Threat perceptions and the valuation of defence policy instruments

Loneliness in older adults contributes significantly to poor health outcomes and increased healthcare costs. Despite the growing prevalence of loneliness, many available interventions remain underutilised. To quantify older Australians' preferences for loneliness support programme features, their willingness to pay (WTP) for these features, and examine heterogeneity in preferences based on loneliness severity, socioeconomic, and mobility-related differences. A discrete choice experiment was conducted among 250 adults aged 65 years and older. Participants completed eight choice tasks comparing hypothetical programmes characterised by six attributes. Preferences were analysed using an error-component logit model, and WTP was calculated. Respondents significantly preferred community engagement (WTP = AUD 14.47, p < 0.01) compared to peer support, whereas virtual reality was least preferred (WTP = -AUD 9.58, p = 0.009). Fully virtual programmes were significantly less preferred than in-person options (WTP = -AUD 11.69, p = 0.019), with hybrid methods slightly preferred over fully virtual (WTP = -AUD 7.95, p < 0.01). Weekly interactions were strongly preferred over daily (WTP = AUD 16.93, p < 0.01) and monthly sessions (WTP = AUD 9.21, p = 0.005). Longer sessions (2 hours: WTP = AUD 5.08, p = 0.059; 4 hours: WTP = AUD 5.85, p = 0.037) were preferred over 30-minute sessions, while programmes requiring significant travel (50+ km) or higher costs significantly decreased programme desirability. Findings suggest interventions to reduce loneliness among older adults should prioritise affordable, regular, locally accessible, and community-oriented programmes, tailored specifically according to socioeconomic and mobility-related differences.

To compare direct and indirect willingness to pay (WTP) elicitation methods in terms of feasibility, reliability, and comparability. The application is obstetrics, where always both a mother's and a child's health are at stake. An open-ended contingent valuation method (CVM) as a direct WTP elicitation method, and the discrete choice experiment (DCE) as an indirect WTP elicitation method. Vignettes to be valued were based on clinical patient data. Participants were 88 laypersons who received their questionnaires by postal mail. The DCE task was completed faster (p=0.006) and was regarded easier (p<0.001) than the CVM task. Test-retest for CVM was substantial (ICC=0.76), and for DCE moderate (k=0.49). Female sex (p<0.001), age≥50 years (p=0.013), higher income (p<0.001), and higher education (p<0.001) were associated with higher WTP. Correlation between CVM and DCE was 0.79 (Kendall's Tau-b; p<0.001). The implied WTP as derived with DCE was between 2.3 and 10.2 times higher than with CVM. The relationship between the WTPs was linear. It is yet unclear what lies behind the numbers of DCE. DCE has no methodological benefits over the conventional CVM when eliciting WTP for complex health outcomes in obstetrics.

This project concerns the impacts of food hypersensitivity on people’s quality of life and the monetary value people assign to the removal of those impacts. Food hypersensitivities (FHS) are, in this report, defined as comprising food allergy, coeliac disease and food intolerance. Estimates of the economic value of removal of food hypersensitivity were generated from a stated preference (SP) survey in which people completed a discrete choice experiment (DCE). The DCE comprised of choices between (i) no change in respondents’ food hypersensitivity and (ii) the condition being removed for a specified period, at a cost. The surveys were conducted between July and December 2021 by adults regarding their own food hypersensitivity or by parents/carers regarding their child’s food hypersensitivity. The samples comprised 1426 adults and 716 parents. The average WTP for the removal of an adult’s FHS for a year, pooled across all conditions was £718. For models estimated separately by condition, the WTP values for food allergy, coeliac disease and food intolerance were £1064, £1342 and £540 respectively. In models estimated on DCE data from parents regarding their children’s food hypersensitivity the average WTP, pooled across all conditions, was £2501. The annual WTP values by condition were: £2766 for food allergy; £1628 for coeliac disease; £1689 for food intolerance. Respondents rated their (child’s) health and the impacts of their (child’s) FHS using several established instruments including the Food Allergy Quality of Life Questionnaire (FAQLQ); Food Intolerance Quality of Life Questionnaire (FIQLQ); Coeliac Disease Quality of Life Questionnaire, (CDQ). In the adult allergy and intolerance models we find robust evidence of effects of the perceived severity of FHS on WTP – the higher people’s FAQLQ and FIQLQ scores, the more they are willing to pay to remove their condition. There was no effect of variation in the CDQ score on WTP to remove coeliac disease. In the child WTP results we find condition-severity effects in the coeliac sample: the worse the child’s CDQ score the higher the parents’ WTP to remove the condition. The WTP values are estimates of the combined annual costs associated with (i) the intangible costs including the pain, anxiety, inconvenience and anxiety caused by FHS and (ii) additional incurred costs (time and money) and lost earnings. The values can be incorporated into the FSA Cost of Illness (COI) model, the Burden of Foodborne disease in the UK (Opens in a new window) which is currently used to measure the annual, social, cost of foodborne disease. A Best Worst Scaling (BWS) exercise was conducted to identify the relative importance of the many and diverse impacts which comprise the FAQLQ, FIQLQ and CDQ instruments. The BWS results indicate that people assign very different levels of importance to the impacts comprising the three instruments. This unequal prioritisation contrasts with the equal weighting used in the construction of the FAQLQ, FIQLQ and CDQ measures. Embarrassment and fear related to eating out or social situations feature in the top three impacts for all the conditions. Identifying the effects which most affect quality of life (from the perspective of people living with those conditions) has the potential to inform policy and practice by both regulators and private organisations such as food business operators.

Ecosystem services offered by freshwater ecosystems, in the form of natural pools have not been fully realized by the public, which has led to limited attention on the conservation of these pools. This study therefore was conducted to investigate the user preferences for sustainable enhancement of recreational values of natural pools and their immediate environment. A total of 320 local users of natural pools located in Rangala and Nillambe were surveyed as the sample. A Discrete Choice Experiment (DCE) was employed to elicit the preference and user Willingness to Pay (WTP). The Marginal Willingness to Pay (MWTP) for the improvement of recreational values of natural pools was estimated using a conditional logit (CL) model. Outcomes of the WTP disclosed a clear preference hierarchy for various enhancements and contributions. Users were willing to pay Sri Lankan Rupees (LKR) 297.6 to reduce the environmental damage by 50% and LKR 84.4 to raise the community income by 20%. The option to have a higher number of recreational activities was highly valued. Respondents were willing to pay a value of LKR 554.8 per year for the multiple benefits provided by the pool ecosystems. Conclusively, the study suggested that efforts to upgrade these natural pools should prioritise income generation, broadening of recreational activities and environmental conservation, in line with respondents’ inclinations.

Convergent validity between a discrete choice experiment and a direct, open-ended method: Comparison of preferred attribute levels and willingness to pay estimates

Background and ObjectivePatients may get more treatment options with off-label use of drugs while exposed to unknown risks of adverse events. Little is known about the public or demand-side perspective on off-label drug use, which is important to understand how to use off-label treatment and devise financial assistance. This study aimed to quantify public preference for off-label cancer treatment outcomes, process, and costs, and perceived importance of associated adverse events.MethodsA discrete choice experiment and a best-worst scaling were conducted in Hong Kong in December 2022. Quota sampling was used to randomly select the study sample from a territory-wide panel of working-age adults. Preferences and willingness to pay (WTP) for treatment effectiveness, risk of adverse events, mode of drug administration, and availability of off-label treatment guidelines were estimated using a random parameter logit model and latent class model. The relative importance of different adverse events was elicited using Case 1 best-worst scaling.ResultsA total of 435 respondents provided valid responses. In the discrete choice experiment, the respondents indicated that extra overall survival as treatment effectiveness (WTP: HK$448,000/US$57,400 for 12-month vs 3-month extra survival) was the most important attribute for off-label drugs, followed by the risk of adverse events (WTP: HK$318,000/US$40,800 for 10% chance to have adverse event vs 55%), mode of drug administration (WTP: HK$42,000/US$5300 for oral intake vs injection), and availability of guidelines (WTP: HK$31,000/US$4000 for available versus not available). Four groups with distinct preferences were identified, including effectiveness oriented, off-label use refusal, oral intake oriented, and adverse event risk aversion. In the best-worse scaling, hypothyroidism, nausea/vomiting, and arthralgia/joint pain were the three most important adverse events based on the perceptions of respondents. Risk-averse respondents, who were identified from the discrete choice experiment, had different perceived importance of the adverse events compared with those with other preferences.ConclusionsKnowing the preference and WTP for cancer treatment-related characteristics from a societal perspective facilitates doctors’ communications with patients on decision making and treatment goal-setting for off-label treatment, and enables devising financial assistance for related treatments. This study also provides important insight to inform evaluations of public acceptance and information dissemination in drug development as well as future economic evaluations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40258-024-00912-1.

Willingness to Accept versus Willingness to Pay in a Discrete Choice Experiment

ObjectivesThe objective of this study was to determine the relationship between consumer demographic characteristics and willingness to pay for beef.Materials and MethodsData were collected from consumers (n = 4080) from April to December 2018 in conjunction with consumer eating quality assessments in Lubbock, TX. All beef samples were prepared and demographics and willingness to pay (WTP) questionnaires were administered in accordance with Meat Standards Australia protocols. The following demographic characteristics were collected: age, gender (GEN), occupation (OCC), consumption (CONS), number of adults in household (NOA), number of children (NOC), beef preferences (PREF), preferred degree of doneness (DOD), income (INC), education (EDU), and heritage (HER). At the conclusion of a tasting session, which consisted of 7 beef samples prepared and served as steaks, smoked brisket, or fajita strips, consumers were asked how much they would pay for each of the four quality levels [Unsatisfactory (UNS), Good everyday (GOOD), Better than everyday (BTE), and Premium (PREM)], using line scales anchored from $0/lb. to $40/lb. Data were analyzed using the STEPWISE option of PROC REG of SAS. Variables had to meet a 0.15 significance level for entry and to remain in the model. Willingness to pay data were analyzed using PROC GLIMMIX of SAS with fixed effects of quality level, cook method, and their interaction (α = 0.05).ResultsRegression analysis revealed that demographic characteristics accounted for 6, 7, 6, and 7% of the variation in willingness to pay for UNS, GOOD, BTE, and PREM quality beef, respectively (P &lt; 0.01). For UNS, increasing AGE, CONS, NOA, PREF, and DOD were positively linked with WTP, while GEN, NOC, INC, and EDU were negatively linked with WTP (P &lt; 0.15). Increasing CONS, NOA, and PREF elevated WTP for GOOD quality, while AGE and EDU had a negative impact (P &lt; 0.15). For BTE quality, NOA, PREF, INC, and GEN positively influenced WTP, while AGE, NOC, and EDU reduced WTP (P &lt; 0.15). Finally, increasing CONS, NOA, PREF, and INC resulted in greater WTP of PREM quality beef, but AGE and NOC were negatively linked (P &lt; 0.15).An interaction between quality level and cook method was observed for WTP (P &lt; 0.01). Consumers were willing to pay the most for PREM quality with significant differentiation between each quality level (PREM &gt; BTE &gt; GOOD &gt; UNS). Overall, consumers were willing to pay $17.84, $12.96, $8.65, and $3.80 for PREM, BTE, GOOD, and UNS, respectively. However, within quality level, consumer WTP varied due to cook method. For PREM and UNS WTP, consumers were willing to pay more (P &lt; 0.05) for samples cooked as steaks and fajitas than as brisket. For BTE and GOOD WTP, consumers were willing to pay more (P &lt; 0.05) for samples cooked as steaks than as brisket, but WTP of fajita samples was similar (P &gt; 0.05) to the other cook methods.ConclusionDemographic characteristics can account for a small proportion of the variation in consumer WTP for beef products. Increasing age, number of children, and education consistently had negative impacts on WTP, regardless of quality level. Conversely, increasing beef consumption and preferences, along with number of adults lifted WTP across all quality levels. Cook method also influenced consumer WTP within each quality level.

Who cares and how much? Narrative for advances in aquatic ecosystem services through non-market valuation with spatial dimensions using a discrete choice experiment

ObjectiveThe study aims to quantify patients’ risk-benefit preferences for chemotherapy in the treatment of non-small cell lung cancer (NSCLC), and to elicit their willingness to pay (WTP) for treatment outcomes.MethodsA face-to-face discrete choice experiment (DCE) was conducted on NSCLC patients in four tertiary hospitals each from Beijing, Shanghai, Guangzhou and Chengdu in China. Patients were invited to complete choice questions that constructed by seven attributes: progression-free survival (PFS), disease control rate (DCR), rash, nausea and vomiting, tiredness, mode of administration and out-of-pocket costs. A mixed logit model was used to evaluate the choice model. Estimates of relative preferences and marginal willingness to pay for each attribute were then explored.ResultsA total of 361 patients completed the survey. Improvements in PFS (10, 95% CI: 8.4–11.6) were the most important attribute for patients, followed by increase in DCR (4.6, 95% CI: 3.4–5.8). Tiredness (3.9, 95% CI: 2.9–5.1) was judged to be the most important risk. While remaining attributes were ranked in decreasing order of importance: nausea and vomiting (1.9, 95% CI: 0.9–3.0), mode of administration (0.8, 95% CI: 0.2–1.4) and rash (0.5, 95% CI: −0.6–1.5). There was little variation in preferences among patients with different sociodemographic characteristics. Patients were monthly willing to pay $2304 (95% CI, $1916–$2754) that guaranteed 11 months of PFS, followed by $1465 (95% CI, $1163-$1767) per month to improve their disease control rate by 90%.ConclusionThe results suggested that efficacy was the most important attribute for patients. Side effects, mode of administration and treatment cost significantly influenced patient preferences. Patient engagement in prioritizing their treatment preferences should be emphasized during the clinical decision-making process and regimen implementation.

The main objective of this research is to estimate non-market (preservation) value of mangrove forest in Hormozgan Province. Non-market value to be obtained by the mean of willing to pay (WTP) for preservation in mangrove forest. Contingent valuation method (CVM) and double dichotomous choice (DDC) questionnaire are used to measure WTP for mangrove forest in Hormozgan Province. Logit model and maximum likelihood methods are used to estimate WTP. The result showed that 92%, of persons beneath to examination in this research, agree to pay for preservation of mangrove forest. The mean of WTP for preservation value of mangrove forest calculated 450000 Rial/person. Non market value of mangrove forest calculated mean of WTP for preserve forest. Finally, the results lend support to calls for greater policy emphasis on conservation of unique and irreplaceable mangrove forest.

Generally, people spend most of their time indoors, and the COVID-19 pandemic has further increased the amount of time people spent at home, owing to the widespread adoption of remote work. Consequently, there has been a heightened interest in indoor comfort, including thermal, visual, and acoustic comfort and indoor air quality. This interest has prompted a need to understand the economic value of each aspect of indoor comfort. To address this, a discrete choice experiment (DCE) was performed to estimate the willingness to pay (WTP) for advanced technological solutions that provide greater comfort than basic solutions in residential housing. The research showed a significant WTP for all aspects of comfort, with the greatest appreciation for thermal comfort. Additionally, the WTP for each aspect of comfort was greater than the additional costs required to implement advanced technological solutions to enable the desired comfort. The findings demonstrated that the sample population, mostly comprising people under the age of forty, was highly sensitive to comfort considerations and the related benefits derived from energy-efficient solutions. Specifically, comparing the WTP of the different aspect of comfort and the total one identified, the following relative importance was found: 51 % for thermal comfort (WTP = 377.94 EUR/m2); 22 % for visual comfort (WTP = 166.83 EUR/m2); 16 % for acoustic comfort (WTP = 119.60 EUR/m2) and 11 % for indoor air quality (WTP = 79.21 EUR/m2). These motivations can guide future decision-making and designers in the building market.

BackgroundIn Ethiopia, limited use of long-acting reversible contraceptives (LARCs) contributes to unintended pregnancies, unsafe abortions, and preventable maternal deaths. Despite their proven effectiveness, LARCs remain underutilized. Evidence on women’s preferences and willingness to pay (WTP) is scarce. This study examined women’s stated preferences, WTP, and trade-offs regarding LARC use in Gondar.MethodsAn institution-based cross-sectional study was conducted among 344 contraceptive users, generating 8,256 observations. A discrete choice experiment (DCE) with 24 choice tasks, divided into two blocks, was employed. Each task presented two unlabeled alternatives defined by six key attributes, identified through literature review and expert consultation. Data were analyzed using mixed logit models to estimate preference strength and WTP based on model coefficients.ResultsThe analysis revealed that provider type significantly influenced women’s preferences. Women showed the highest WTP for LARCs provided by midwives [528 ETB (10.15 USD)], compared to services offered by doctors [285 ETB (5.48 USD)] and health officers [215 ETB (4.13 USD)]. Preferences were also shaped by side-effect profiles: methods associated with slight weight gain [155 ETB (2.98 USD)], high effectiveness [80 ETB (1.54 USD)], and absence of bleeding [74 ETB (1.43 USD)] were positively valued. Conversely, heavy menstrual bleeding led to the largest reduction in WTP [–688 ETB (–13.24 USD)], indicating a significant barrier to LARC uptake. Longer-acting methods also reduced WTP [–139 ETB (–2.68 USD)], possibly reflecting concerns about long-term commitment or side effects. Cost sensitivity was evident, as increases of 100 ETB (1.92 USD) or 500 ETB (9.92 USD) further reduced uptake likelihood.ConclusionWomen’s preferences for LARCs are influenced by provider type, side effects, and cost. Enhancing LARC services by prioritizing midwife-led delivery, addressing side effects such as heavy menstrual bleeding, and considering women’s WTP can increase uptake. These findings highlight the need for affordable, user-centered contraceptive services in Ethiopia.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13561-025-00683-y.

The rubber expansion in Asian countries has led to various environmental problems. To smoothly promote the ecological restoration programs, an essential premise is that the local government must consider public attitude and understand the public willingness to pay (WTP) for the programs. In this study, we employ an integrated contingent valuation (ICV) survey to evaluate the citizen’s WTP of implementing rubber plantation ecological restoration (RPER) programs in Hainan, China. Considering three types of the respondents’ WTP data (interval truncated, merged, and point data), we adopt the Point and Interval Data (PID) model to estimate the determinants of WTP and calculate the non-market value with the comparison of the Tobit model. Results show that the mean value of WTP for the RPER program is 178 yuan per year, and the total non-market value throughout the province is worth approximately 1.839 billion yuan per year after controlling the regional differences. We also find that the respondents’ WTP has a significant regional difference, in which Danzhou has the highest WTP, followed by Haikou, Wanning, and Sanya. Age has a significant negative effect on the WTP for the restoration program, whereas the factors such as education, family burden, income, and residents’ environmental knowledge have a significant positive effect. Our findings add to the evidence that using improved estimation methods can generate diverse results, where neglecting the bias caused by the usual interval data model would lead to downward biased estimates.

BackgroundThe increasing number of people with chronic diseases challenges workforce capacity. Type 2 diabetes (T2D) can have work-related consequences, such as early retirement. Laws of most high-income countries require workplaces to provide accommodations to enable people with chronic disabilities to manage their condition at work. A barrier to successful implementation of such accommodations can be lack of co-workers’ willingness to support people with T2D. This study aimed to examine the willingness to pay (WTP) of people with and without T2D for five workplace initiatives that help individuals with type 2 diabetes manage their diabetes at work.MethodsThree samples with employed Danish participants were drawn from existing online panels: a general population sample (n = 600), a T2D sample (n = 693), and a matched sample of people without diabetes (n = 539). Participants completed discrete choice experiments eliciting their WTP (reduction in monthly salary, €/month) for five hypothetical workplace initiatives: part-time job, customized work, extra breaks with pay, and time off for medical consultations with and without pay. WTP was estimated by conditional logits models. Bootstrapping was used to estimate confidence intervals for WTP.ResultsThere was an overall WTP for all initiatives. Average WTP for all attributes was 34 €/month (95% confidence interval [CI]: 27–43] in the general population sample, 32 €/month (95% CI: 26–38) in the T2D sample, and 55 €/month (95% CI: 43–71) in the matched sample. WTP for additional breaks with pay was considerably lower than for the other initiatives in all samples. People with T2D had significantly lower WTP than people without diabetes for part-time work, customized work, and time off without pay, but not for extra breaks or time off with pay.ConclusionsFor people with and without T2D, WTP was present for initiatives that could improve management of diabetes at the workplace. WTP was lowest among people with T2D. Implementation of these initiatives seems feasible and may help unnecessary exclusion of people with T2D from work.