited a higher WTP amount toward the vaccine with longer protection duration (Vaccine B).

CONCLUSION

Strong acceptance toward dengue vaccine reflects the high value of the vaccine in Malaysia. The WTP estimates offer quantification of the private benefit in reducing occurrences of the disease. Besides, the people's preferences-based WTP value for the vaccine tends to complement scientific decision-making and prioritization in the management of dengue in the country.

Ecological degradation of an inland river basin and an evaluation of the spatial and distance effect on willingness to pay for its improvement

Improvements in the ecological attributes of inland rivers have been projected to provide considerable non-market benefits, and the monetary valuation of these attributes has steadily increased over the past several decades. The present study addresses the spatial heterogeneity of the public's preference for ecological attributes and the distance-decay effect of willingness to pay (WTP) to improve various attributes of the river basin. The results revealed that spatial heterogeneity exists among the individuals; for example, the respondents of Liangzhou County prefer a large improvement in the natural landscape, forest coverage, and eco-tourism and are willing to pay 491.89, 369.32, and 338.37 yuan per year, respectively, for one unit improvement in these ecological attributes. Similarly, the respondents of Jinchang County value and are willing to pay 447.60, 431.81, and 318.18 yuan for one unit improvement in tourism, forest coverage, and natural landscape, respectively. Furthermore, the results from the random parameter logit model show a significant distance-decay effect of the household WTP for ecological attributes. For example, the respondents living within 5 km of the river are willing to pay more money, that is, 832.61, 365.62, and 353.05 yuan per year for improving the natural landscape, water quantity, and grass cover, respectively. As the distance from the river increases, the corresponding WTP decreases, meaning that the respondents (users) living near the Shiyang River Basin are willing to pay more for ecological attribute improvement than those living far away from the river.

Willingness to pay for higher construction waste landfill charge: A comparative study in Shenzhen and Qingdao, China

High landfill charge presents an effective approach to divert construction waste from landfill. The stakeholders' willingness to pay (WTP) for the disposal of construction waste in landfill provide the useful information to set a reasonable charge level. Considering the diversity in stakeholder groups and regional socioeconomic conditions, contingent valuation method (CVM) was employed in this study to investigate the WTP of two major stakeholder groups in two typical Chinese cities. In addition, the perception of stakeholders towards landfill charge policy was measured and the impact of various factors on WTP was explored. The results indicated that there were statistically significant disparities of WTP between cities and stakeholder groups. Stakeholders from Shenzhen were willing to pay more than their counterparts in Qingdao. Contractors were willing to pay less than owners. Respondents who evaluate the policy as effective in reducing construction waste landfill were willing to pay more. However, firm size, ownership, position of respondent and perceived equity factors did not show statistically significant effect on WTP. These findings highlight the necessity to customize landfill charge policy according to local socioeconomic conditions.

Patients' attitude and willingness to pay for pharmaceutical care: An international message from a developing country

BACKGROUND

Since patients are essential partners in determining priorities and resource allocation in the healthcare system, considerable efforts have been made to shift the focus of pharmacy profession from drug dispensing to patient-oriented care. Accordingly, the assessment of patient-oriented care has become a prominent method to evaluate the quality of the healthcare services delivered and willingness to pay (WTP) to receive them.

OBJECTIVE(S)

To determine patients' attitude towards pharmaceutical care services among general population in Jordan and their WTP for this service.

METHODS

A cross-sectional study was conducted in a teaching hospital in Jordan over a period of six months. A contingent valuation method was used, with closed-ended questions to elicit participants' attitudes and WTP for pharmaceutical care services.

RESULTS

A total of 223 participants were interviewed. Most of the participants showed a positive attitude towards pharmaceutical care services, with an average attitude score of 0.82 (±0.19). Almost 96.0% of participants believed that pharmacists must be committed to more counseling roles than dispensary activities. The majority of participants (194, 87.0%) expressed their interest in pharmacists checking their medications at least once per month. Most of the participants (212, (95.1%) believed that the pharmacist should be reimbursed for providing a pharmaceutical care service that would potentially reduce medication-related problems (MRPs) by 50%. Of these, 208 (93.3%) participants were willing to pay out of their pockets an average maximum amount of $3.95 (±4.23) for the pharmaceutical care services they may receive to reduce 50% of the risk of MRPs.

CONCLUSIONS

This study revealed that Jordanian people have a supportive attitude regarding pharmacists' abilities in providing pharmaceutical care services in addition to dispensing. Majority of participants in this study were willing to pay for pharmaceutical care services that would reduce the risk of MRPs.

Consumer interest in environmental impact, safety, health and animal welfare aspects of modern pig production: Results of a cross-national choice experiment

Are consumers interested in aspects of pig production and do they take these into account in their buying decisions when such information is available? Samples of consumers in Germany and Poland selected the two - for them - most important out of a list of ten production characteristics, relating to animal welfare, health and safety, and environmental issues. In a subsequent choice experiment, the relative weight these characteristics had in consumers' choices was estimated. Relative importance of production characteristics varied between consumer segments, with the production interested segment being bigger in Germany than in Poland. With the exception of one animal welfare related criterion in Germany, those production characteristics that consumers perceive as most important relate to health and safety aspects rather than to animal welfare and environmental impact.

Measuring the Monetary Value of Dental Implants for Denture Retention: A Willingness to Pay Approach

Purpose:

Two interforaminal dental implants in is a common treatment option for denture retention in edentulous patients. Economic methods to assess the patient’s quality of life include the willingness to pay (WTP) for implant treatment and willingness to accept (WTA) to forgo implant treatment. The purpose of this study was to assess the monetary value of implant retained complete dentures using WTP and WTA.

Methods:

We included a convenience sample of 16 patients from a previously published cohort study on the survival of immediately loaded implants in edentulous patients to assess WTP and WTA for this treatment option.

Results:

The average maximum WTP for implant treatment was 4606 (95% CI: 2991-6222) Swiss Francs. Out of the 16 patients, only 5 were willing to trade their implants for money, with a mean WTA of CHF 33'500 (range: 3000-100'000).All patients would agree to undergo the implant surgery procedure again.

Conclusion:

The results of the present study show that most patients are not willing to trade the increase in quality of life after implant surgery against money, suggesting that WTA exceeds by large WTP for the same health condition.

A Comparative Study on Willingness to Pay for Breast Cancer and Osteoporosis Screening in Kerman, Southeastern Iran

BACKGROUND

One of the economic evaluation techniques involves calculation of willingness to pay (WTP) for a service to find out the value of that service from the clients' perspective. This study estimated WTP for both breast cancer and osteoporosis screening and comparatively examined the contributing factors. In fact, the comparisons served to provide an exact analysis of individual attitudes and behaviors in relation to screening programs for cancers and other diseases.

METHODS

This study was first designed in six scenarios several questionnaires concerning individual breast cancer and osteoporosis screening cases, and determined the WTP median in each scenario between people in Kerman Province of Iran in 2016. Then, the demand function for breast cancer and osteoporosis screening was formulated. Moreover, the factors contributing to WTP were examined through various scenarios in Stata and econometric techniques.

RESULTS

The median and mean values of WTP in all the above scenarios were greater for breast cancer screening than for osteoporosis screening. Theoretically, the price assumed a minus sign whereas risk assumed a plus sign within the demand function formulated for both screening programs. Regarding the evaluated factors, age in breast cancer screening and risk of disease in osteoporosis screening were the major factors contributing to WTP.

CONCLUSION

Breast cancer screening was more valuable than osteoporosis screening program from the perspective of the subjects. The programs can be successfully designed by concentrating on patients' age groups in breast cancer screening and high-risk patients in osteoporosis screening.

Do agents' characteristics affect their valuation of 'common pool' resources? A full-preference ranking analysis for the value of sustainable river basin management

In this paper we develop a full-preference ranking Choice Experiment (CE) designed to investigate how respondents evaluate a set of proposed improvements towards sustainable river basin management, as per the prescriptions of the European Union-Water Framework Directive (2000). The CE is applied in the Asopos River Basin (ARB) in Greece. Our interest is to test whether residency in the river basin, or otherwise, affects the preferences of the relevant agents. We first estimate a rank-ordered logistic regression based on a full set of choices in order to calculate the willingness to pay (WTP) of respondents for each one of the three attributes considered in the CE (i.e., environmental conditions, impact on the local economy and changes in the potential uses of water). The model is initially estimated for the full sample and then re-estimated twice for two sub-samples: the first one only includes the residents of Athens and the second only includes the residents of Asopos. Afterwards, we examine the effect of various demographic and socio-economic factors (such as income, gender, age, employment and education) on the estimates of our model in order to reveal any differences among respondents with different characteristics, mainly focusing on whether they reside or have personal experience of the RB under valuation. Thus, our analysis simultaneously provides a robustness check on previous findings in the literature and additional information about how various demographic and socio-economic characteristics affect the evaluation of the selected attributes.

What, who and when? Incorporating a discrete choice experiment into an economic evaluation

BACKGROUND

Economic evaluation focuses on Quality-Adjusted-Life-Years (QALYs) as the main valuation method. However, it is well known that factors beyond health related quality of life are important to patients and the public. Whilst discrete-choice-experiments (DCE) have been extensively used to value such factors, their incorporation within an economic evaluation framework is limited. This study is the first to incorporate patient preferences for factors beyond QALYs into an economic evaluation and compare results with the standard cost-per-QALY approach, using randomised-controlled-trial (RCT) participants.

METHODS

Costings, clinical-effectiveness (appropriateness-of-treatment), QALYs and patient satisfaction data were collected at baseline and 12-month follow-up for a new pharmacy-service within a randomised-controlled-trial. Trial participants who replied to the follow-up survey and had not subsequently withdrawn from the study were mailed a DCE questionnaire at 24-months. WTP for the standard and new service was derived from the DCE. Results from QALYs and the DCE were compared.

RESULTS

At 12 months, costs, clinical-effectiveness and QALYs did not differ between the intervention and control; however there was a significant increase in satisfaction in the intervention. The DCE valued this increased satisfaction in the intervention (positive net-benefit). The longer the time patients experienced the new service the greater the reported net-benefit.

CONCLUSION

When incorporating a DCE into an economic evaluation a number of questions are raised: what factors should be valued, whose values (trial-groups vs. all-trial-population) and when should they be elicited (still-receiving-the-intervention or afterwards). Consideration should also be given to status quo bias.

Government employees' perception of urban air pollution and willingness to pay for improved quality: a cross-sectional survey study in Nanchang, China

To improve the public's awareness of urban air pollution and promote establishment of more efficient policy toward urban air pollution, we investigated the government employees' perceptions of current urban air pollution and their willingness to pay (WTP) taxes for improved quality in Nanchang, China. Stratified cluster sampling strategy was used to distribute 629 questionnaires, and 608 were completed anonymously, yielding a 96.7 % response rate. Descriptive statistics frequencies and proportions were used to summarize the sample characteristics, and logistic regression models were performed to assess the associations of perception of urban air quality and WTP versus demographic variables. We found low awareness of urban air pollution (34.5 %) as well as low WTP (44.9 %), especially among the middle aged people (age 30-39 and age 40-49). Our study shows that female employees have better awareness of urban air pollution but much less willingness to pay for air quality improvement. Majority of the government employees showed their support to the government for more effective policies toward environmental protection, indicating more enhanced public education and environmental protection campaigns to improve the public's awareness of air pollution and work with every citizen to improve air quality. This study also obtained baseline information useful to the local regional and even national government in developing nations in their attempt to control urban air pollution in future.

Satisfaction with in vitro fertilization treatment: patients' experiences and professionals' perceptions

BACKGROUND

This paper investigates patients' satisfaction with various aspects of fertility care and seeks to determine to what extent fertility specialists are able to assess patient satisfaction. Patients' experiences with in-vitro fertilization (IVF) services and facilities have been compiled and examined in order to discover whether patients' satisfaction is correlated to psychological factors and demographic, socio-economic, and health characteristics, and whether patients' satisfaction has an influence on the willingness to pay (WTP) for IVF treatment.

METHODS

The study was carried out on 204 patients and 19 fertility professionals from 8 public IVF units in Israel.

RESULTS

The study found that, overall, infertile patients are satisfied with the care they received. Several demographic variables (age; education; income; number of fertility treatments) and psychological factors ('Pessimism' and 'Activeness'), were found to be significantly correlated with patient satisfaction with IVF. The results yielded a negative correlation between the WTP for IVF treatment and the satisfaction with access to care and physical conditions.

CONCLUSIONS

Patient satisfaction is an important component in the evaluation of fertility treatments as well as other medical interventions. Insights into the quality of care as seen from the patients' perspective may help healthcare staff better meet patients' needs, wishes, and priorities.

Farmers' willingness to pay for less health risks by pesticide use: A case study from the cotton belt of Punjab, Pakistan

The amount of pesticides used in crop production in Pakistan has increased rapidly in the last decades, whereas farmers in many areas of the country show little knowledge of safe and efficient use of pesticides. The level of willingness to pay (WTP) for avoiding health risks by pesticides was studied among 318 randomly selected cotton farmers from two districts of the area of Punjab (i.e., Vehari and Lodhran) in Pakistan, using the contingent valuation method. Most farmers felt that pesticide use is a prerequisite for successful cotton production, whereas at the same time they were well aware of pesticide health risks, which they considered minor. The majority of the farmers (77%) showed varying levels of WTP some fee up to 20% of the current pesticide expenditures for avoiding pesticide health risks, but few were willing to pay a fee over 20%. The mean WTP per farmer was low, reaching 5.8 $US on an annual basis. By contrast, a considerable proportion of the farmers (23%) were not willing to pay any fee for avoiding pesticide health risks. These individuals were mostly poor small-scale farmers with limited or no education. High levels of risk perception about pesticides, past experience of pesticide intoxication, high levels of education, and high income were associated with high farmers' WTP for less health risks by pesticides. Farmers who perceived major health risks by pesticides appeared to be highly willing to pay a premium for safe pesticides. Elderly farmers appeared more likely to pay some premium for safe pesticides as a result of higher farming experience and higher income than young farmers. Well-educated farmers were more likely to pay a high premium for safe pesticides. Large farm size was a significant predictor of positive WTP, which was interpreted as an indicator of farmers' wealth.

Willingness to pay for telecare programmes to support independent living: results from a contingent valuation study

An ageing population provokes an economic interest in the resource allocation questions posed by long-term care and critically, the development of sustainable community-based health and social care models that support independent living. This paper explores Irish citizens preferences and willingness to pay (WTP) for a range of community-based care programmes, including different telecare programmes that support older people to continue living at home. The paper reports on a cross-sectional multi-good contingent valuation survey conducted between April and September 2009 with three representative samples of the Irish population (N = 1214) to identify rankings and preferences for different community care programmes including: family care programme, a state-provided care programme and three different telecare programmes. The survey design permits the identification of strength, direction and relative preferences of different forms of community care provision. We also investigate convergent validity between ranking and willingness to pay results. We find that while people place significant value on formal state care provision and on telecare programmes, willingness to pay (WTP) estimates continue to highlight the importance of family care, which remains the strongest preference of the Irish population for the provision of community-based care for older people in the country. Respondents weakened their ranking preferences in the WTP exercise. However, both the direction of ranking and WTP estimates confirm the importance of family care. While all telecare programmes generated some economic value, telecare associated with social connection had much stronger support than telecare used to support physical or cognitive care needs. This paper offers unique information on societal values for different forms of community care provision, and in particular, the direction of preferences for technology-based approaches.

Arsenic mitigation in Bangladesh: an analysis of institutional stakeholders' opinions

While Bangladesh made significant achievements in safe water coverage via installation of shallow tubewells (STWs) nationwide, this success was shattered by the discovery of arsenic (As) in the STWs. The extent and severity of As groundwater contamination throughout Bangladesh and its detrimental effects on human health are well known and demand long-term sustainable mitigation. It is an immensely complex and expensive task to bring tens of millions of arsenic exposed people under safe water coverage. While various mitigation measures have been undertaken by various organizations, most have not achieved their expected outcomes due to technical, spatial and socio-economic challenges. Better understanding of these challenges by institutional stakeholders is crucial for sustainable arsenic mitigation in Bangladesh. In this study, institutional stakeholders' opinions on various aspects of As mitigation were elicited to identify their preferences for and reservations of specific mitigation measures. The current status of As mitigation activities and the factors influencing the success of As mitigation were also explored. Institutional weakness, lack of accountability and a latency period were the major factors hindering sustainable As mitigation. The results also suggested that the stakeholders' understanding of the As problem and their preferences for the different mitigation measures have a significant impact on the effectiveness of As mitigation. Mitigation of As contamination is a complex issue that requires a coordinated effort from various levels of stakeholders. The concept of "paying for water", which is currently potentially unknown in the rural areas of Bangladesh, also needs to be developed as this will create a stronger sense of user ownership of As safe water and thus better water management.

Estimating a WTP-based value of a QALY: the 'chained' approach

A major issue in health economic evaluation is that of the value to place on a quality adjusted life year (QALY), commonly used as a measure of health care effectiveness across Europe. This critical policy issue is reflected in the growing interest across Europe in development of more sound methods to elicit such a value. EuroVaQ was a collaboration of researchers from 9 European countries, the main aim being to develop more robust methods to determine the monetary value of a QALY based on surveys of the general public. The 'chained' approach of deriving a societal willingness-to-pay (WTP) based monetary value of a QALY used the following basic procedure. First, utility values were elicited for health states using the standard gamble (SG) and time trade off (TTO) methods. Second, a monetary value to avoid some risk/duration of that health state was elicited and the implied WTP per QALY estimated. We developed within EuroVaQ an adaptation to the 'chained approach' that attempts to overcome problems documented previously (in particular the tendency to arrive at exceedingly high WTP per QALY values). The survey was administered via Internet panels in each participating country and almost 22,000 responses achieved. Estimates of the value of a QALY varied across question and were, if anything, on the low side with the (trimmed) 'all country' mean WTP per QALY ranging from $18,247 to $34,097. Untrimmed means were considerably higher and medians considerably lower in each case. We conclude that the adaptation to the chained approach described here is a potentially useful technique for estimating WTP per QALY. A number of methodological challenges do still exist, however, and there is scope for further refinement.

Willingness to pay for voluntary community-based health insurance: findings from an exploratory study in the state of Penang, Malaysia

Health care in Malaysia is funded primarily through taxation and is no longer sustainable. One funding option is voluntary community-based health insurance (VCHI), which provides insurance coverage for those who are unable to benefit immediately from either a social or private health insurance plan. This study is performed to assess the willingness of Malaysians to participate in a VCHI plan. A cross-sectional study was performed in the state of Penang between August and mid-September 2009 with 472 randomly selected respondents. The respondents were first asked to select their preferred health financing plan from three plans (out-of-pocket payment, compulsory social health insurance and VCHI). The extent of the household's willingness to pay for the described VCHI plan was later assessed using the contingent valuation method in an ex-ante bidding game approach until the maximum amount they would be willing to pay to obtain such a service was agreed upon. Fifty-four per cent of the participants were female, with a mean age of 34 years (SD = 11.9), the majority of whom had a monthly income of Int$1157-2312. The results indicated that more than 63.1% of the respondents were willing to join and contribute an average of Int$114.38 per month per household towards VCHI. This amount was influenced by ethnicity, educational level, household monthly income, the presence of chronic disease and the presence of private insurance coverage (p < 0.05). In conclusion, our study findings suggest that most Malaysians are willing to join the proposed VCHI and to pay an average of Int$114.38 per month per household for the plan.