Abstract
ObjectivesThe contingent valuation (CV) method elicits willingness to pay (WTP) for calculating the value of statistical life (VSL). CV approaches for assessing VSL are uncommon in many low and middle-income countries (LMICs). Between 2008 and 2018 only 44 articles utilized WTP in a health-related field and of these only 5 (11%) utilized CV to assess the WTP for a mortality risk reduction. We elicit WTP estimates and compute VSL using the CV method in Bangladesh.MethodsThe pilot study was primarily aimed at developing best practice guidelines for CV studies in LMICs to get more robust WTP estimates. To this end, we explored three methodological a) Varying the name of the intervention, keeping all other characteristics constant; b) varying the effectiveness of the health intervention and c) offering an overnight period to think about the WTP scenario. The survey was administered 413 randomly selected participants. VSL was for a 1/3000 mortality risk reduction.ResultsWe had more males (54%) than females (46%) and the mean annual self-reported income was $5,683.36. Mean VSL is $11,339.70 with a median of $10,413. The ratio of child: adult WTP is approximately 1 by both gender and age category. The vaccine intervention had the largest amount of $0 WTP and protest responses (52% and 58% respectively). 93% of the participants were able to describe (teach-back) the vaccine effectiveness using their own family as an example.ConclusionOur study provides empirical evidence on how to better generate CV surveys to produce more robust WTP estimates.
Highlights
The ratio of child-to-adult willingness to pay (WTP) is approximately 1 by both gender and age category. This finding implies that the WTP child-to-adult ratio in Bangladesh might be different from the prevailing 1.5:1 ratio found in high-income country settings.[47]
Mean value of statistical life (VSL) using the standard method is $11 339.70 with a median of $10 413. This value is low at approximately 7 times per capita gross domestic product (GDP) of Bangladesh, which is $1698.26.46 When we look at the backedout VSL, this number is even lower at $2189.52 and $3248.71 including and excluding $0 WTP values, respectively
This study examines the effects that survey presentation and methodological decisions may have on results when conducting contingent valuation (CV) to elicit WTP and VSL in a low- and middleincome countries (LMICs) such as Bangladesh
Summary
Out-of-pocket expenditures, and productivity loss, together called the cost of illness, are used ubiquitously to estimate the value of vaccines and immunization strategies in different contexts.[1,2,3,4,5,6,7,8] Using cost of illness as a measure of the economic impact of vaccination likely undervalues the broader benefits of vaccination, because it excludes nonpecuniary gains in welfare for the individual and the involved community.[9,10] Alternatively, the value of a statistical case or value of statistical life (VSL), derived from studies of individuals’ willingness to pay (WTP) for small changes in their own morbidity risk or mortality risk, respectively, can be used to estimate the value of vaccines.
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