我国城市居民对多种癌症联合筛查的频率倾向及支付意愿

目的 了解我国城市居民对常见癌种（肺、胃、食管、肝、结直肠和乳腺癌）联合筛查的频率倾向及支付意愿。方法 2012-2014年基于城市癌症早诊早治项目的13个省份现场,面对面调查不同付费假设下,实际参加项目的居民倾向的筛查频率、对长期推行每3年1次联合筛查的支付意愿和支付额度等。结果 最终完成合格访谈31 029人,年龄（55.2±7.5）岁,近5年家庭人均年收入M值为2.5万元。对于多种癌症联合筛查服务,若完全免费,93.9%的居民选择每1~3年1次的频率;完全自费时对应的比例为67.3%。假设将每3年1次的联合筛查长期推行且需个人部分付费时,76.7%的居民愿意付费,但支付额度超过500元者（联合筛查人均费用约1 500元）仅占11.2%。其余23.3%无支付意愿者主要认为费用难以承受（71.7%）和认为没必要筛查（40.4%）。结论 我国城市参加过癌症筛查的居民对多种癌症联合筛查倾向"高频"模式,提示大范围推广的潜在接受程度较高,但需科学评价与正确引导。尽管多数居民对联合筛查有支付意愿但支付额度有限,提示应加强居民对自我健康的责任管理意识,建立筛查服务共付机制时应设置合理比例。     

Considerations in applying the general equilibrium approach to environmental health assessment

There are currently two commonly used approaches to assessing economic impacts of health damage resulting from environmental pollution： human capital approach （HCA） and willingness-to-pay （WTP）. WTP can be further divided into averted expenditure approach （AEA）, hedonlc wage approach （HWA）, contingent valuation approach （CVA） and hedonlc price approach （HPA）. A general review of the principles behind these approaches by the authors indicates that these methods are incapable of unveiling the mechanism of health impact from the point of view of national economy. On a basis of economic system, the shocks brought about by health effects of environmental pollution change the labor supply and medical expenditure, which in turn affects the level of production activity in each sector and the total final consumption pattern of the society. The general equilibrium approach within the framework of macroeconomic theory is able to estimate the health impact on national economy comprehensively and objectively. Its mechanism and applicability are discussed in detail by the authors.     

孕产妇对新生儿遗传代谢病串联质谱筛查认知及支付意愿分析

目的了解孕产妇对新生儿遗传代谢病串联质谱筛查的认知现状及支付意愿,为扩展新生儿疾病筛查提供科学依据。方法 2019年6月,采用自行设计的问卷调查深圳市6家助产机构的720例孕产妇,调查内容包括:孕产妇基本信息、对新生儿遗传代谢病串联质谱筛查的认知和支付意愿状况。结果共回收720份有效问卷,回收有效率92. 31%。孕产妇对新生儿遗传代谢病串联质谱筛查的知晓率为54. 44%,从医院获取信息占90. 31%,认为有必要增加新生儿遗传代谢病串联质谱筛查占68. 33%,愿意让孩子参与筛查占81. 67%。孕产妇对新生儿遗传代谢病串联质谱筛查愿意支付金额的平均数为242元,最高愿意支付金额的平均数为656元,其支付意愿水平与家庭收入有关。结论孕产妇对新生儿遗传代谢病串联质谱筛查认知度不高,需给予多渠道健康教育,树立正确的筛查理念,提升其认知水平。提倡政府与家庭共同承担新生儿遗传代谢病串联质谱筛查费用,提高新生儿家长让孩子参与筛查的积极性。     

Maintenance behaviour and long-lasting insecticide-treated nets (LLITNs) previously introduced into Bourapar district, Khammouane province, Lao PDR

BACKGROUND: Long-lasting insecticide-treated nets (LLITNs) are expected to be an important advance in malaria control, but operational experience is still scarce. This study presents some operational findings concerning the introduction of Olysettrade mark LLITNs (Sumitomo Chemical Co., Ltd, Japan) in Laos. The study site, Bourapar district, a remote district at high risk of malaria, received Olysettrade mark nets during 1999-2000. After distribution of the nets the number of malaria cases in the district hospital decreased for a time, however it began to rise again a year after the intervention. To sustain the effect of the nets, net users were given instructions on maintenance and use. This study aimed to investigate the condition of Olysettrade mark nets and the maintenance behaviour of net users after 2-3 years of use, and to examine the associations between maintenance behaviour and the number of malaria episodes during the previous year. METHODS: Questionnaire interviews and inspections of nets were conducted at 240 households during February-March 2003. RESULTS: About 40% of the observed nets had holes/were torn, and the maintenance instructions had not been followed sufficiently. Households following the recommended washing frequency (38.2%) reported fewer malaria episodes during the past year, which demonstrates the importance of the recommended washing frequency in the effective use of the nets. CONCLUSIONS: Our study promotes the idea that, in addition to pursuing high coverage of LLITNs, more effort should be made to ensure that nets are kept in good condition in future LLITN programmes.     

Preferences for end-of-life care among community-dwelling older adults and patients with advanced cancer: A discrete choice experiment

Singapore is in the midst of several healthcare reforms in efforts to finance and deliver health services for a rapidly aging population. The primary focus of these reforms is to make healthcare services, including those at the end of life (EOL), affordable. Given the increasingly high health care costs at the EOL, policy makers need to consider how best to allocate resources. One strategy is to allocate resources based on the preferences of sub-populations most likely to be affected. This paper thus aims to quantify preferences for EOL care both among community dwelling older adults (CDOAs) and among patients with a life-limiting illness. A discrete choice experiment was administered to CDOAs and advanced cancer patients in Singapore and willingness to pay (WTP) for specific EOL improvements was estimated. We find that patients have a higher WTP for nearly all EOL attributes compared with CDOAs. We also show that, for both groups, moderate life extension is not the most important consideration; WTP for one additional life year is lower than common thresholds for cost-effectiveness. Irrespective of whose preference are considered, the results highlight the importance of pain management and supporting home deaths at the EOL, perhaps at the expense of public funding for costly but only marginally effective treatments.     

A comparison between willingness to pay and willingness to give up time

We compared the willingness-to-pay and willingness to give up time methods to assess preferences for digital subtraction angiography (DSA), computed tomography angiography (CTA) and magnetic resonance angiography (MRA). Respondents were hypertensive patients suspected of having renal artery stenosis. Data were gathered using telephone interviews. Both the willingness-to-pay and willingness to give up time methods revealed that patients preferred CTA to MRA in order to avoid DSA. The agreement between willingness-to-pay and willingness to give up time responses was high (kappa 0.65–0.85). The willingness-to-pay method yielded relatively more protest answers (12%) as compared to willingness to give up time (2%). So, our results provided evidence for the comparability of willingness to pay and willingness to give up time. The high percentage of protest answers on the willingness-to-pay questions raises questions with respect to the application of the willingness-to-pay method in a broad decision-making context. On the other hand, the strength of willingness-to-pay is that the method directly arrives at a monetary measure well founded in economic theory, whereas the willingness to give up time method requires conversion to monetary units.      

The marginal willingness-to-pay for attributes of a hypothetical HIV vaccine

This paper estimates the marginal willingness-to-pay for attributes of a hypothetical HIV vaccine using discrete choice modeling. We use primary data from 326 respondents from Bangkok and Chiang Mai, Thailand, in 2008–2009, selected using purposive, venue-based sampling across two strata. Participants completed a structured questionnaire and full rank discrete choice modeling task administered using computer-assisted personal interviewing. The choice experiment was used to rank eight hypothetical HIV vaccine scenarios, with each scenario comprising seven attributes (including cost) each of which had two levels. The data were analyzed in two alternative specifications: (1) best-worst; and (2) full-rank, using logit likelihood functions estimated with custom routines in Gauss matrix programming language. In the full-rank specification, all vaccine attributes are significant predictors of probability of vaccine choice. The biomedical attributes of the hypothetical HIV vaccine (efficacy, absence of VISP, absence of side effects, and duration of effect) are the most important attributes for HIV vaccine choice. On average respondents are more than twice as likely to accept a vaccine with 99% efficacy, than a vaccine with 50% efficacy. This translates to a willingness to pay US$383 more for a high efficacy vaccine compared with the low efficacy vaccine. Knowledge of the relative importance of determinants of HIV vaccine acceptability is important to ensure the success of future vaccination programs. Future acceptability studies of hypothetical HIV vaccines should use more finely grained biomedical attributes, and could also improve the external validity of results by including more levels of the cost attribute.     

老年人对医养结合型医疗机构的认知、入住意愿及支付意愿——基于成都市的实证分析

目的:了解老年人对医养结合型医疗机构的认知、入住意愿及支付意愿。方法:随机抽取成都市主城区350名老年人进行问卷调查。结果:在认知方面,老年人对医养结合型医疗机构的认知程度较低,大部分老年人(80.60%)不了解或没听说过医养结合型医疗机构。在入住意愿方面,56.72%的老年人愿意入住医养结合型医疗机构。在支付意愿方面,老年人的支付意愿较低,大部分老年人(79.70%)的支付意愿在2 000元/人以下。此外,年龄、养老意愿和对医养结合型医疗机构的认知程度是影响老年人入住医养结合型医疗机构意愿的主要因素。结论:加大宣传力度,提高老年人对医养结合型医疗机构的认知。采取多种方式,减轻老年人入住医养结合型医疗机构的经济负担。实行分级收费,满足不同老年人的入住需要。     

Patients’ willingness to pay for electronic communication with their general practitioner

Despite the common use of electronic communication in other aspects of everyday life, its use between patients and health care providers has been slow to diffuse. Possible explanations are security issues and lack of payment mechanisms. This study investigated how patients value secure electronic access to their general practitioner (GP). One hundred and ninety-nine patients were asked an open-ended willingness-to-pay (WTP) question as part of a randomised controlled trial. We compared the WTP values between two groups of respondents; one group had had the opportunity to communicate electronically with their GP for a year and the other group had not. Fifty-two percent of the total sample was willing to pay for electronic GP contact. The group of patients with access revealed a significantly lower WTP than the group without such access. Possible explanations are that the system had fewer benefits than expected, a presence of hypothetical bias or simply a preference for face-to-face encounters.     

ICE preference maps: nonlinear generalizations of net benefit and acceptability

The Net Benefit (NB) approach to Incremental Cost-Effectiveness (ICE) statistical inference uses a linear function (map) to assign a real valued, numerical preference score to every point on the 2-dimensional ICE plane. We argue that coherent ICE preferences satisfy four intuitive axioms and propose a 2-parameter family of maps that satisfy these axioms and provide highly realistic generalizations of NB. For example, nonlinear maps do not require that returns-to-scale be linear (constant) or that willingness-to-pay (WTP) and willingness-to-accept (WTA) are both equal to the shadow price of health, λ. In fact, all of our maps have the property that With λ held fixed, this geometric mean relationship shows that WTA must decrease when WTP increases and vice versa. This relationship thus provides not only a polar angular measure of the size of “Bernie’s Kink,” WTP < WTA, but also the theoretical basis for Buckingham’s ALICE curve generalization of acceptability. Finally, we argue that uncertainty about economic preferences expressed by varying λ can totally swamp the statistical uncertainty in patient level data expressed by a wedge-shaped, bootstrap ICE confidence region that does not depend upon λ in the sense that it is equivariant under changes in λ. Financial support for this research was provided entirely by Eli Lilly and Company. The author’s independence in writing and publishing his research is ensured by Lilly’s published Principles of Medical Research. The author is a retired pensioner and a stockholder of Eli Lilly and Company.