Cost–benefit analysis of orientation and mobility programs for adults with vision disability: a contingent valuation study

Abstract

Purpose The purpose of this study is to conduct a cost–benefit analysis of orientation and mobility (O&M) programs from three perspectives: the general public, the experienced, and the potential users of O&M programs. Methods Willingness-to-pay (WTP) for O&M programs was collected via a contingent valuation survey using a double-bound dichotomous choice approach. WTP was estimated using interval regression analyses, accounting for study arm, sex, occupation, income, and self-rated health. The cost data were estimated from a service provider’s perspective. The net present value (NPV), variation if delivered by tele-O&M, was investigated. Results The adjusted mean NPV of O&M programs was $3857 (95% CI: $3760–$3954) per client, with highest NPV from the general public ($4289, 95% CI: $4185–$4392), followed by the experienced users ($3158, 95% CI: $2897–$3419) and the potential users ($2867, 95% CI: $2680–$3054). The NPV reached break-even for tele-O&M. Conclusions There was strong community support for investment into O&M programs considering benefits for clients over and above the cost of providing the services. Implications for rehabilitation This study demonstrates the feasibility of using cost–benefit analysis with a contingent valuation approach to economically assess a rehabilitation intervention, where its multi-dimensional benefits cannot be fully captured by a conventional appraisal technique such as cost-effectiveness analysis. The high willingness-to-pay (WTP) values amongst the general public suggests that Australians perceive government’s investment in orientation and mobility (O&M) rehabilitation as value for money and that individuals would be prepared to contribute to its costs. The lower WTP for O&M partially delivered via tele-practice (tele-O&M) indicates a lower acceptance of this innovation in comparison with the traditional face-to-face O&M. The estimated net present values of O&M programs, positive for traditional O&M and break-even for tele-O&M, can be of assistance to service planning and investment decisions within the Australian context.