Household willingness to pay for azithromycin treatment for trachoma control in the United Republic of Tanzania

OBJECTIVE: Household willingness to pay for treatment provides important information for programme planning. We tested for relationships between socioeconomic status, risk of trachoma, perceptions of the effects of azithromycin, and the household willingness to pay for future mass treatment with azithromycin. METHODS: We surveyed 394 households in 6 villages located in central United Republic of Tanzania regarding their willingness to pay for future azithromycin treatment. A random sample of households with children under 8 years of age was selected and interviewed following an initial treatment programme in each village. Data were gathered on risk factors for trachoma, socioeconomic status, and the perceived effect of the initial azithromycin treatment. Ordered probit regression analysis was used to test for statistically significant relationships. FINDINGS: 38% of responding households stated that they would not be willing to pay anything for future azithromycin treatment, although they would be willing to participate in the treatment. A proxy for cash availability was positively associated with household willingness to pay for future antibiotic treatment. Cattle ownership (a risk factor) and being a household headed by a female not in a polygamous marriage (lower socioeconomic status) were associated with a lower willingness to pay for future treatment. A perceived benefit from the initial treatment was marginally associated with a willingness to pay a higher amount. CONCLUSIONS: As those at greatest risk of active trachoma indicated the lowest willingness to pay, imposing a cost recovery fee for azithromycin treatment would likely reduce coverage and could prevent control of the disease at the community level.     

Willingness to pay for public health care: a comparison of two approaches

When applying willingness-to-pay (WTP) in economic evaluations, there have been strong theoretical arguments for the use of ex ante insurance-based questions, which can be framed either as insurance premiums or taxation contributions. This paper suggests theoretical reasons why respondents may value a programme differently in these two different ex ante approaches, and inquires empirically into the potential existence of such differences. A split-sample interview study was undertaken in Denmark. The proportion of respondents willing to pay is higher in the community version, and the respondents use different reasons for being and not being willing to pay.     

Patient willingness to pay for preventive measures in primary care: a study of five GPs in a German community

Summary Objectives:To explore the willingness of patients in a usual primary care setting to pay out-of-pocket fees for their own health promotion, in correlation with risk factors and net income, and compared to patients of an educational programme.Methods:A standardised health survey carried out in five general practices (GPs) of a small community with a special GP-based health education programme was combined with a questionnaire to explore the special attitudes of patients from a practice sample (n=973) and from educational courses (n=202): covering, in addition to cardiovascular risk factors, the sociodemographic factors, net income, and out-of-pocket fees that could be spent for own health promotion.Results:After attending an educational programme, the patients willingness to spend 15–40 €/month for their own health promotion was high but there was no correlation with the income (p<0.56), in contradiction to the patients of the practice sample who would pay more money the more they earn (p<0.001). High levels of cardiovascular risk were associated with low education (p<0.001), but net income and willingness to pay for preventive measures did not significantly correlate with cardiovascular risk factors.Conclusions:Participants of educational courses are willing to pay a rational out-of-pocket fee for preventive measures without correlation with their incomes, thus reducing the social gradient; future preventive measures should take into account that reasonable cost sharing is well accepted by well-informed patients.     

儿童牙科畏惧症的心理、行为特点及防治研究

目的 探讨儿童牙科畏惧症的相关因素及防治对策。方法 采用问卷式调查，治疗前填表，治疗后由经治医师对患儿行为进行评价，评价方法采用以体征为依据的6级分类法。结果 309例患者有牙科畏惧症者250例，发生率为80．91％，其中学龄前儿童牙科畏惧症发生率为85．29％，学龄儿童牙科畏惧症发生率为72．38％。结论 儿童牙科畏惧症与其口腔卫生状况、看牙经历、精神状态及家长的文化程度高低密切相关，采用心理疏导疗法治疗牙科畏惧症具有良好效果。     

乙型肝炎母婴阻断策略成本效果可支付性分析

目的 分析我国乙型肝炎（乙肝）母婴阻断策略的成本效果价值,探索支付意愿和预算规模对项目持续投入的影响。方法 以乙肝母婴阻断为研究策略,不接种为对照策略,采用决策分析马尔科夫模型,以我国2013年出生人口数为队列人群,通过TreeAge Pro 2015软件实现模拟运行。分别从全社会和支付者角度计算成本,效果包括乙肝相关疾病人数和质量调整生命年（QALYs）,策略间比较采用增量成本效果比（ICER）。由敏感性分析明确各参数的不确定性,绘制成本效果可支付曲线评价策略的可支付性。结果 接受乙肝母婴阻断后终其一生所承担的成本为4 063.5元/人,比不接种节省37 829.7元/人。人均获得QALYs为24.516 1,与不接种策略相比增加明显,且可以减少乙肝相关疾病的发生。从全社会角度看,乙肝母婴阻断与不接种相比,每多获得一个QALYs分别可节省59 136.6元,根据本研究成本效果阈值,说明乙肝母婴阻断具有成本效果价值。一维、多维和概率敏感性分析显示,上述结果稳定可靠。成本效果可接受曲线显示,结果不会因公众支付意愿变化而影响,且研究策略完全实现的支付意愿小于成本效果阈值。可支付分析显示,我国实施该策略的年预算在5.904亿~6.888亿元,不会超出财政支付能力;同一支付意愿下,年预算越高本研究策略具有经济性及可支付性的概率越高,只有当年预算达到6.888亿元,该策略才能完全实现。结论 我国推行的乙肝母婴阻断策略具有成本效果价值,并未超出公众支付意愿和财政预算能力,顺应了全球消除乙肝的目标要求,值得大力实施和推广。     

Self-reported dental fear among dental students and their patients

The aim of the present study was to compare self-reported dental fear among dental students and patients at a School of Dentistry in Belo Horizonte, Brazil. Eighty students ranging in age from 20 to 29 years and 80 patients ranging in age from 18 to 65 years participated in the study. A self-administered pre-tested questionnaire consisting of 13 items was used for data acquisition. The city of Belo Horizonte Social Vulnerability Index (SVI) was employed for socioeconomic classification. The chi-square test and binary and multinomial logistic regression were employed in the statistical analysis, with the significance level set at 0.05. The majority of dental students (76.5%) sought the dentist for the first time for a routine exam, while patients (77.3%) mostly sought a dentist for the treatment of dental pain. Dental fear was more prevalent among the patients (72.5%) than the students (27.5%). A total of 47.1% of the students and 52.9% of the patients reported having had negative dental experiences in childhood. The logistic model revealed an association between dental fear and a pain-related experience (OR: 1.8; 95%CI: 1.3-2.6). Patients were more prone to dental fear (OR: 2.2; 95%CI: 1.0-5.0). Although at different percentages, both students and patients experienced dental fear. Current patient with previous experience of dental pain had more dental fear.     

Assessing the Value of Symptom Relief for Patients with Gastroesophageal Reflux Disease Treatment: Willingness to Pay Using a Discrete Choice Experiment

ObjectivesTo assess patients’ preferences and estimate willingness to pay (WTP) for gastroesophageal reflux disease (GERD) treatments.MethodPatients were randomly selected from a multicenter clinical study to participate in the discrete choice experiment (DCE) survey. Relevant treatment attributes were identified through literature review, clinical expert consultation, and focus groups. The DCE included 14 choice tasks composed of six attributes, three treatment profiles, and a “none”option considering orthogonality, D-efficiency, and level balance, while keeping patient response burden reasonable. Individual-level preferences and WTP were estimated by aggregate-level conditional logit and hierarchical Bayes analyses.ResultsOur sample of 361, drawn from a clinical trial, had a mean age of 57 years, were primarily women (53%), and rated their GERD symptoms as mild/moderate (31%) and moderately severe/severe (7%). Most important attributes of GERD treatment were (in order) as follows: avoiding side effects, sleeping discomfort, daytime discomfort, dietary changes, medication cost, and treatment frequency. Simulations found that patients are willing to pay an additional US $36 to reduce susceptibility to side effects from moderate to mild or to decrease the frequency of sleeping discomfort. Patients 65 years or older were willing to pay less for daytime discomfort relief, while women would pay more to avoid sleeping discomfort.ConclusionsKey factors concerning patients with GERD and their preference for treatment features to control GERD symptoms were confirmed. A DCE estimated WTP by GERD sufferers for relief from symptoms and avoidance of side effects using relevant treatment costs. These findings may help guide clinical treatment decisions for individual patients to improve GERD symptom control.     

AIDS AND DENTISTRY IN AUSTRALIA: KNOWLEDGE,INFECTION CONTROL PRACTICES AND ATTITUDES TO TREATMENT IN A RANDOM SAMPLE OF AUSTRALIAN DENTISTS

1130 dentists surveyed by mail from Australian capital cities (response rate 80%) answered a questionnaire on knowledge of clinical manifestations of AIDS and HIV, attitudes to treatment and referral of AIDS/HIV patients, infection control practices and personal risk factors for HIV. Despite a third of dentists being willing to treat HIV antibody-positive patients and 22% being willing to treat AIDS patients, over 50% believe AIDS to be a major problem for dentists, with two thirds claiming that their staff would not treat AIDS patients and 55% believing they would lose patients if word spread that they were treating HIV/AIDS patients. The perhaps irreconcilable tension between variable willingness to treat and the concerns of staff and other patients suggests that a policy of improving the dental referral network among people with AIDS may be in the best interests of the dental health and well-being of people with AIDS.     

Willingness to participate in HIV vaccine clinical trials among Chinese men who have sex with men

HIV vaccine trials require volunteers. Little is known about willingness to participate (WTP) in HIV vaccine trials among Chinese MSM. A survey of 550 MSM was conducted from March to June 2008, in Beijing, China. Data were collected on demographics, behaviors, perceptions about HIV/AIDS and HIV vaccines, and concerns about participation in HIV vaccine clinical trials. Of study participants, 35.8% were definitely willing to participate, 35.1% were probably willing, 16.4% were probably not willing, and 12.7% were definitely not willing. Analyses suggest that perceived family support, perceived protection against HIV infection and fear that participation would result in social distancing were associated with WTP. MSM in China may be good candidates for HIV vaccine trials. Further studies are needed to evaluate actual enrollment.     

Willingness to pay for methadone maintenance treatment in Vietnamese epicentres of injection-drug-driven HIV infection

Objective

Willingness to pay for methadone maintenance treatment (MMT) in three Vietnamese epicentres of injection-drug-driven human immunodeficiency virus (HIV) infection was assessed.

Methods

A convenience sample of 1016 patients receiving HIV treatment in seven clinics was enrolled during 2012. Contingent valuation was used to assess willingness to pay. Interviewers reviewed adverse consequences of injection drug use and the benefits of MMT. Interviewers then described the government’s plan to scale up MMT and the financial barriers to scale-up. Willingness to pay was assessed using double-bounded binary questions and a follow-up open-ended question. Point and interval data models were used to estimate maximum willingness to pay.

Findings

A total of 548 non-drug-users and 468 injection drug users were enrolled; 988 were willing to pay for MMT. Monthly mean willingness to pay among non-drug-users, 347 drug users not receiving MMT and 121 drug users receiving MMT was 10.7 United States dollars [US$] (35.7% of treatment costs), US$ 21.1 (70.3%) and US$ 26.2 (87.3%), respectively (mean: US$ 15.9; 95% confidence interval, CI: 13.6–18.1). Fifty per cent of drug users were willing to pay 50% of MMT costs. Residence in households with low monthly per capita income and poor health status predicted willingness to pay less among drug users; educational level, employment status, health status and current antiretroviral therapy receipt predicted willingness to pay less among non-drug-users.

Conclusion

Willingness to pay for MMT was very high, supporting implementation of a co-payment programme.     

The paradox of the cost and affordability of traditional and government health services in Tanzania

Since the introduction of user fee systems in the government health facilities of most African countries, which shifted part of the burden of financing health care onto the community, affordability of basic health care has been a much discussed topic. It is sometimes assumed that in areas where high levels of spending for traditional treatments are common, people would be able to pay for basic health care at governmental facilities, but may not be willing to do so. However, examining willingness to pay and ability to pay in the broader context of different types of illness and their treatment leads us to a very different conclusion. In the course of a medical-ethnographic study in south-eastern Tanzania, we found evidence that people may indeed be willing, but may nevertheless not be able, to pay for biomedical health care--even when they can afford costly traditional medicine. In this article, we suggest that the ability to pay for traditional treatment can differ from ability to pay for hospital attendance for two main reasons. First, many healers--in contrast to the hospital--offer alternatives to cash payments, such as compensation in kind or in work, or payment on a credit basis. Secondly, and more importantly, the activation of social networks for financial help is different for the two sectors. For the poor in particular, ability to pay for health care depends a great deal on contributions from relatives, neighbours and friends. The treatment of the 'personalistic' type of illness, which is carried out by a traditional healer, involves an extended kin-group, and there is high social pressure to comply with the requirements of the family elders, which may include providing financial support. In contrast, the costs for the treatment of 'normal' illnesses at the hospital are usually covered by the patient him/herself, or a small circle of relatives and friends.     

Attitude to telemedicine, and willingness to use it, in audiology patients

We studied the willingness of patients to use telemedicine for ear- and hearing-related appointments, and the factors that influenced their decision to participate in telemedicine. A survey was designed with questions about patient appointments, perceived advantages and barriers to telemedicine, and prior use of the Internet for health-related matters. A total of 116 patients in four audiology centres were surveyed from December 2004 to May 2005. There were 54 male and 62 female respondents; 46% of the participants were aged over 66 years. In all, 75% had not previously heard of telemedicine. The most common reasons for willingness to use telemedicine were to reduce the time waiting for an appointment and cost. The most common barrier to using telemedicine was a preference for face-to-face visits. Of those surveyed, 32% were willing to use telemedicine, 10% would sometimes be willing, 28% were unsure, and 30% were not willing. There was no relationship between willingness and age or gender, except that women over the age of 55 years were less willing. Patients who had previously heard of telemedicine and used the Internet for health-related matters, especially men, were more inclined to have a telemedicine appointment.     

Differences in willingness to pay for artemisinin-based combinations or monotherapy: experiences from the United Republic of Tanzania

OBJECTIVE: The cost of combination treatment is thought to be one of the greatest barriers to their deployment, but this has not been tested directly. Estimates of willingness to pay were compared across four drug combinations used to treat Tanzanian children with uncomplicated malaria. The reasons behind respondents' valuations and the effect of socioeconomic status on willingness to pay were explored. METHODS: One hundred and eighty mothers whose children had been recruited into a recently completed randomized effectiveness trial of amodiaquine + artesunate (AQ+AS), amodiaquine + sulfadoxine-pyrimethamine (AQ+SP), artemether-lumefantrine (coartemether) and amodiaquine monotherapy (AQ) were interviewed about their willingness to pay for these drugs two weeks after treatment. Estimates of willingness to pay were elicited with the bidding game technique. FINDINGS: A significant difference was detected in the mean amounts respondents were willing to pay, with those who received AQ+AS willing to pay the most, followed by co-artemether, AQ+SP and finally AQ. The amounts patients' mothers were willing to pay for the artemisinin-based combinations, however, fell well short of the market costs. Socioeconomic status was not found to have a statistically significant effect on mean willingness to pay scores for any treatment group. CONCLUSION: This study shows that families who live in an area in which drug resistance to monotherapy is very high are willing to pay more for more effective artemisinin-based combination therapies. These amounts, however, are nowhere near the real costs of delivering the new drugs. Only with subsidies will artemisinin-based combination therapies realistically have any impact.     

Willingness to Pay for Lung Cancer Treatment

ObjectivesThe increasing health-care cost of lung cancer treatment has caused debates regarding the reimbursement of new medications. The purpose of this study was to estimate patients' willingness to pay (WTP) for a hypothetical new drug.MethodsPatients with lung cancer were recruited through referrals by senior specialists from two medical centers in Taiwan. Double-bounded dichotomous choice questions and follow-up open-ended questions were employed to elicit patients' WTP. The contingent valuation question assumed that a novel medication was available, which provided a cure for lung cancer; however, patients would have to pay for this new cure out of their own pocket. In addition, the question was asked as to how much patients would be willing to pay for supplementary hospitalization insurance? Interval regression and linear regression were used to estimate the maximum WTP.ResultsA total of 294 patients were recruited; their mean age was 67 years; 74% were male and 26% were female. The results show that patients were prepared to pay New Taiwan dollar (NTD) 7416 or NTD 7032 per month to purchase this new medication. Sex, religion, income, the Karnofsky Performance Scale score, and having family that takes care of you are significant factors influencing a patient's WTP.ConclusionsPatients would like to pay less than the actual price of the new medication for their lung cancer. Thus government and health policymakers should consider the ability to pay when making their decision regarding the coverage of new drugs.     

Hospitalized Women’s Willingness to Pay for an Inpatient Screening Mammogram

Lower rates for breast cancer screening persist among low income and uninsured women. Although Medicare and many other insurance plans would pay for screening mammograms done during hospital stays, breast cancer screening has not been part of usual hospital care. This study explores the mean amount of money that hospitalized women were willing to contribute towards the cost of a screening mammogram. Of the 193 enrolled patients, 72% were willing to pay a mean of $83.41 (95% CI, $71.51–$95.31) in advance towards inpatient screening mammogram costs. The study’s findings suggest that hospitalized women value the prospect of screening mammography during the hospitalization. It may be wise policy to offer mammograms to nonadherent hospitalized women, especially those who are at high risk for developing breast cancer.     

Economic implications of in vitro fertilization using willingness to pay

Introduction

Fertility levels are determined by social, religious, and cultural factors on one hand, and by financial considerations that affect the demand for children as well as the supply of children on the other. Using theoretical and empirical models we examine the private and social benefit of children, and the private and social welfare differences that are generated by technological innovation in fertility technology.

Subjects and methods

A theoretical model measures the marginal private and social benefit when the children’s potential output depends on the natural potential fertility combined with medical fertility technology. It is followed by an empirical model that focuses on the evaluation of the general public’s, and in vitro fertilization patients’ “willingness to pay” for fertility treatments. The economic evaluation method is based on willingness to pay, which is derived from answers to hypothetical questions.

Results

Based on questionnaires distributed between in vitro fertilization actual patients and the general public, the empirical model’s findings are that the average willingness to pay amongst patients is $5,482, whereas for the general public it is $4,398. Both the general public as well the actual patients are willing to pay more than the actual average cost of an in vitro fertilization treatment, which is $3,257.

Conclusion

We find that when considering the appropriate allocation of limited resources, subsidizing fertilization should receive high priority since the net benefits for both patients and society are high.     

牙科畏惧症患者的心理学评价

[目的 ]了解不同诊疗环境对牙科畏惧症患者的心理影响 ;[方法 ]对牙科畏惧症患者进行问卷调查 ,通过对比性研究方法进行分析 ;[结果 ]获得所需要的数据与表格 ;[结论 ]pd理论指导下的牙科治疗模式对牙科畏惧症患者症状的改善和降低紧张心理有显著作用     

Changes and factors associated with dentists' willingness to treat patients with severe disabilities

OBJECTIVE: This study investigated changes in dentists' willingness to treat severely disabled patients and to understand dentists' opinions on reimbursements after the implementation of a dental care financial reward program in Taiwan. METHODS: Three hundred dentists from 29 teaching hospitals were randomly selected to answer a structured questionnaire, and 184 structured questionnaires were returned. Multiple regression analysis was used to examine the factors associated with dentists' willingness to treat severely disabled patients. RESULTS: Approximately 60% of the dentists said reimbursements for treatment of severely disabled patients were reasonable. 50.4% of dentists were willing or very willing to treat disabled patients. Seventy-nine percent dentists affected by the program had a higher willingness but 83.7% dentists said this program did not make a significant difference to their income. 52.8% of dentists agreed the program would increase the quality of dental care. The factors significantly affecting dentists' willingness included dentist's age, specialty field, perception of the program in promoting the quality of dental services, and perception of the ability to provide adequate treatments for severely disabled patients. CONCLUSIONS: The rewards program significantly increased the willingness of most hospital-base dentists to treat the severely disabled patients although the effect of incentive to their income was limited.     

Should radon be reduced in homes? A cost-effect analysis

BACKGROUND: Radon is a radioactive gas that may leak into buildings from the ground. Radon exposure is a risk factor for lung cancer. An intervention against radon exposure in homes may consist of locating homes with high radon exposure (above 200 Bq m(-3)) and improving these, and protecting future houses. The purpose of this paper is to calculate the costs and the effects of this intervention. METHODS: We performed a cost-effect analysis from the perspective of the society, followed by an uncertainty and sensitivity analysis. The distribution of radon levels in Norwegian homes is lognormal with mean = 74.5 Bq m(-3), and 7.6% above 200 Bq m(-3). RESULTS: The preventable attributable fraction of radon on lung cancer was 3.8% (95% uncertainty interval: 0.6%, 8.3%). In cumulative present values the intervention would cost $238 (145, 310) million and save 892 (133, 1981) lives; each life saved costs $0.27 (0.09, 0.9) million. The cost-effect ratio was sensitive to the radon risk, the radon exposure distribution, and the latency period of lung cancer. Together these three parameters explained 90% of the variation in the cost-effect ratio. CONCLUSIONS: The uncertainty in the estimated cost per life is large, mainly due to uncertainty in the risk of lung cancer from radon. Based on estimates from road construction, the Norwegian society has been willing to pay $1 million to save a life. This is above the upper uncertainty limit of the cost per life. The intervention against radon in homes, therefore, seems justifiable.     

Cost–effectiveness of a comprehensive programme for drug-resistant tuberculosis in China

Objective

To investigate the cost–effectiveness of a comprehensive programme for drug-resistant tuberculosis launched in four sites in China in 2011.

Methods

In 2011–2012, we reviewed the records of 172 patients with drug-resistant tuberculosis who enrolled in the comprehensive programme and we collected relevant administrative data from hospitals and China’s public health agency. For comparison, we examined a cohort of 81 patients who were treated for drug-resistant tuberculosis in 2006−2009. We performed a cost–effectiveness analysis, from a societal perspective, that included probabilistic uncertainty. We measured early treatment outcomes based on three-month culture results and modelled longer-term outcomes to facilitate estimation of the comprehensive programme’s cost per disability-adjusted life-year (DALY) averted.

Findings

The comprehensive programme cost 8837 United States dollars (US$) per patient treated. Low enrolment rates meant that some fixed costs were higher, per patient, than expected. Although the comprehensive programme appeared 30 times more costly than the previous one, it resulted in greater health benefits. The comprehensive programme, which cost US$ 639 (95% credible interval: 112 to 1322) per DALY averted, satisfied the World Health Organization’s criterion for a very cost–effective intervention.

Conclusion

The comprehensive programme, which included rapid screening, standardized care and financial protection, improved individual outcomes for MDR tuberculosis in a cost-effective manner. To support post-2015 global heath targets, the comprehensive programme should be expanded to non-residents and other areas of China.