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Zhou W, Guo X, Lu J, Lu X, Fu X, Lu Y. 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. Vaccine 2024; 42:2246-2253. [PMID: 38423812 DOI: 10.1016/j.vaccine.2024.02.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
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.
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Affiliation(s)
- Weiyu Zhou
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety (Fudan University), School of Public Health, Fudan University, Shanghai 200032, China
| | - Xiang Guo
- Institute of Immunization Planning, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - Jia Lu
- Department of Immunization Planning, Minhang District Center for Disease Control and Prevention, Shanghai 201101, China
| | - Xinyue Lu
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety (Fudan University), School of Public Health, Fudan University, Shanghai 200032, China
| | - Xiaoya Fu
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety (Fudan University), School of Public Health, Fudan University, Shanghai 200032, China
| | - Yihan Lu
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety (Fudan University), School of Public Health, Fudan University, Shanghai 200032, China.
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Peasgood T, Howell M, Raghunandan R, Salisbury A, Sellars M, Chen G, Coast J, Craig JC, Devlin NJ, Howard K, Lancsar E, Petrou S, Ratcliffe J, Viney R, Wong G, Norman R, Donaldson C. Systematic Review of the Relative Social Value of Child and Adult Health. PHARMACOECONOMICS 2024; 42:177-198. [PMID: 37945778 PMCID: PMC10811160 DOI: 10.1007/s40273-023-01327-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES We aimed to synthesise knowledge on the relative social value of child and adult health. METHODS Quantitative and qualitative studies that evaluated the willingness of the public to prioritise treatments for children over adults were included. A search to September 2023 was undertaken. Completeness of reporting was assessed using a checklist derived from Johnston et al. Findings were tabulated by study type (matching/person trade-off, discrete choice experiment, willingness to pay, opinion survey or qualitative). Evidence in favour of children was considered in total, by length or quality of life, methodology and respondent characteristics. RESULTS Eighty-eight studies were included; willingness to pay (n = 9), matching/person trade-off (n = 12), discrete choice experiments (n = 29), opinion surveys (n = 22) and qualitative (n = 16), with one study simultaneously included as an opinion survey. From 88 studies, 81 results could be ascertained. Across all studies irrespective of method or other characteristics, 42 findings supported prioritising children, while 12 provided evidence favouring adults in preference to children. The remainder supported equal prioritisation or found diverse or unclear views. Of those studies considering prioritisation within the under 18 years of age group, nine findings favoured older children over younger children (including for life saving interventions), six favoured younger children and five found diverse views. CONCLUSIONS The balance of evidence suggests the general public favours prioritising children over adults, but this view was not found across all studies. There are research gaps in understanding the public's views on the value of health gains to very young children and the motivation behind the public's views on the value of child relative to adult health gains. CLINICAL TRIAL REGISTRATION The review is registered at PROSPERO number: CRD42021244593. There were two amendments to the protocol: (1) some additional search terms were added to the search strategy prior to screening to ensure coverage and (2) a more formal quality assessment was added to the process at the data extraction stage. This assessment had not been identified at the protocol writing stage.
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Affiliation(s)
- Tessa Peasgood
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Martin Howell
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia.
| | - Rakhee Raghunandan
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia
| | - Amber Salisbury
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia
| | - Marcus Sellars
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - Joanna Coast
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nancy J Devlin
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia
| | - Emily Lancsar
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Rosalie Viney
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
| | - Germaine Wong
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Cam Donaldson
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
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3
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Somta S, Völker M, Widyastari DA, Mysook S, Wongsingha N, Potharin D, Katewongsa P. Willingness-to-pay in physical activity: how much older adults value the community-wide initiatives programs? Front Public Health 2023; 11:1282877. [PMID: 38026321 PMCID: PMC10644721 DOI: 10.3389/fpubh.2023.1282877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background Previous studies have shown insufficient physical activity (PA) as a significant global health concern and a major risk factor for non-communicable diseases (NCDs). Community-wide initiatives in physical activity (CWIPA) is considered as a best-buy for Community-wide initiatives in physical activity (CWIPA) is considered as a best-buy for NCDs prevention. However, assessment regarding resource allocation and cost-effectiveness of existing programs is lacking. This study investigated local residents' willingness-to-pay (WTP) for community PA programs in Southern Thailand. Methods The contingent valuation method (CVM) using the payment card approach was employed to elicit the WTP of 472 residents aged 45 years and over in selected provinces in which community PA programs had been implemented. Respondents were asked to indicate their WTP for the continuous offering of free CWIPA by choosing how much they were willing to pay from eight bid-value options, payable through their monthly electricity bill. Results The mean WTP of Thai older adults was found to be 72 baht/month ($2/month) or 868 baht/year ($25/year). This indicated the maximum amount an older person was willing to pay for any community-based PA program. More than half the sample (54.2%) chose zero as their answer, while there was a fairly large variation in other levels of WTP. The WTP was lower among older respondents and those who resided in rural areas but was higher among those with a history of participation in an organized PA program. Conclusion The level of WTP can be interpreted as an indicator of community satisfaction with CWIPA. That finding can be used as evidence for the government and policy makers in allocating resources and designing future CWIPA. A variety of organized PA programs should be offered to all community members to ensure inclusivity and also to provide equal access for senior citizens.
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Affiliation(s)
- Sittichat Somta
- Thailand Physical Activity Knowledge Development Centre (TPAK), Salaya, Nakhon Pathom, Thailand
| | - Marc Völker
- Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | | | - Sirinapa Mysook
- Sisaket Provincial Public Health Office, Mueang, Sisaket, Thailand
| | - Narakorn Wongsingha
- Thailand Physical Activity Knowledge Development Centre (TPAK), Salaya, Nakhon Pathom, Thailand
| | - Danusorn Potharin
- Thailand Physical Activity Knowledge Development Centre (TPAK), Salaya, Nakhon Pathom, Thailand
| | - Piyawat Katewongsa
- Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand
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Long MC. Altruism and the Statistical Value of Human Life for Policy and Regulation. SOCIAL INDICATORS RESEARCH 2021; 160:341-355. [PMID: 34611375 PMCID: PMC8485118 DOI: 10.1007/s11205-021-02784-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED Policymakers use estimates of the Value of a Statistical Life (VSL) in performing regulatory reviews to assess the benefits and costs of policies that affect mortality. This paper empirically estimates an adjustment to conventional VSL measures to account for altruistic sentiments and concludes that conventional VSL measures are underestimated by a factor of two to three, suggesting we are greatly undervaluing life in regulatory reviews. This conclusion is attained by estimating the VSL multiplier suggested by Jones-Lee (Econ J 102(410):80-90, 1992), which hinges on assessing whether individuals are more health altruistic than wealth altruistic. The estimated VSL multiplier is greatest for policies that affect children's mortality, as health altruism is dominant regarding children. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11205-021-02784-7.
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Affiliation(s)
- Mark C. Long
- Evans School of Public Policy and Governance, University of Washington, 1100 NE Campus Parkway, Seattle, WA 98105 USA
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Mussio I, Brandt S, Hanemann M. Parental beliefs and willingness to pay for reduction in their child's asthma symptoms: A joint estimation approach. HEALTH ECONOMICS 2021; 30:129-143. [PMID: 33094866 DOI: 10.1002/hec.4181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 07/27/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
Many aspects of asthma-in particular the relationship between beliefs, averting behaviors, and symptoms-are not directly observable from market data. An approach that combines observable market data with nonmarket valuation to gather data on unobservable aspects of the illness can improve efforts to quantify the burden of asthma if it accounts for the endogeneity in the system. Such approaches are used in the valuation of recreation but have not been widely used to value the burden of a chronic illness. We estimate parents' willingness to pay (WTP) to reduce their child's asthma symptoms using a three-equation model that combines revealed preference, contingent valuation, and burden of asthma, increasing the efficiency of estimation and correcting for endogeneity. WTP for a device that reduces a child's asthma symptoms by 50% is $125/month (s.d. $20). Parents' valuations are driven by beliefs about asthma and by their degree of worry about asthma between episodes. There is a nonlinear relationship between the number of days with symptoms and WTP per symptom day. The experience of living with asthma affects families' responses to a contingent valuation scenario, because it influences willingness to spend money to manage the illness and their subjective perceptions and beliefs about the illness itself.
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Affiliation(s)
- Irene Mussio
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Sylvia Brandt
- School of Public Policy, University of Massachusetts Amherst, Amherst, Massachusetts, USA
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Michael Hanemann
- Department of Agricultural and Resource Economics, University of California, Berkeley, Berkeley, California, USA
- Department of Economics, Arizona State University, Tempe, Arizona, USA
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Myers K, Redere A, Fefferman NH. How resource limitations and household economics may compromise efforts to safeguard children during outbreaks. BMC Public Health 2020; 20:270. [PMID: 32093663 PMCID: PMC7041186 DOI: 10.1186/s12889-019-7968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 11/19/2019] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Epidemiological models have been employed with great success to explore the efficacy of alternative strategies at combating disease outbreaks. These models have often incorporated an understanding of age-based susceptibility and severity of outcome, considering how to limit the adverse outcomes or disease burden relative to an age structure. Such models frequently recommend the preferential treatment/vaccination of children or the elderly, demonstrating how prevention of serious disease within these etiological subgroups can provide both protection within the subgroup itself and indirect protection to the broader population. However, it is most frequently the case that these target populations are consumers, rather than providers, of household resources. In areas of the globe where continued health of household members relies on continued provision of resources, these models may fail to provide the most effective overall strategies for health outcomes in both target populations and overall. This is particularly important for tropical diseases impacting rural and low-income areas in which the disease may be endemic or newly emergent, particularly in the wake of natural disasters.
Methods
We propose a modified epidemiological model with targeted treatment in resource-limited populations. We evaluate the model over a broad parameter space.
Results
This model demonstrates how economic limitations may shift the optimal strategy. It may be advantageous to treat populations at lesser direct risk if they are responsible for providing secondary protection to higher-risk population(s) by producing household resources. Evaluation of this model over the parameter space reveals that, in some cases, targeting treatment towards consumers may result in greater numbers of consumer infections.
Conclusions
Our results demonstrate how household resource limitation can drastically affect the impact of targeted treatment strategies for limiting epidemics. Depending on the economic circumstances, it is possible that focusing treatment on consumers such as children can produce a counter-intuitive outcome in which more children contract the disease.
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Gender and life-stage dependent reactions to the risk of radioactive contamination: A survey experiment in Sweden. PLoS One 2020; 15:e0232259. [PMID: 32353020 PMCID: PMC7192462 DOI: 10.1371/journal.pone.0232259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/10/2020] [Indexed: 11/19/2022] Open
Abstract
This article proposes and examines gender and life-stage factors as determinants of public worry and risk avoidance in a nuclear fallout scenario. Drawing on a survey (N 2,291) conducted in Sweden, the article demonstrates statistically significant results that women as well as parents with children at home are more likely to express high levels of worry for radiation exposure and have a preference to move away from a fallout area despite assurance of successful remediation. Moreover, a negative relationship is shown between age and both worry for radiation exposure and preference to move. These novel results from Northern Europe thus support a life-stage framing of public risk attitudes. As radiation physicists develop new methods showing that women and children are at higher risk of cancer than other groups at the same radiation exposure, we may actually see the precaution among women and parents as a regulating mechanism for the higher objective risk they face. The results are moreover in agreement with studies of public risk reactions in Japan, creating a strong knowledge base that human-induced radiation pollution is largely an intolerable risk to the public. Considering the public opinion, managing an intolerable risk through risk mitigation by remediation alone is likely insufficient in many cases. A viable strategy would offer a range of social support options that enable individual decision-making and the protection of risk groups.
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8
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Seyedin H, Safari M, Parnian E. Willingness-to-pay for improvement of hypothetical health status in patients visiting the emergency department: A contingent valuation study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Tanikawa T, Sasamoto K, Tani Y, Ogasawara K. [Willingness to Acceptance for the Information Leakage of Medical Information Data Using the Contingent Valuation Method]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:1277-1285. [PMID: 31748453 DOI: 10.6009/jjrt.2019_jsrt_75.11.1277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Appropriate information security measures are very important for today's highly computerized hospitals to maintain the trust from patients. If once the personal information leakage of medical information was occurred, the hospital could lose their trust that has built for long time so far. It is important for hospitals to know the impact of the leakage accident previously advance to decide the investment for information security. The purpose of this study is to evaluate the impact of medical information leakage. The comforting fee for the patient's mental damage as the willingness to accept (WTA) was estimated, when the information leak occurred from a hospital using the contingent valuation method (CVM). Questionnaire survey was conducted using an internet survey service in Japan. We asked for 300 citizens about the use of personal information communication equipment and information security measures and their awareness for the information leakage. In addition, we presented a hypothetical scenario regarding information leakage of own medical information, asked the WTA as the comforting fee by the one choice of acceptance or rejection for the presented fee. In 300 responses, 190 were could be used for WTA estimation. WTA as the comforting fee when the information leakage of medical care information occurred, was estimated 570,541 yen in total. The result was similar with the value estimated by the damage compensation payment estimation model.
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Affiliation(s)
- Takumi Tanikawa
- Faculty of Health Science, Hokkaido University of Science.,Faculty of Health Sciences, Hokkaido University
| | - Kyouhei Sasamoto
- Department of Health Sciences, Hokkaido University (Current Address: Department of Radiological Technology, Kitasaito Hospital)
| | - Yuji Tani
- Faculty of Health Sciences, Hokkaido University.,Department of Medical Informatics and Hospital Management, Asahikawa Medical University
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John J, Koerber F, Schad M. Differential discounting in the economic evaluation of healthcare programs. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:29. [PMID: 31866768 PMCID: PMC6918700 DOI: 10.1186/s12962-019-0196-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background The question of appropriate discount rates in health economic evaluations has been a point of continuous scientific debate. Today, it is widely accepted that, under certain conditions regarding the social objective of the healthcare decision maker and the fixity of the budget for healthcare, a lower discount rate for health gains than for costs is justified if the consumption value of health is increasing over time. To date, however, there is neither empirical evidence nor a strong theoretical a priori supporting this assumption. Given this lack of evidence, we offer an additional approach to check the appropriateness of differential discounting. Methods Our approach is based on a two-goods extension of Ramsey's optimal growth model which allows accounting for changing relative values of goods explicitly. Assuming a constant elasticity of substitution (CES) utility function, the growth rate of the consumption value of health depends on three variables: the growth rate of consumption, the growth rate of health, and the income elasticity of the willingness to pay for health. Based on a review of the empirical literature on the monetary value of health, we apply the approach to obtain an empirical value of the growth rate of the consumption value of health in Germany. Results The empirical literature suggests that the income elasticity of the willingness to pay for health is probably not larger but rather smaller than 1 and probably not smaller but rather larger than 0.2. Combining this finding with reasonable values of the annual growth rates in consumption (1.5-1.6%) and health (0.1%) suggests, for Germany, an annual growth rate of the consumption value of health between 0.3 and 1.5%. Conclusion In the light of a two-goods extension of Ramsey's optimal growth model, the available empirical evidence makes the case for a growing consumption value of health. Therefore, the current German practice of applying the same discount rate to costs and health gains introduces a systematic bias against healthcare technologies with upfront costs and long-term health effects. Differential discounting with a lower rate for health effects appears to be a more appropriate discounting model.
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Affiliation(s)
- Jürgen John
- 1Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | | | - Mareike Schad
- 3Independent Researcher, Grüner Weg 2, 88339 Bad Waldsee, Germany
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11
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Andersson H, Levivier E, Lindberg G. Private and public willingness to pay for safety: A validity test. ACCIDENT; ANALYSIS AND PREVENTION 2019; 123:170-175. [PMID: 30517899 DOI: 10.1016/j.aap.2018.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/14/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
Stated preference (SP) methods are often used to elicit an affected population's preferences for, e.g., increased safety or better environmental quality. SP methods are based on hypothetical market scenarios which have advantages, since decision alternatives are known to the analysis, but also necessitate thorough validity tests of the results, since decisions are hypothetical. This study suggests a validity test based on theoretical predictions and empirical findings for private and public safety measures. According to the test, willingness to pay (WTP) for a public safety measure should exceed or be equal to the private one. Based on a rich data set eliciting both private and public WTP the results show that private WTP exceeds public WTP. Hence, the findings in this study highlight the importance of validity tests of preference estimates for safety, and suggest that WTP also for a private safety measure should be elicited in studies eliciting WTP for public safety measures, to allow for the validity test.
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Affiliation(s)
- Henrik Andersson
- Toulouse School of Economics, University of Toulouse Capitole, Toulouse, France.
| | - Elodie Levivier
- Toulouse School of Economics, University of Toulouse Capitole, Toulouse, France
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12
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Avilés Blanco MV, Brey R, Araña J, Pinto Prades JL. Emotions and scope effects in the monetary valuation of health. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:315-325. [PMID: 28341905 DOI: 10.1007/s10198-017-0885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 03/09/2017] [Indexed: 06/06/2023]
Abstract
This study presents evidence on the role of emotions in the monetary evaluation of health technologies, namely, drug-eluting stents (DES) in our case. It is shown that subjects who are very afraid of having to undergo an angioplasty are: (a) less sensitive to the size of the risk reduction provided by DES and (b) willing to pay more. The lack of scope sensitivity questions the normative validity of the responses of highly emotional subjects. We provide evidence of this effect using what we call the cognitive-emotional random utility model and the responses of a face-to-face, computer-assisted personal interview survey conducted in a representative sample of the Spanish general population (n = 1663).
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Affiliation(s)
| | - Raúl Brey
- University Pablo de Olavide, Seville, Spain
| | - Jorge Araña
- University of Las Palmas de Gran Canaria, Las Palmas, Spain
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13
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Sauerborn R, Gbangou A, Dong H, Przyborski JM, Lanzer M. Willingness to pay for hypothetical malaria vaccines in rural Burkina Faso. Scand J Public Health 2016; 33:146-50. [PMID: 15823976 DOI: 10.1080/14034940510005743] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: This study aims to set priorities for anti-disease malaria vaccines by determining community preference in a hyperendemic area. Methods: A bidding game technique was used to elucidate willingness to pay in rural Burkina Faso and 2,326 adults were interviewed. Results: It is shown that there are significant differences between community preference for an anti-disease vaccine aimed at reducing pathology in pregnant women, and for a vaccine directed against childhood malaria. While the target population was willing to pay CFAfr 2101 for a vaccine against maternal malaria, its members were prepared to pay only CFAfr 1433 for a vaccine against childhood malaria. Conclusions: Whilst it is increasingly likely that anti-disease malaria vaccines will become available in the foreseeable future, lessons from the past suggest that a lack of acceptance and support from the intended recipients may lead to less than optimal compliance, and hence efficacy. For the planning of vaccine development and application strategies, it is therefore highly important to take community views into account. Here it is argued that such information could help researchers and funding agencies to set priorities for future vaccine research.
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Affiliation(s)
- Rainer Sauerborn
- Hygiene Institut, Abteilung für Tropenmedizin und öffentliches Gesundheitswesen, Germany.
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14
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Robinson LA, Hammitt JK. Valuing Reductions in Fatal Illness Risks: Implications of Recent Research. HEALTH ECONOMICS 2016; 25:1039-52. [PMID: 26132383 DOI: 10.1002/hec.3214] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/06/2015] [Accepted: 05/25/2015] [Indexed: 05/28/2023]
Abstract
The value of mortality risk reductions, conventionally expressed as the value per statistical life, is an important determinant of the net benefits of many government policies. US regulators currently rely primarily on studies of fatal injuries, raising questions about whether different values might be appropriate for risks associated with fatal illnesses. Our review suggests that, despite the substantial expansion of the research base in recent years, few US studies of illness-related risks meet criteria for quality, and those that do yield similar values to studies of injury-related risks. Given this result, combining the findings of these few studies with the findings of the more robust literature on injury-related risks appears to provide a reasonable range of estimates for application in regulatory analysis. Our review yields estimates ranging from about $4.2 million to $13.7 million with a mid-point of $9.0 million (2013 dollars). Although the studies we identify differ from those that underlie the values currently used by Federal agencies, the resulting estimates are remarkably similar, suggesting that there is substantial consensus emerging on the values applicable to the general US population. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lisa A Robinson
- Harvard University (Center for Risk Analysis), Boston, MA, USA
| | - James K Hammitt
- Harvard University (Center for Risk Analysis), Boston, MA, USA
- Toulouse School of Economics (LERNA), Toulouse, France
- U.S. Department of Health and Human Services, Washington, D.C., USA
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15
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Petrou S. Methodological and applied concerns surrounding age-related weighting within health economic evaluation. Expert Rev Pharmacoecon Outcomes Res 2014; 14:729-40. [PMID: 25040009 DOI: 10.1586/14737167.2014.940320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Economic evaluations that measure the benefits of health interventions in terms of units of health gain inevitably require decision-makers to make judgments about the 'value for money' of those health gains. Decision-making bodies have also commonly returned to the position that a unit of health gain, such as an additional quality-adjusted life year, is of equal value regardless of the characteristics of the recipient. This paper focuses on whether and how health gains in economic evaluation should be differentially weighted by age of recipient. The paper presents a structured overview of evidence from the revealed preference and stated preference literature in this area. It discusses a number of methodological issues raised by differential weighting of health gains by age of recipient. These include identifying appropriate samples for the derivation of age-related weights, methodological issues surrounding the application of the quality-adjusted life year measure, the relative merits of alternative valuation techniques for weighting exercises, the impact of context and design effects on derived values and operational concerns surrounding the application of age-related weights within economic evaluation. The paper ends with pointers for potential future research in this area.
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Affiliation(s)
- Stavros Petrou
- Division of Health Sciences, Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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16
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Mabugu T, Revill P, van den Berg B. The Methodological Challenges for the Estimation of Quality of Life in Children for Use in Economic Evaluation in Low-Income Countries. Value Health Reg Issues 2013; 2:231-239. [PMID: 29702870 DOI: 10.1016/j.vhri.2013.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The assessment of quality of life (QOL) in children has been underresearched in high- and low-income countries alike. This is partly due to practical and methodological challenges in characterizing and assessing children's QOL. This article explores these challenges and highlights considerations in developing age-specific instruments for children affected by HIV and other health conditions in Africa and other low-income settings. METHODS A literature search identified works that have 1) developed, 2) derived utilities for, or 3) applied QOL tools for use in economic evaluations of HIV interventions for children. We analyzed the existing tools specifically in terms of domains considered, variations in age bands, the recommended respondents, and the relevance of the tools to African and also other low-income country contexts. RESULTS Only limited QOL research has been conducted in low-income settings on either adults or children with HIV. A few studies have developed and applied tools for children (e.g., in Thailand, Brazil, and India), but none have been in Africa. The existing methodological literature is inconclusive on the appropriate width or depth by which to define pediatric QOL. The existing instruments include QOL domains such as "physical functioning," "emotional and cognitive functioning," "general behavior (social, school, home)," "health perception," "coping and adaptation," "pain and discomfort," "extended effects," "life perspective," and "autonomy." CONCLUSIONS QOL assessment in children presents a series of practical and methodological challenges. Its application in low-income settings requires careful consideration of a number of context-specific factors.
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Affiliation(s)
- Travor Mabugu
- Clinical Research Centre, University of Zimbabwe, Harare, Zimbabwe.
| | - Paul Revill
- Centre for Health Economics, University of York, York, UK
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17
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Hurley J, Mentzakis E. Health-related externalities: evidence from a choice experiment. JOURNAL OF HEALTH ECONOMICS 2013; 32:671-81. [PMID: 23631833 DOI: 10.1016/j.jhealeco.2013.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 03/16/2013] [Accepted: 03/18/2013] [Indexed: 05/15/2023]
Abstract
Health-related external benefits are of potentially large importance for public policy. This paper investigates health-related external benefits using a stated-preference discrete-choice experiment framed in a health care context and including choice scenarios defined by six attributes related to a recipient and the recipient's condition: communicability, severity, medical necessity, relationship to respondent, location, and amount of contribution requested. Subjects also completed a set of own-treatment scenarios and a values-orientation instrument. We find evidence of substantial health-related external benefits that vary as expected with the scenario attributes and subjects' value orientations. The results are consistent with a number of hypotheses offered by the general theoretical analysis of health-related externalities and the analysis of externalities specific to health care.
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Affiliation(s)
- Jeremiah Hurley
- Department of Economics and Centre for Health Economics and Policy Analysis, McMaster University, Kenneth Taylor Hall, Rm 430, 1280 Main Street West, Hamilton, Ontario L8S 4M4, Canada.
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18
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Prosser LA, Payne K, Rusinak D, Shi P, Messonnier M. Using a discrete choice experiment to elicit time trade-off and willingness-to-pay amounts for influenza health-related quality of life at different ages. PHARMACOECONOMICS 2013; 31:305-15. [PMID: 23512145 DOI: 10.1007/s40273-013-0029-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Recent research suggests that values for health-related quality of life may vary with the age of the patient. Traditional health state valuation questions and discrete choice experiments are two approaches that could be used to value health. OBJECTIVE To measure whether public values for health vary with the age of the affected individual. METHODS A discrete choice experiment was administered via the Internet in December 2007 to measure preferences for different attributes of influenza-related health-related quality of life: age of hypothetical affected individual (range 1-85 years), length of episode (days of illness), severity of illness (workdays lost) and time trade-off or willingness-to-pay amounts. Each respondent answered identical choice questions for a hypothetical family member and for himself/herself. Data on sociodemographic characteristics and influenza illness experience were also collected. Respondents were US adults randomly sampled from an Internet survey panel (n = 1,012). The relative value of attributes was estimated using generalized estimating equations and controlling for sociodemographic characteristics and illness experience. Marginal time traded and marginal willingness to pay using discrete choice and traditional time trade-off or willingness-to-pay questions were compared. RESULTS Respondents preferred shorter influenza episodes but did not significantly prefer fewer workdays lost if episode length was held constant. Respondents were more likely to choose to avert uncomplicated illness in children and less likely to choose to avert uncomplicated illness in working-age adults. Marginal time trade-off and willingness-to-pay amounts elicited using discrete choice questions were larger than those elicited using direct valuation questions. CONCLUSIONS Approaches that assume values for health-related quality of life do not vary with the age of a patient may bias economic analyses that use these values. If patient age could affect valuations, then age should be included in the valuation exercise. Additional research should evaluate the effect of patient age on values for other conditions.
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Affiliation(s)
- Lisa A Prosser
- Child Health Evaluation and Research Unit, Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, 300 N. Ingalls St., Room 6E14, SPC 5456, Ann Arbor, MI 48109, USA.
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19
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Roman HA, Hammitt JK, Walsh TL, Stieb DM. Expert elicitation of the value per statistical life in an air pollution context. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2012; 32:2133-2151. [PMID: 22571466 DOI: 10.1111/j.1539-6924.2012.01826.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The monetized value of avoided premature mortality typically dominates the calculated benefits of air pollution regulations; therefore, characterization of the uncertainty surrounding these estimates is key to good policymaking. Formal expert judgment elicitation methods are one means of characterizing this uncertainty. They have been applied to characterize uncertainty in the mortality concentration-response function, but have yet to be used to characterize uncertainty in the economic values placed on avoided mortality. We report the findings of a pilot expert judgment study for Health Canada designed to elicit quantitative probabilistic judgments of uncertainties in Value-per-Statistical-Life (VSL) estimates for use in an air pollution context. The two-stage elicitation addressed uncertainties in both a base case VSL for a reduction in mortality risk from traumatic accidents and in benefits transfer-related adjustments to the base case for an air quality application (e.g., adjustments for age, income, and health status). Results for each expert were integrated to develop example quantitative probabilistic uncertainty distributions for VSL that could be incorporated into air quality models.
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Affiliation(s)
- Henry A Roman
- Industrial Economics, Incorporated, 2067 Massachusetts Ave, Cambridge, MA 02140, USA.
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20
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Lang HC, Chang K, Ying YH. Quality of life, treatments, and patients' willingness to pay for a complete remission of cervical cancer in Taiwan. HEALTH ECONOMICS 2012; 21:1217-1233. [PMID: 21905153 DOI: 10.1002/hec.1786] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/26/2011] [Accepted: 07/12/2011] [Indexed: 05/31/2023]
Abstract
Cervical cancer is one of the leading causes of cancer deaths in Taiwan. To investigate the disease cost and then raise awareness of the importance of screening for cervical cancer and promote early detection, this paper employs contingent valuation and willingness to pay (WTP) method to study how health-related quality of life, disease severity, and after-treatment disease status affect patients' WTP for a complete remission of the disease. The inclusive criteria for the study were primary case outpatients at least 3 months after they had received therapy at the time of our study period. Face-to-face interviews were conducted for the retrospective format of the survey. The result of the study indicates a lifetime WTP of $US21 221.96 for Taiwanese cervical cancer patients, which is significantly higher than the cost of screening for early detection. Disease stages do not show a consistent pattern in influencing WTP, but patients with surgery are willing to pay a significantly higher amount for a complete remission from the disease than patients without. In addition, mental health, positive attitudes toward life, and quality of life also are key factors that influence WTP.
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Affiliation(s)
- Hui-Chu Lang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
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21
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Schad M, John J. Towards a social discount rate for the economic evaluation of health technologies in Germany: an exploratory analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2012; 13:127-44. [PMID: 21170731 DOI: 10.1007/s10198-010-0292-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 12/01/2010] [Indexed: 05/05/2023]
Abstract
Over the last decades, methods for the economic evaluation of health care technologies were increasingly used to inform reimbursement decisions. For a short time, the German Statutory Health Insurance makes use of these methods to support reimbursement decisions on patented drugs. In this context, the discounting procedure emerges as a critical component of these methods, as discount rates can strongly affect the resulting incremental cost-effectiveness ratios. The aim of this paper is to identify the appropriate value of a social discount rate to be used by the German Statutory Health Insurance for the economic evaluation of health technologies. On theoretical grounds, we build on the widespread view of contemporary economists that the social rate of time preference (SRTP) is the adequate social discount rate. For quantifying the SRTP, we first apply the market behaviour approach, which assumes that the SRTP is reflected in observable market interest rates. As a second approach, we derive the SRTP from optimal growth theory by using the Ramsey equation. A major part of the paper is devoted to specify the parameters of this equation. Depending on various assumptions, our empirical findings result in the range of 1.75-4.2% for the SRTP. A reasonable base case discount rate for Germany, thus, would be about 3%. Furthermore, we deal with the much debated question whether a common discount rate for costs and health benefits or a lower rate for health should be applied in health economic evaluations. In the German social health insurance system, no exogenously fixed budget constraint does exist. When evaluating a new health technology, the health care decision maker is obliged to conduct an economic evaluation in order to examine whether there is an economically appropriate relation between the value of the health gains and the additional costs which are given by the value of the consumption losses due to the additional health care expenditures. Therefore, a discount rate lower than the SRTP for consumption should be applied if an increase in the consumption value of health is expected. However, given the limited empirical evidence on the relationship between consumption and the value of health, it is hardly possible to make reliable forecasts of this value. Regarding the practice of the German evaluation authority, it is not recommended to use differential discounting in the base case. Instead, the issue of differential discounting should be addressed in sensitivity analyses. Reducing the discount rate for health compared to the rate for costs by a figure in the range between near 0% and 3% may be considered to be appropriate for Germany.
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Affiliation(s)
- Mareike Schad
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich/Neuherberg, Germany
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22
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Willingness to pay for compulsory deworming of pets entering Sweden to prevent introduction of Echinoccoccus multilocularis. Prev Vet Med 2012; 106:9-23. [PMID: 22425257 DOI: 10.1016/j.prevetmed.2012.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 01/23/2012] [Accepted: 02/17/2012] [Indexed: 01/13/2023]
Abstract
To investigate if the Swedish entry rules for pets to prevent the introduction of Echinococcus multilocularis (EM) are proportional (i.e. that their costs do not exceed the value of their benefits), a dichotomous-choice contingent valuation study was conducted. The study was performed before the first case of EM was detected in Sweden in February 2011. About 5000, randomly selected, Swedish citizens were invited to participate and 2192 of them (44%) accepted to do so. Missing information on whether or not one would accept to pay for keeping the rules for 143 respondents resulted in 2049 observations (41%) available for the estimation of willingness to pay (WTP), and missing information on personal characteristics for another 274 respondents reduced the number of observations available for sensitivity analysis to 1775 (36%). Annual expected WTP for keeping the rules ranged between € 54.3 and € 99.0 depending on assumptions about compensations demanded by respondents not willing to pay. The estimates are conservative since only answers from respondents that were absolutely certain they would pay the suggested bid were regarded as yes-responses. That WTP is positive implies that Swedish citizens perceived the benefits of the rules to be larger than their costs.
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23
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Powdthavee N, van den Berg B. Putting different price tags on the same health condition: re-evaluating the well-being valuation approach. JOURNAL OF HEALTH ECONOMICS 2011; 30:1032-43. [PMID: 21715036 DOI: 10.1016/j.jhealeco.2011.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 04/27/2011] [Accepted: 06/02/2011] [Indexed: 05/07/2023]
Abstract
Many recent writings in health policy have proposed that health be valued directly and in monetary terms using the new well-being valuation method. Yet there is no clear consensus on what the best measure of individual's experience may be for the evaluation process. To shed light on this issue, monetary values for a number of health problems are compared across different well-being measures within the same UK data set. We find that, whilst there is strong internal consistency of health impacts within each well-being measure, hugely different monetary valuations are obtained for the same health problem across different well-being measures. Our results, although should only viewed as illustrative, call for economists to rethink about which measure of well-being or experienced utility to be used in the well-being valuation method, should the approach ever be implemented in real policy contexts.
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Affiliation(s)
- Nattavudh Powdthavee
- Division of Economics, HSS, Nanyang Technological University, 14 Nanyang Drive, Singapore 637332, Singapore.
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24
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Ungar WJ. Challenges in health state valuation in paediatric economic evaluation: are QALYs contraindicated? PHARMACOECONOMICS 2011; 29:641-52. [PMID: 21604821 DOI: 10.2165/11591570-000000000-00000] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
With the growth in the use of health economic evaluation to inform healthcare resource allocation decisions, the challenges in applying standard methods to child health have become apparent. A unique limitation is the paucity of child-specific preference-based measures. A single, valid, preference-based measure of utility that can be used in children of all ages does not exist. Thus, the ability to derive a QALY for use in cost-utility analysis (CUA) is compromised. This paper presents and discusses existing and novel options for deriving utilities for paediatric health states for use in CUAs. While a direct elicitation may be preferred, a child's ability to complete a standard gamble or time trade-off task is hampered by cognitive and age limitations. The abstract notions contained in indirect instruments such as the EQ-5D and Health Utilities Index may also pose challenges for young children. Novel approaches to overcome these challenges include the development of age-appropriate instruments such as the EQ-5D-Y, the development of new child-specific utility instruments such as the Child Health Utility-9D and the re-calibration of existing adult instruments to derive preference weights for health states from children themselves. For children aged <6 years, researchers have little choice but to use a proxy reporter such as parents. While parents may be reliable reporters for physical activity limitations and externally manifest symptoms, their ability to accurately report on subjective outcomes such as emotion is questionable. Catalogues of utility weights for a range of conditions are increasingly becoming available but retain many of the same limitations as valuing health states from children or from proxies. Given the dynamic relationship in quality of life (QOL) between family members when a child is ill, it seems appropriate to consider a 'family perspective' rather than an individual perspective in child health state valuation. In a collective approach, health state utilities derived from multiple family members may be combined mathematically. Alternatively, in a unitary approach, a single utility estimate may be determined to represent the family's perspective. This may include deriving utilities through parent-child dyad estimation or by using a household model that combines the utility weights of the patient and family members, incorporating reciprocal QOL effects. While these various approaches to child health state valuation represent novel research developments, the measurement challenges and threats to validity persist. Given the importance of non-health benefits to child health, especially in the domains of education and public policy, it may be worthwhile to consider an approach that allows incorporation of externalities to produce a cost-benefit analysis. The use of discrete-choice methods to assess willingness to pay for novel child health interventions holds promise as a means to produce meaningful economic evidence. Regardless of the approach taken, the highest degree of methodological rigour is essential. The increasing attention being paid by health economic researchers to the measurement challenges of paediatric health state valuation can only increase the value of child health economic evidence for decision making.
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Affiliation(s)
- Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
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25
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Prosser LA, Payne K, Rusinak D, Shi P, Uyeki T, Messonnier M. Valuing health across the lifespan: health state preferences for seasonal influenza illnesses in patients of different ages. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:135-143. [PMID: 21211495 DOI: 10.1016/j.jval.2010.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE This study sought to measure whether public values for health states vary with the age of the affected individual. METHODS Health state preferences were measured via a 15-minute survey administered through the Internet in December 2007 using a probability sample of the adult population of the United States (N = 1012). Respondents were asked to value hypothetical descriptions of seasonal influenza illness (uncomplicated influenza illness, hospitalization) and possible vaccine-related adverse events (anaphylaxis, Guillain-Barré syndrome) using time trade-off or willingness-to-pay questions. Respondents were randomized to four different ages for an affected hypothetical individual: 1-year-old, 8-year-old, 35-year-old, 85-year-old. All other aspects of the health state description were held constant. Summary statistics for each health state and age were calculated. The Kruskal-Wallis test was used to measure differences in responses across ages of affected individuals in the hypothetical scenarios. Regression analyses were used to evaluate the effect of age on time trade-off or willingness-to-pay amounts controlling for respondent characteristics. RESULTS Median values for time trade-off and willingness-to-pay were highest for young children. This pattern was generally consistent across responses and type of valuation. CONCLUSIONS Approaches that assume health state values do not differ with the age of a patient may bias economic analyses that use these values. If patient age is likely to affect health state valuations, then age should be included as an attribute in the valuation exercise.
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Affiliation(s)
- Lisa A Prosser
- Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
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26
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Carlsson F, Daruvala D, Jaldell H. Preferences for lives, injuries, and age: a stated preference survey. ACCIDENT; ANALYSIS AND PREVENTION 2010; 42:1814-21. [PMID: 20728632 DOI: 10.1016/j.aap.2010.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 04/28/2010] [Accepted: 05/04/2010] [Indexed: 05/07/2023]
Abstract
One of the more difficult ethical questions from a public decision-making perspective is whether the estimation of benefits from risk reducing projects should be influenced by factors such as age groups and risk domains. For example, should a project that saves the lives of elderly people be assigned a more different benefit value in cost-benefit analyses than one that saves the same number of children's lives? This paper examines the preferences of the general public in Sweden on these issues. We design a choice experiment in which subjects are required to make six pair-wise choices where the characteristics of each choice are accident type (fire and traffic), number of fatalities and serious injuries avoided, and age of those saved (5-15-, 35-45- and 65-75-year-olds). We find that avoiding the fatality of one 5-15-year-old is equivalent to avoiding 1.4 fatalities of 35-45-year-olds. Likewise, avoiding the fatality of one 5-15-year-old is equivalent to avoiding 3.3 fatalities of 65-75-year-olds. We find no significant differences between the causes of accident. One avoided fatality is found to be equivalent to around 3.5 avoided severe injuries, which is lower than the official value of 6 used by the Swedish Road Administration.
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Affiliation(s)
- Fredrik Carlsson
- Department of Economics, Göteborg University, Box 640, SE-40530 Göteborg, Sweden.
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27
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Lee GM, Salomon JA, Gay C, Hammitt JK. Preferences for health outcomes associated with Group A Streptococcal disease and vaccination. Health Qual Life Outcomes 2010; 8:28. [PMID: 20226042 PMCID: PMC2848145 DOI: 10.1186/1477-7525-8-28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 03/12/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A 26-valent Group A Streptococcus (GAS) vaccine candidate has been developed that may provide protection against pharyngitis, invasive disease and rheumatic fever. However, recommendations for the use of a new vaccine must be informed by a range of considerations, including parents' preferences for different relevant health outcomes. Our objectives were to: (1) describe parent preferences for GAS disease and vaccination using willingness-to-pay (WTP) and time trade-off (TTO) methods; and (2) understand how parents' implied WTP for a quality-adjusted life year (QALY) gained might vary depending on the particular health outcome considered (e.g. averted GAS disease vs. vaccine adverse events). METHODS Telephone interviews were conducted with parents of children diagnosed with GAS pharyngitis at 2 pediatric practice sites in the Boston metropolitan area. WTP and TTO (trading parental longevity for child's health) questions for 2 vaccine and 4 disease-associated health states were asked using a randomly selected opening bid, followed by a 2nd bid and a final open-ended question about the amount willing to pay or trade. Descriptive analyses included medians and interquartile ranges for WTP and TTO estimates. The Wilcoxon signed-rank test was used to assess differences in WTP/QALY values for vaccine adverse events vs. disease states. RESULTS Of 119 respondents, 100 (84%) and 96 (81%) provided a complete set of responses for WTP and TTO questions, respectively. The median WTP and discounted (at 3% per year) TTO values to avoid each health state were as follows: local reaction, $30, 0.12 days; systemic reaction, $50, 0.22 days; impetigo, $75, 1.25 days; strep throat, $75, 2.5 days; septic arthritis, $1,000, 6.6 days; and toxic shock syndrome, $3,000, 31.0 days. The median WTP/QALY was significantly higher for vaccine adverse events (approximately $60,000/QALY) compared to disease states ($18,000 to $36,000/QALY). CONCLUSIONS Parents strongly prefer to prevent GAS disease in children compared to vaccine adverse events. However, implied WTP/QALY ratios were higher for the prevention of vaccine adverse events. Regret for errors of commission vs. omission may differ and should be considered by vaccine policymakers.
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Affiliation(s)
- Grace M Lee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, Boston, MA 02215, USA
- Division of Infectious Diseases, Department of Medicine, and Department of Laboratory Medicine, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Joshua A Salomon
- Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Charlene Gay
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, Boston, MA 02215, USA
| | - James K Hammitt
- Center for Risk Analysis and Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115, USA
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McKenzie JE, Priest P, Audas R, Poore MR, Brunton CR, Reeves LM. Hand sanitisers for reducing illness absences in primary school children in New Zealand: a cluster randomised controlled trial study protocol. Trials 2010; 11:7. [PMID: 20096128 PMCID: PMC2823737 DOI: 10.1186/1745-6215-11-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 01/23/2010] [Indexed: 11/25/2022] Open
Abstract
Background New Zealand has relatively high rates of morbidity and mortality from infectious disease compared with other OECD countries, with infectious disease being more prevalent in children compared with others in the population. Consequences of infectious disease in children may have significant economic and social impact beyond the direct effects of the disease on the health of the child; including absence from school, transmission of infectious disease to other pupils, staff, and family members, and time off work for parents/guardians. Reduction of the transmission of infectious disease between children at schools could be an effective way of reducing the community incidence of infectious disease. Alcohol based no-rinse hand sanitisers provide an alternative hand cleaning technology, for which there is some evidence that they may be effective in achieving this. However, very few studies have investigated the effectiveness of hand sanitisers, and importantly, the potential wider economic implications of this intervention have not been established. Aims The primary objective of this trial is to establish if the provision of hand sanitisers in primary schools in the South Island of New Zealand, in addition to an education session on hand hygiene, reduces the incidence rate of absence episodes due to illness in children. In addition, the trial will establish the cost-effectiveness and conduct a cost-benefit analysis of the intervention in this setting. Methods/Design A cluster randomised controlled trial will be undertaken to establish the effectiveness and cost-effectiveness of hand sanitisers. Sixty-eight primary schools will be recruited from three regions in the South Island of New Zealand. The schools will be randomised, within region, to receive hand sanitisers and an education session on hand hygiene, or an education session on hand hygiene alone. Fifty pupils from each school in years 1 to 6 (generally aged from 5 to 11 years) will be randomly selected for detailed follow-up about their illness absences, providing a total of 3400 pupils. In addition, absence information will be collected on all children from the school rolls. Investigators not involved in the running of the trial, outcome assessors, and the statistician will be blinded to the group allocation until the analysis is completed. Trial registration ACTRN12609000478213
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Affiliation(s)
- Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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29
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Liao CH, Liu JT, Pwu RF, You SL, Chow I, Tang CH. Valuation of the economic benefits of human papillomavirus vaccine in Taiwan. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12 Suppl 3:S74-S77. [PMID: 20586987 DOI: 10.1111/j.1524-4733.2009.00632.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The study aims to apply the contingent valuation method to elicit the willingness-to-pay (WTP), and measure the value of a statistic life (VSL), for human papillomavirus (HPV) vaccine in Taiwan. METHODS A total of 512 questionnaires were completed on women aged 20 to 55 years with at least one daughter, during March through May 2007. The respondents' WTP for the vaccines was elicited by double-bounded binary-choice questions under two scenarios: one was to protect themselves from cervical cancer (CC) and the other was for their daughter(s). The WTP was modeled as a function of the respondents' knowledge score, attitudes toward CC and HPV vaccine, the vaccination outcome scenarios, and individual characteristics. A log-normal survival model was constructed and the maximum-likelihood method was used for estimation. RESULTS The median regression-adjusted WTP was estimated at US$1098 to US$1233 (US$913-1004) for vaccinating the daughter (mother); and the VSL was estimated at approximately US$0.65 to US$4.09 (US$0.56-3.16) million for vaccinating the daughter (mother). CONCLUSIONS The study results provided important evidences on the monetary value women placed on a HPV vaccine, and the differential benefits between vaccinating the women and their daughters.
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Affiliation(s)
- Chih-Hsien Liao
- School of Health Care Administration, Taipei Medical University, Taiwan
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Schwarzinger M, Carrat F, Luchini S. "If you have the flu symptoms, your asymptomatic spouse may better answer the willingness-to-pay question". Evidence from a double-bounded dichotomous choice model with heterogeneous anchoring. JOURNAL OF HEALTH ECONOMICS 2009; 28:873-884. [PMID: 19362383 DOI: 10.1016/j.jhealeco.2009.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 02/22/2009] [Accepted: 03/04/2009] [Indexed: 05/27/2023]
Abstract
The small sample size of contingent valuation (CV) surveys conducted in patients may have limited the use of the single-bounded (SB) dichotomous choice format which is recommended in environmental economics. In this paper, we explore two ways to increase the statistical efficiency of the SB format: (1) by the inclusion of proxies in addition to patients; (2) by the addition of a follow-up dichotomous question, i.e. the double-bounded (DB) dichotomous choice format. We found that patients (n=223) and spouses (n=64) answering on behalf of the patient had on average a similar willingness-to-pay for earlier alleviation of flu symptoms. However, a patient was significantly more likely to anchor his/her answer on the first bid as compared to a spouse. Finally, our original DB model with shift effect and heterogeneous anchoring reconciled the discrepancies found in willingness-to-pay statistics between SB and DB models in keeping with increased statistical efficiency.
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Affiliation(s)
- Michaël Schwarzinger
- Center for Health Policy, Freeman Spogli Institute for International Studies/Center for Primary Care & Outcomes Research, School of Medicine, Stanford University, CA 94305-6019, USA.
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Andersson H, Lindberg G. Benevolence and the value of road safety. ACCIDENT; ANALYSIS AND PREVENTION 2009; 41:286-293. [PMID: 19245887 DOI: 10.1016/j.aap.2008.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 11/19/2008] [Accepted: 11/27/2008] [Indexed: 05/27/2023]
Abstract
This study uses the contingent valuation method to elicit individuals' preferences for their own and others' safety in road-traffic. Whereas one group is asked about a private safety device for themselves, other groups are asked about safety devices for their children, household, relatives and the public. Support is found for the hypothesis that individuals are not purely selfish when it comes the safety of others.
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Liu JT, Tsou MW, Hammitt JK. Willingness to pay for weight-control treatment. Health Policy 2009; 91:211-8. [PMID: 19167128 DOI: 10.1016/j.healthpol.2008.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Revised: 12/09/2008] [Accepted: 12/09/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate willingness to pay (WTP) for alternative forms of weight-control treatment and evaluate how it varies with individual characteristics. METHODS Contingent valuation (CV) survey of employed females in Taiwan using double-bounded dichotomous-choice question format and telephone interview. Statistical models include an estimated correction for sample-selection bias associated with respondents' interest in weight loss. RESULTS Estimated WTP is strongly and positively associated with younger age, greater personal income, higher body weight, adverse personal weight perceptions, and greater peer pressure for weight control. There is a little evidence of sample-selection bias associated with the decision to lose weight. Estimated WTP for a weight-loss medicine is about US$ 12 per month, larger than estimated WTP for a low-calorie diet of about US$ 10 per month. CONCLUSIONS WTP for weight-control treatment among women in Taiwan is significant and related to individual characteristics such as age, income, and perceptions about current and optimal weight.
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Affiliation(s)
- Jin-Tan Liu
- Department of Economics, National Taiwan University and NBER, Taiwan
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Tianviwat S, Chongsuvivatwong V, Birch S. Different dental care setting: does income matter? HEALTH ECONOMICS 2008; 17:109-18. [PMID: 17415722 DOI: 10.1002/hec.1237] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In this paper we consider the use of mobile dental clinics as a means of improving access to dental care among primary school children in Southern Thailand by reducing the opportunity cost of service use to parents. Parents' willingness to pay (WTP) is measured for three different services provided in a community hospital dental clinic and a school-based mobile clinic. Although the service setting does not affect significantly the WTP for treatment directly, the estimated positive association between WTP and income is modified by setting. The results indicate that the potential for mobile clinics to increase utilization of services among primary school children is associated with parents' income, with the difference in valuation of dental services between the two settings being less among lower income parents than higher income parents. However, even among lower income parents our results indicate that the potential for increasing service utilization among children depends on the improvements in access associated with the mobile clinic not being achieved at the opportunity cost of lower levels of effectiveness.
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Affiliation(s)
- Sukanya Tianviwat
- Prince of Songkla University, Faculty of Dentistry, Department of Preventive Dentistry, Songkhla, Thailand.
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Abstract
Contingent valuation (CV) studies in health care have used the willingness to pay (WTP) approach, to the virtual exclusion of willingness to accept (WTA). Outside the health care field, disparities between WTP and WTA values have been observed. Were such disparities to be demonstrated for health care technologies, the conventional assumption of a linear cost-effectiveness plane would be invalidated. This paper employs data derived from interviews with users of the UK's paediatric cochlear implantation (PCI) programme based in Nottingham (i) to assess the feasibility of estimating WTA for the potential discontinuation of an existing technology, and (ii) to investigate any WTA-WTP disparity which might be revealed. Only one-third of subjects providing WTP values were willing and able to offer a corresponding WTA value. Our qualitative data revealed that modes of response differed between the two valuation approaches. In particular, the presumption of fungibility of the health care intervention was a far more serious obstacle to completing the WTA task than it was for WTP. Among those prepared to offer values under both approaches, mean WTA was approximately four times mean WTP. Until more health studies are conducted, it remains unclear whether or not the findings are specific both to the intervention and to the elicitation format.
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Affiliation(s)
- David K Whynes
- School of Economics, University of Nottingham, Nottingham NG7 2RD, UK.
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Watson V, Ryan M. Exploring preference anomalies in double bounded contingent valuation. JOURNAL OF HEALTH ECONOMICS 2007; 26:463-82. [PMID: 17123652 DOI: 10.1016/j.jhealeco.2006.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Revised: 10/24/2006] [Accepted: 10/25/2006] [Indexed: 05/12/2023]
Abstract
Double bounded dichotomous choice (DBDC) contingent valuation offers increased efficiency of willingness to pay (WTP) estimates compared with the single bounded format. However, evidence suggests DBDC generates anomalous respondent behaviour. This paper provides the first investigation and explanation of these anomalies in health. Results suggest the incentives for truthful preference revelation are altered in the presence of a follow up question. This result is found using both regression techniques and analysis of raw responses. Although findings suggest 'very certain' respondents exhibit less anomalous behaviour inconsistencies remain across bounds. The results of this study question the use of iterative valuation formats.
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Affiliation(s)
- Verity Watson
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 9ZD, UK.
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Prosser LA, Hammitt JK, Keren R. Measuring health preferences for use in cost-utility and cost-benefit analyses of interventions in children: theoretical and methodological considerations. PHARMACOECONOMICS 2007; 25:713-26. [PMID: 17803331 DOI: 10.2165/00019053-200725090-00001] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Valuing the health of children for cost-utility or cost-benefit analysis poses a number of additional challenges when compared with valuing adult health. Some of these challenges relate to the inability of young children to value changes in health directly and the potential biases associated with using proxy respondents. Other challenges arise from children not being able to perform as independent economic actors, but dependent on others for care and decision making. In addition, illness in children may affect parent/caregiver quality of life, further complicating the measurement of value associated with a change in a child's health status. We review the most common approaches (QALYs and willingness-to-pay values) for valuing health in economic evaluations and consider the methodological and practical issues associated with measuring child health using each framework. Recommendations for advancing the field of valuing child health for economic evaluations will vary by age; a 'one size fits all' approach does not readily fit. Although limitations exist for all of the methods considered for valuing child health, the currently recommended approach for infants and preschoolers is direct valuation by a proxy respondent. For school-age children and adolescents, existing multi-attribute instruments can be applied in some situations but direct valuation may be required for others. Future research should focus on minimising bias from proxy respondents, consideration of a family- or household-based approach to valuing health effects, and development of generic instruments with domains that are appropriate to children and that vary with age.
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Affiliation(s)
- Lisa A Prosser
- Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
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Leung J, Guria J. Value of statistical life: adults versus children. ACCIDENT; ANALYSIS AND PREVENTION 2006; 38:1208-17. [PMID: 16870128 DOI: 10.1016/j.aap.2006.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 05/15/2006] [Accepted: 05/22/2006] [Indexed: 05/11/2023]
Abstract
Most studies on the value of statistical life (VOSL) and values for prevention of injuries provide only the average values for the overall population. It is often argued that the values for children may be higher than that for adults because parents are usually more concerned about the mortality and morbidity risks of their children than for themselves. However, it is not an easy task to determine separate VOSLs for children and adults. Only a few empirical results are available and they do not show a definite pattern. Using the results of a value of safety survey carried out in New Zealand in 1997-1998, this paper investigates whether the willingness to pay based VOSL is higher or lower for children. Formal statistical tests were carried out to test the differences and also a regression analysis was carried out to estimate the VOSL separately for adults and children, particularly in households with children. The analysis shows that for the whole sample, the value is higher for children. However, when some outliers were removed the results indicate a higher value for adults than for children. A further trimming shows the value of children is slightly higher. Therefore, no definite conclusion could be drawn. Households without children have the highest VOSL.
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Van Houtven G, Powers J, Jessup A, Yang JC. Valuing avoided morbidity using meta-regression analysis: what can health status measures and QALYs tell us about WTP? HEALTH ECONOMICS 2006; 15:775-95. [PMID: 16544361 DOI: 10.1002/hec.1105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Many economists argue that willingness-to-pay (WTP) measures are most appropriate for assessing the welfare effects of health changes. Nevertheless, the health evaluation literature is still dominated by studies estimating nonmonetary health status measures (HSMs), which are often used to assess changes in quality-adjusted life years (QALYs). Using meta-regression analysis, this paper combines results from both WTP and HSM studies applied to acute morbidity, and it tests whether a systematic relationship exists between HSM and WTP estimates. We analyze over 230 WTP estimates from 17 different studies and find evidence that QALY-based estimates of illness severity--as measured by the Quality of Well-Being (QWB) Scale--are significant factors in explaining variation in WTP, as are changes in the duration of illness and the average income and age of the study populations. In addition, we test and reject the assumption of a constant WTP per QALY gain. We also demonstrate how the estimated meta-regression equations can serve as benefit transfer functions for policy analysis. By specifying the change in duration and severity of the acute illness and the characteristics of the affected population, we apply the regression functions to predict average WTP per case avoided.
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Hashimoto K, Nakamura T, Wada I, Yoshida K, Satoh S, Abo M, Seta H, Ohashi M. How great is willingness to pay for recovery from sequelae after severe traumatic brain injury in Japan? J Rehabil Med 2006; 38:141-3. [PMID: 16546774 DOI: 10.1080/16501970500441690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate the burden on families with a family member suffering traumatic brain injury sequelae in Japan. DESIGN Cross-sectional study. METHODS Family members' burden from the sequelae of traumatic brain injury was estimated by use of willingness-to-pay models and the contingent valuation method. A national survey among 1707 members of the Japan Traumatic Brain Injury Association was conducted by postal questionnaire with open-ended questions. A total of 509 (29.8%) of the family members responded (405 men and 104 women). Mean age of patients with traumatic brain injury was 33.4 (SD 14.3) years and of responding family members 53.3 (SD 14.5) years. RESULTS Willingness-to-pay for the family member's recovery from sequelae of traumatic brain injury (8,694,502 Japanese yen; 79,134 US dollars/year) was similar to that reported for a family member's survival from incurable terminal disease (8,342,953 Japanese yen; 75,934 US dollars/year). CONCLUSION The data indicate that family members perceive the burden of a family member with traumatic brain injury sequelae as similar to what would have been caused by an incurable terminal disease.
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Affiliation(s)
- Keiji Hashimoto
- Department of Neurotraumatology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.
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Ho JJ, Liu JT, Wang JD. Stated preferences for the removal of physical pain resulting from permanently disabling occupational injuries. A contingent valuation study of Taiwan. ACCIDENT; ANALYSIS AND PREVENTION 2005; 37:537-548. [PMID: 15784208 DOI: 10.1016/j.aap.2005.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Revised: 01/05/2005] [Accepted: 01/24/2005] [Indexed: 05/24/2023]
Abstract
Within the process of calculating the true costs of illness, physical pain is a component of intangible, or human, costs. One method of estimating the monetary value of such costs is the 'contingent valuation method' (CVM), a stated preference method based upon the elicitation of levels of willingness to pay (WTP) facilitated through surveys. This study is amongst the first of its kind to apply CVM to the estimation of the cost of the removal of physical pain resulting from permanently disabling occupational injuries. We assume that a painkilling drug has been invented to mitigate physical pain with the advantages of validity and instantaneity, and without any side effects. The WTP of each of the respondents is determined by a two-step sequential-bidding process. The maximum WTP under log normal distribution was NT 1791 US dollars/day (65.1 US dollars), whilst under Weibull distribution it was NT 1913 US dollars/day (69.6 US dollars). Older respondents, those with higher household income, fall injuries, longer periods of hospitalization, or with a perceived demand for the painkilling drug in excess of one day, displayed a positive independent effect on the eliciting of their WTP. In addition, respondents with higher 'out-of-pocket' expenses, or where the interview took place 2 years or more after the injury occurred, responded with a lower WTP.
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Affiliation(s)
- Jiune-Jye Ho
- Institute of Occupational Safety and Health, Council of Labor Affairs, The Executive Yuan, No. 99, Lane 407, Henke Road, Sijhih City, Taipei County 221, Taiwan
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Lee GM, Salomon JA, LeBaron CW, Lieu TA. Health-state valuations for pertussis: methods for valuing short-term health states. Health Qual Life Outcomes 2005; 3:17. [PMID: 15780145 PMCID: PMC555848 DOI: 10.1186/1477-7525-3-17] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Accepted: 03/21/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of reported adolescent and adult pertussis continues to rise in the United States. Acellular pertussis vaccines for adolescents and adults have been developed and may be available soon for use in the U.S. Our objectives were: (1) to describe patient valuations of pertussis disease and vaccination; and (2) to compare valuations for short-term and long-term health states associated with pertussis. METHODS We conducted telephone surveys with 515 adult patients and parents of adolescent patients with pertussis in Massachusetts to determine valuations of pertussis-related health states for disease and vaccination using time trade-off (TTO) and contingent valuation (CV) techniques. Respondents were randomized to complete either a short-term or long-term TTO exercise. Discrimination between health states for each valuation technique was assessed using Tukey's method, and valuations for short-term vs. long-term health states were compared using the Wilcoxon rank-sum test. RESULTS Three hundred three (59%) and 309 (60%) respondents completed and understood the TTO and CV exercises, respectively. Overall, respondents gave lower valuations (lower TTO and higher CV values) to avoid a given state for adolescent/adult disease compared to vaccine adverse events. Infant complications due to pertussis were considered worse than adolescent/adult disease, regardless of the method of valuation. The short-term TTO resulted in lower mean valuations and larger mean differences between health states than the long-term TTO exercise. CONCLUSION Pertussis was considered worse than adverse events due to vaccination. Short-term health-state valuation is better able to discriminate among health states, which is useful for cost-utility analysis.
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Affiliation(s)
- Grace M Lee
- Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, 133 Brookline Ave, 6floor, Boston, MA 02215, USA
- Division of Infectious Diseases, Children's Hospital Boston, MA, USA
| | - Joshua A Salomon
- Department of Population and International Health, Center for Population and Development Studies, Harvard School of Public Health, Boston, MA, USA
| | - Charles W LeBaron
- National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tracy A Lieu
- Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, 133 Brookline Ave, 6floor, Boston, MA 02215, USA
- Division of General Pediatrics, Children's Hospital Boston, MA, USA
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Carlsson KS, Höjgård S, Lethagen S, Lindgren A, Berntorp E, Lindgren B. Willingness to pay for on-demand and prophylactic treatment for severe haemophilia in Sweden. Haemophilia 2005; 10:527-41. [PMID: 15357780 DOI: 10.1111/j.1365-2516.2004.00954.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of the present paper was to provide an estimate of the benefits of on-demand and prophylaxis treatment strategies for severe haemophilia in monetary terms. Using the contingent-valuation method, which simulates a missing market by asking people about their willingness to pay (WTP), we asked a representative sample (n = 609) of the Swedish population if they would be willing to pay a specific amount (bid) so that patients with severe haemophilia could receive on-demand treatment and another bid for prophylactic treatment. Different respondents were offered different bids and the bid vector ranged from 71 Euro cents to EUR 130. The order of the bid questions was randomized so that half of the respondents were asked first about their WTP for on-demand treatment, and then about their WTP for prophylaxis, while the order was reversed for the other half of the respondents. The mean estimated WTP (year 2002) was EUR 39 (95% CI 31-47) for on-demand and EUR 65 (95% CI 55-73) for prophylaxis. Our sensitivity analysis showed that the ranking of the two treatment alternatives was robust in that the WTP was greater for prophylaxis in all possible subsets. The point estimates of WTP varied somewhat in subsets defined by individual characteristics, but confidence intervals always overlapped that of the main results. The WTP for on-demand and prophylaxis exceeded the calculated cost of treatment per taxpayer of providing on-demand and prophylactic treatment, respectively, based on our previous results.
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Affiliation(s)
- K Steen Carlsson
- Department of Community Medicine, Malmö University Hospital and Lund University Centre for Health Economics, Lund University, Lund, Sweden.
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Liu JT, Hammitt JK, Wang JD, Tsou MW. Valuation of the risk of SARS in Taiwan. HEALTH ECONOMICS 2005; 14:83-91. [PMID: 15386665 DOI: 10.1002/hec.911] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Two surveys conducted in Taiwan during the spring 2003 severe acute respiratory syndrome (SARS) epidemic reveal a high degree of concern about the threat posed by SARS to Taiwan and its residents, although respondents believe they are knowledgeable about the risk of SARS and that it is susceptible to individual control. Willingness to pay (WTP) to reduce the risk of infection and death from SARS is elicited using contingent valuation methods. Estimated WTP is high, implying values per statistical life of US dollars 3 to 12 million. While consistent with estimates for high-income countries, these values are substantially larger than previous estimates for Taiwan and may be attributable to the high degree of concern about SARS at the time the data were collected.
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Affiliation(s)
- Jin-Tan Liu
- Department of Economics, National Taiwan University, Taiwan
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Yeung RYT, Smith RD. Can we use contingent valuation to assess the demand for childhood immunisation in developing countries?: a systematic review of the literature. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2005; 4:165-73. [PMID: 16309334 DOI: 10.2165/00148365-200504030-00005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Childhood immunisation is one of the most cost-effective public health interventions, yet its population coverage in low- and middle-income countries is severely limited by the fiscal constraints that health services face. A recent proposal suggested that commitments to purchase vaccines and make them available to developing countries for modest co-payments could solve the problem. However, this is dependent on communities being willing and able to share the cost in this way, which is difficult to assess. One possible method to assess this demand is contingent valuation (CV). This article evaluates the usefulness of using CV in this way, by reviewing applications of CV in developing countries against current 'standards' for CV of immunisation in the literature. A structured review was adopted with reference to the standard frameworks for methodological evaluation. A set of five criteria were developed for evaluating an 'acceptable' CV study: (i) response rate; (ii) association between willingness to pay (WTP) and socioeconomic status (SES); (iii) sensitivity of WTP to benefit scale/scope; (iv) predictive validity; and (v) reliability in elicitation formats. Two strands of literature search were conducted using electronic databases (MEDLINE, EMBASE, HEALTHSTAR and Econlit) from 1966 to 2003, one for CV studies of immunisation and one for CV studies in developing countries. Twelve CV studies of vaccination and 13 CV studies undertaken within developing countries were identified and reviewed. The quality of existing CV studies conducted in developing countries exceeded the benchmark standard set by studies of immunisation in the developed world in four of the five criteria. WTP estimates appeared both internally valid (i.e. associations with SES) and externally valid (i.e. predictive validity), reliability in developing countries was no less than that of the benchmark level in the existing literature, and the high response rates suggested that CV can be administered to a rural, and perhaps less literate, population. Only sensitivity to scale/scope was not well demonstrated. Our assessment indicated that the CV technique offers a promising tool to estimate the demand for childhood immunisation in low- and middle-income countries. International agencies are therefore encouraged to devote resources to such an application when designing their support to the immunisation programmes.
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Barron AC, Lee TL, Taylor J, Moore T, Passo MH, Graham TB, Griffin TA, Grom AA, Lovell DJ, Brunner HI. Feasibility and construct validity of the parent willingness-to-pay technique for children with juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2004; 51:899-908. [PMID: 15593249 DOI: 10.1002/art.20829] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the feasibility and construct validity of the willingness-to-pay (WTP) technique for measuring health care preferences in families of children with juvenile idiopathic arthritis (JIA). METHODS Parents were asked to estimate the monthly US dollar amount they would be willing to pay to obtain for their child the following hypothetical drugs: ARTHRO, which guarantees complete clinical response; and NO-STOM-ACHE, a drug that eliminates gastrointestinal (GI) symptoms. A yes/no question was used with random assignment of the starting bids. Parents who agreed to pay the starting bid were then asked whether they would be willing to pay 200% and then 400% of this initial bid. Socioeconomic data and information on medications, disease activity, patient physical function, wellbeing, and health-related quality of life (HRQOL) were obtained. RESULTS Sixty-two families of children with JIA were interviewed. GI symptoms were present in 54%, and 53% of the children had joints with active arthritis or limited range of motion. Four parents (7%) were unwilling to pay anything for any of the studied medications. The mean amount (median; mean percentage of available family income) families were willing to pay was $395 ($300; 15%) for ARTHRO and $109 ($80; 4%) for NO-STOM-ACHE. Correlation and regression analysis supported that, adjusted for the available family income, the WTP for ARTHRO was associated with disease activity, pain, and the HRQOL of the patients. After correction for the starting bids and the available family income, the WTP for NO-STOM-ACHE was associated with the patient's HRQOL, pain, and the amount of GI discomfort. CONCLUSION The WTP technique is feasible and has construct validity for measuring health care preferences for children with JIA. Relatively large WTP estimates support a possible important negative impact of the disease on families of children with JIA.
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Affiliation(s)
- Andrea C Barron
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229-3039, USA
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Amin M, Khondoker F. A contingent valuation study to estimate the parental willingness-to-pay for childhood diarrhoea and gender bias among rural households in India. Health Res Policy Syst 2004; 2:3. [PMID: 15214964 PMCID: PMC446217 DOI: 10.1186/1478-4505-2-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2003] [Accepted: 06/24/2004] [Indexed: 11/17/2022] Open
Abstract
We used contingent valuation technique to estimate the parental willingness to pay for an episode of diarrhoea among 324 children of both sexes aged between five and seven years in two rural villages of Chennai in India. The aim was to examine if there was any gender bias in the parental willingness to treat children for a diarrhoeal episode, and if so to what extent. The willingness to pay was specified as a hedonic function of the duration and severity of an episode, and of parents' socioeconomic characteristics. The findings suggest that parents were willing to pay more to protect their male child compared to the female child suffering from a diarrhoeal episode. The median willingness to pay to avoid an episode for male and female children were calculated at Rs. 33.7 (approx. US$ 0.72) and Rs. 25.2 (approx. US$ 0.54) respectively – a difference of around 34%. After adjusting for the greater duration and severity of the illness, it was found that the difference between the two medians increased to 51%.
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Affiliation(s)
- Mo Amin
- Department of Economics, University of Ottawa, 2 Saddle Crescent, Ottawa, Ontario K1G 5L4, Canada
| | - Farhana Khondoker
- Clinical Epidemiology Program, Ottawa Health Research Institute, 503 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
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Prosser LA, Ray GT, O'Brien M, Kleinman K, Santoli J, Lieu TA. Preferences and willingness to pay for health states prevented by pneumococcal conjugate vaccine. Pediatrics 2004; 113:283-90. [PMID: 14754939 DOI: 10.1542/peds.113.2.283] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To measure parents' and other adults' values for preventing disease associated with pneumococcal infection and to evaluate how including these values changes the economic appraisal of pneumococcal conjugate vaccine. METHODS Data on preferences and willingness to pay to reduce risk of illness were collected for 6 illnesses that are preventable by pneumococcal conjugate vaccine (simple otitis media, complex otitis media, moderate pneumonia, severe pneumonia, bacteremia, and meningitis) and 1 vaccine-related adverse event (fever and fussiness after vaccine). Interviews were conducted with 2 groups of respondents: 1) parents of children who had experienced 1 or more of the outcomes described in the survey (n = 101) and 2) a US community sample (n = 109). The 30-minute telephone interview used modified time trade-off questions and willingness-to-pay questions. Values from the interview were incorporated in an existing decision-analytic model that simulated the cost-effectiveness and cost-benefit of pneumococcal conjugate vaccine in a hypothetical cohort of newborns. RESULTS Among parents, the median amount of time that respondents said that they would be willing to trade to avoid diseases ranged from 0 days for otitis media to 1 year for severe pneumonia and 2 years for meningitis. Among the US community sample, the median amounts of time traded were higher, ranging from 7 days for otitis media to 3 years for meningitis. Median willingness-to-pay amounts varied from 100 dollars to prevent 1 episode of otitis media and 500 dollars to reduce the risk of meningitis from 21 in 100 000 to 6 in 100 000 and were similar between parents and community members. Incorporating time trade-off amounts into the existing economic model for pneumococcal conjugate vaccine resulted in cost-effectiveness ratios <10 000 dollars per quality-adjusted life year at a vaccine cost of 58 dollars per dose. CONCLUSIONS Both parents and community members assign relatively high values to preventing meningitis, pneumonia, and complex otitis media. When the value of preventing pneumococcal diseases is incorporated into economic analyses, pneumococcal conjugate vaccine has a cost-effectiveness ratio in the range of other widely used health interventions.
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Affiliation(s)
- Lisa A Prosser
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
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Dong H, Kouyate B, Cairns J, Mugisha F, Sauerborn R. Willingness-to-pay for community-based insurance in Burkina Faso. HEALTH ECONOMICS 2003; 12:849-862. [PMID: 14508869 DOI: 10.1002/hec.771] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE To study the willingness-to-pay (WTP) for a proposed community-based health insurance (CBI) scheme in order to provide information about the relationship between the premium that is required to cover the costs of the scheme and expected insurance enrollment levels. In addition, factors that influence WTP were to be identified. METHODS Data were collected from a household survey using a two-stage cluster sampling approach, with each household having the same probability of being selected. Interviews were conducted with 2414 individuals and 705 household heads. The take-it-or-leave-it (TIOLI) and the bidding game were used to elicit WTP. RESULTS The average individual was willing to pay 2384 (elicited by the TIOLI) or 3191 (elicited by the bidding game) CFA (3.17 US dollars or 4.25 US dollars) to join CBI for him/herself. The head of household agreed to pay from 6448 (elicited by the TIOLI) or 9769 (elicited by the bidding game) CFA (8.6 US dollars or 13.03 US dollars) to join the health insurance scheme for his/her household. These results were influenced by household and individual ability-to-pay, household and individual characteristics, such as age, sex and education. The two methods yielded similar patterns of estimated WTP, in that higher WTP was obtained for higher income level, higher previous medical expenditure, higher education, younger people and males. A starting point bias was found in the case of the bidding game. CONCLUSIONS Both TIOLI and bidding game methods can elicit a value of WTP for CBI. The value elicited by the bidding game is higher than by the TIOLI, but the two approaches yielded similar patterns of estimated WTP. WTP information can be used for setting insurance premium. When setting the premiums, it is important to consider differences between the real market and the theoretical one, and between the WTP and the cost of benefits package. The beneficiaries of CBI should be enrolled at the level of households or villages in order to protect vulnerable groups such as women, elders and the poor.
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Affiliation(s)
- Hengjin Dong
- Department of Tropical Hygiene and Public Health, University of Heidelberg, Germany.
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Dong H, Kouyate B, Snow R, Mugisha F, Sauerborn R. Gender's effect on willingness-to-pay for community-based insurance in Burkina Faso. Health Policy 2003; 64:153-62. [PMID: 12694952 DOI: 10.1016/s0168-8510(02)00144-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose was to study gender's effect on willingness-to-pay (WTP) for community-based insurance (CBI) in order to provide information for deciding enrolment unit and setting premium in Burkina Faso. A two-stage cluster sampling was used in the household survey, with each household having the same probability of being selected. One thousand one hundred and seventy-eight men and 1236 women in the 800 households were interviewed. The bidding game approach was used to elicit WTP. We found that compared to male, female had less education, lower income and expenditure, less episodes of diseases and lower ratio of becoming household head, but higher marriage rate. These characteristics influenced the WTP difference between men and women. Men were willing to pay 3666 CFA ($4.89) to join CBI, 928 CFA higher than women were. Education and economic status positively influenced WTP, implying higher years of schooling and economic status and higher WTP. Age and distance to health facility negatively influenced WTP, thus higher age and longer distance and less WTP. Based on the results from this study, we suggest that CBI should be enrolled on the basis of households or villages in order to protect vulnerable persons, such as the aged, women and the poor. In setting premium a policy-maker needs to take into account costs of the CBI benefits package, possible subsidies from government and other agencies and WTP information. WTP should never be taken as a premium because it only provides some information for the respondents' financial acceptability for a certain benefits package.
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Affiliation(s)
- Hengjin Dong
- Department of Tropical Hygiene and Public Health, University of Heidelberg, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany.
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Larson BA, Rosen S. Understanding household demand for indoor air pollution control in developing countries. Soc Sci Med 2002; 55:571-84. [PMID: 12188464 DOI: 10.1016/s0277-9536(01)00188-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
More than 2 billion people rely on solid fuels and traditional stoves or open fires for cooking, lighting, and/or heating. Exposure to emissions caused by burning these fuels is believed to be responsible for a significant share of the global burden of disease. To achieve widespread health improvements, interventions that reduce exposures to indoor air pollution will need to be adopted and consistently used by large numbers of households in the developing world. Given that such interventions remain to be adopted by large numbers of these households, much remains to be learned about household demand for interventions designed (in part at least) to reduce indoor air pollution. A general household framework is developed that identifies in detail the determinants of household demand for indoor air pollution interventions, where demand for an intervention is expressed in terms of willingness to pay. Household demand is shown to be a combination of three terms: (1) the direct consumption effect; (2) the child health effect; and (3) the adult health effect. While micro-level data are not available to estimate directly this model, existing data and information are used to estimate just the health effects component of household demand. Based on such existing information, it might be concluded that household demand should seemingly be strong given that willingness to pay, based on existing information, is seemingly large compared to costs for common interventions like improved stoves. Given that household demand is not strong for existing interventions, this analysis shows that more clearly focused research on household demand for interventions is needed if such interventions are going to be demanded (i.e. adopted and used) by large numbers of households throughout the developing world. Four priority areas for future research are: (1) improving information on dose-response relationships between indoor air pollution and various health effects (e.g. increased mortality and morbidity risks); (2) improving information on impacts from interventions in terms of air pollution reductions and also cooking times, fuel use, and heat intensities; (3) improving information on household shadow values for improved health, with separate information for adult and child health; and (4) considering more directly household information, and its adequacy, for their ability to evaluate the relationships between fuel use and health.
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Affiliation(s)
- Bruce A Larson
- Department of Agricultural and Resource Economics, University of Connecticut, Storrs 06269, USA.
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