Willingness to pay to reduce waiting time: Study of an Advanced Practice Physiotherapy Clinic

BackgroundThe objective of this systematic review is to appraise evidence on the economic evaluations of advanced practice physiotherapy (APP) care compared to usual medical care.MethodsSystematic searches were conducted up to September 2021 in selected electronic bibliographical databases. Economic evaluation studies on an APP model of care were included. Economic data such as health care costs, patient costs, productivity losses were extracted. Methodological quality of included studies was assessed with the Effective Public Health Practice Project tool and the Critical Appraisal Skills Programme checklist. Meta-analyses were performed and mean differences (MD) in costs per patient were calculated using random-effect inverse variance models. Certainty of the evidence was assessed with the GRADE Approach.ResultsTwelve studies (n = 14,649 participants) including four randomized controlled trials, seven analytical cohort studies and one economic modeling study were included. The clinical settings of APP models of care included primary, emergency and specialized secondary care such as orthopaedics, paediatrics and gynaecology. The majority of the included participants were adults with musculoskeletal disorders (n = 12,915). Based on low quality evidence, health system costs including salaries, diagnostic tests, medications, and follow-up visits were significantly lower with APP care than with usual medical care, at 2 to 12-month follow-up (MD: -139.08 €/patient; 95%CI: -265.93 to -12.23; n = 7648). Based on low quality evidence, patient costs including travel and paid medication prescriptions, or treatments were significantly higher with APP care compared to usual medical care, at 2 to 6-month follow-up (MD: 29.24 €/patient; 95%CI: 0.53 to 57.95 n = 1485). Based on very low quality evidence, no significant differences in productivity losses per patient were reported between both types of care (MD: 590 €/patient; 95%CI: -100 to 1280; n = 819).ConclusionsThis is the first systematic review and meta-analysis on the economic evaluation of APP models of care. Low quality evidence suggests that APP care might result in lower health care costs, but higher patient costs compared to usual medical care. Costs differences may vary depending on various factors such as the cost methodology used and on the clinical setting. More evidence is needed to evaluate cost benefits of APP models of care.

Background: Japanese emergency medical services (EMS) can be used by anyone for free. Recently, EMS usage has increased; the increased costs and the prolonged time for ambulance transport have become recent social problems. Objective: We surveyed the willingness to pay (WTP) for resuscitation provided by EMS. Methods: In November 2011, men and women (3160) aged 20 - 59 years were asked to assume that they were experiencing a cardiopulmonary arrest (CPA), and their WTP for EMS services was assessed in the following three situations: Case A, ambulance transport alone; Case B, chest compression in addition to ambulance transport; and Case C, artificial ventilation through chest compression and intratracheal intubation, in addition to ambulance transport. We calculated the mean WTP for each case. Results: The WTP for Case A, B, and C were ￥6,696 ($65.0), ￥16,081 ($156.1), and ￥27,505 ($267.0), respectively. The WTP for Case B was significantly higher in respondents aged 40 - 59 years compared to those aged 20 - 39 years. The WTP for case B and C were significantly higher in males compared to females. WTP was significantly lower in students than it was in private employees. Although women’s intention to pay was higher than that of men, their WTP was lower than that of men. Public employees’ and students’ intention to pay was significantly lower than that of private employees. Conclusions: Our study provides information about the optimal fee for EMS, which will be useful for discussions on the feasibility of introducing a fee for EMS in Japan.

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 < 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 < 0.15). Increasing CONS, NOA, and PREF elevated WTP for GOOD quality, while AGE and EDU had a negative impact (P < 0.15). For BTE quality, NOA, PREF, INC, and GEN positively influenced WTP, while AGE, NOC, and EDU reduced WTP (P < 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 < 0.15).An interaction between quality level and cook method was observed for WTP (P < 0.01). Consumers were willing to pay the most for PREM quality with significant differentiation between each quality level (PREM > BTE > GOOD > 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 < 0.05) for samples cooked as steaks and fajitas than as brisket. For BTE and GOOD WTP, consumers were willing to pay more (P < 0.05) for samples cooked as steaks than as brisket, but WTP of fajita samples was similar (P > 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.

BackgroundHealth-care workers (HCWs) are among the highest risk groups for COVID-19 infection. The vaccine is found to be vital for HCWs, their household contacts, and their patients to protect against COVID-19 infection and maintain the safety of health systems. The actual willingness to pay for COVID-19 vaccination and associated factors remain uncertain among health-care workers in Ethiopia. Therefore, studying health-care workers’ willingness to pay (WTP) for COVID-19 vaccination helps to have an insight on valuation of the vaccine.MethodsInstitution-based cross-sectional study was conducted among 403 randomly selected health-care workers working in health facilities in eastern Ethiopia from February 3 to March 20, 2021. Pretested structured questionnaire was used to collect data. Binary logistic regression analysis was fitted to test the associations between outcome and explanatory variables. A p-value of <0.05 with 95% confidence interval was used to declare statistical significance.ResultsThe magnitude of willingness to pay for a COVID-19 vaccine was 42.8%. The median amounts of money respondents willing to pay was 400 ETB (US$ 10.04). Sex (male, AOR = 2.33; 95% CI: 1.39, 3.93), monthly income (>7000 ETB, AOR = 1.22; 95% CI: 1.11, 2.51), affordability (AOR = 1.99; 95% CI: 1.18, 3.35), fear of side effects (AOR = 3.75; 95% CI: 2.13, 6.60), support vaccinations (AOR = 2.97; 95% CI: 1.65, 5.35), the likelihood of getting COVID-19 infection (AOR = 2.11; 95% CI: 1.26, 3.52) were independent determinants of WTP for a COVID-19 vaccine.ConclusionHealth-care workers’ willingness to pay for COVID-19 vaccination was found to be low. Detailed health education and training about COVID-19 vaccines are required regarding their side effects, and efficacy to make an informed decision to enhance the willingness to pay for the vaccine. Moreover, the government should consider providing COVID vaccines free of charge for low-income groups and at an affordable price for those who could pay.

SUMMARY This study was carried out to determine the estimated value of the environmental service functions of the forests of the Ibadan metropolis. It employed the payment card format — Contingent Valuation approach — to elicit willingness to pay (WTP) for environmental rehabilitation of the Ibadan metropolis through reforestation projects, and to investigate the extent to which socio-economic factors influence the WTP. Data were obtained from a multi-stage randomly sampled 370 residents within the five local government areas of the metropolis. The results show that 77% of the respondents were willing to pay various amounts ranging from ₦50–₦500 monthly, ₦100 being the modal value, having recorded a 52% response. The mean monthly WTP value is ₦161, resulting in an aggregate estimated value of Ibadan urban forests' environmental service functions, ranging between ₦185 468 586 and ₦240 868 294 (US$1 = ₦100). The reduced model of the double log regression equation revealed the respondents' employment status and proximity to the urban forest reserves as the only socio-economic variables that significantly influenced WTP. The differences in the mean WTP values within each independent socio-economic variable were not significant (p > 0.05). The results of this study show that there is a need for social valuation of forestry and non-forestry projects that have to do with conversion of forest lands, as a panacea for uncontrolled deforestation.

Determinants of Willingness to Pay (WTP) for drinking water facilities help a lot in identifying price concerns and appropriate strategies for the facilities of drinking water to the households. The current study investigates the key determining factors of WTP for drinking water services and presents a logical setup that explains the significance of WTP determinants. We applied Contingent Valuation Approach (CVA) and analyzed the results through multinomial logistic regression. Findings disclosed that the income, education of the household head, highest education in the family, family size and residential area of the household significantly influence the WTP. It is suggested that education and awareness about water quality have to be disseminated among the households to increase their WTP for the drinking water services. The government should boost the income-generating programs to improve the financial status of the households to enhance their willingness to pay and purchasing power. Keywords: Drinking water, Contingent Valuation Approach (CVA), Determinants, Household, Willingness to Pay (WTP), Policy.

PURPOSE: Advanced Practice Physiotherapy (APP) in paediatric orthopaedics is an effective adjunct to traditional consultant-led clinics, improving patient access to outpatient services, and reducing both waiting lists and times. However there has been no published economic evaluation of a paediatric orthopaedic APP service. This study performs a cost analysis, utilising a cost minimisation approach, comparing an APP Clinic in Paediatric Orthopaedics with usual care, from a health care perspective. METHODS: Data on all patients managed by the APP clinic for one calendar year were collected and outcomes and associated costs were calculated, including follow-up care. These costs were compared to the estimated costs of the usual care pathway, an Orthopaedic Consultant Elective Clinic (OCEC) and incremental savings per patient was calculated. RESULTS: A total of 534 patients attended the APP clinic for initial assessment during the calendar year 2017. The unit cost of a new appintment with the APP clinic is € 32.46 in comparison with € 56.98 for a new appointment in the OCEC. Our results demonstrate an incremental per patient saving of € 24.51 in favour of the APP clinic. Sensitivity analysis demonstrates that the cost savings obtained hold consistent in all cases, varying from € 23.13 to € 29.67 per patient in favour of the APP clinic pathway. This represents a cost saving of 43% for the APP Pathway over that of usual care. CONCLUSION(S): This is the first study to perform an economic analysis of the APP role in paediatric orthopaedics and demonstrates that an APP clinic for non-complex paediatric orthopaedic patients is substantially less costly than usual care.

To determine the level of willingness to pay (WTP) for re-treatment of mosquito nets and to compare the theoretical validity of WTP estimates from three contingent valuation question formats: the bidding game, binary with follow-up technique, and a novel structured haggling technique that mimicked price-taking behaviour in the study area. WTP was elicited from randomly selected respondents from three villages in Southeast Nigeria, using pretested interviewer-administered questionnaires. Respondents' WTP for insecticide-treated nets (ITNs) was first elicited before their WTP for re-treatment of ITNs. Ordinary least-squares regression was used to assess theoretical validity. More than 95% of the respondents were willing to pay for re-treatment. The mean WTP was 37.1 Naira, 43.4 Naira and 49.2 Naira in the bidding game, binary with follow-up and structured haggling groups, respectively (US dollar 1.00 = 120 Naira). The WTP estimates elicited across the three question formats were statistically different (P < 0.01). Ordinary least-squares estimation showed that WTP was positively related to many variables, especially stated WTP for ITNs (P < 0.05). Structured haggling generated the highest number of statistically significant variables to explain WTP. The three contingent valuation approaches generated different distributions of WTP for net retreatment, possibly due to their inherent differences. Structured haggling generated the most theoretically valid estimates of WTP. The levels of WTP identified suggest that user fees exceeding 50 Naira per net re-treatment may discourage demand for the service. This is an important challenge for ITN programmes.

BackgroundHepatitis B virus (HBV) infection is a global public health problem. The burden of the disease is high in low and middle income countries like Ethiopia. However, for highly vulnerable groups such as health professionals, vaccination coverage is a major issue in the developing countries where health professionals are expected to pay for vaccination. Therefore, the objective of this study was to assess health professionals’ acceptance and willingness to pay (WTP) and associated factors for vaccination against HBV.MethodsCross-sectional study was conducted from March to April, 2017 in Gondar city administration governmental health institutions among 423 health professionals. Simple random sampling method was employed to select the study participants. Data were collected using self- administered questionnaire. Tobit model was used to analyze the determinants of WTP and the maximum amount of money the individuals might pay for HBV vaccination. P-value < 0.05 was considered statistically significant.ResultA total of 423 health professionals (physicians, nurses, midwives, laboratory technicians/technologists, and others) participated in the study with a response rate of 100, and 62.4% of them were willing to pay for HBV vaccination. The mean amount of money the participants might pay for HBV vaccination was 325.83 ± 283.46 ETB (US$ 14.39 ± 12.52). The study indicated that the WTP for HBV vaccination of health professionals from health centers was 179.41 ETB less compared to health professionals from hospital. The WTP for HBV vaccination of the participants who had no experience of seeing previous patients with HBV was 157.87 ETB less compared to participants who had experience of seeing previous patients with HBV. As monthly income of the study participants increased by one ETB, the WTP was increased by 0.027 ETB.ConclusionThe study revealed that the mean amount of money the participants might pay for HBV vaccination was much less than the market price for HBV vaccination. Type of workplace and experience of seeing/observing patients with HBV, and income were the predictors of WTP for HBV vaccination. Availing the vaccine with affordable cost in governmental health institutions may increase WTP of health professionals for HBV vaccination.

In order to allocate health care resources more efficiently, it is necessary to relate health improvements provided by new medicines to their cost. It is necessary to ascertain when the additional cost of introducing a new health technology is justified by the additional health gain produced. Eplerenone is a new medicine that reduces the risk of death after myocardial infarction (MI) but produces additional cost to the health system. The contingent valuation approach can be used to measure the monetary value of this risk reduction and to estimate society's willingness to pay (WTP) for a new medicine that reduces the risk of death after MI by 2% points. We used a contingent valuation approach to evaluate WTP amongst members of the general population. We used the ex-ante and the ex-post approach. In the ex-ante approach, subjects are asked if they would accept an increase in their taxes in order to have access to eplerenone should they need it in the future. In the ex-post approach, subjects are asked if they would pay a certain amount of money as co-payment per month during 5 years if they suffered an MI. We used the dichotomous choice method, using five bids in each approach. The WTP was estimated using both single-bound and double-bound dichotomous choice (SBDC, DBDC). Extensive piloting (n = 187) preceded the final survey (n = 350). The WTP in the ex-ante case was euro 58 per year under both SBDC and DBDC. In the ex-post case, monthly WTP was euro 141 for the SBDC and euro 85 for the DBDC. Subjects with higher income and subjects with a higher perception of risk showed a higher WTP (P 0.05). Society is willing to pay an additional amount of money in order to give eplerenone to present and future patients. We estimate that euro 85 per month is a conservative estimate of the monetary value of a 2% risk reduction in mortality after MI and to spend this additional amount of money in Eplerenone can be considered an efficient policy.

Willingness to pay for avoiding coronary restenosis and repeat revascularization: results from a contingent valuation study

Cataract is the leading cause of avoidable blindness globally. It is estimated that 89% of people with visual impairment live in low- and middle-income countries where the cost of cataract surgery represents a major barrier for accessing these services. Developing self-sustaining healthcare programs to cater the unmet demands warrants a better understanding of patients' willingness to pay (WTP) for their services. Using a sample of patients visiting eye care facilities in Dhaka, Bangladesh, we estimate WTP for two different cataract extraction techniques, namely small incision cataract surgery (SICS) and phacoemulsification. We used contingent valuation (CV) approach and elicited WTP through double-bounded dichotomous choice experiments. We interviewed 556 randomly selected patients (283 for SICS and 273 for phacoemulsification) from five different eye care hospitals of Dhaka. In this paper, we estimated the mean and marginal WTP using interval regression models. We also compared the estimated WTP and stated demand for cataract surgeries against the prevailing market prices of SICS and phacoemulsification. We found the mean WTP of BDT 7579 (US$93) for SICS and BDT 10,208 (US$126) for phacoemulsification are equivalent to 12 and 16days of household income, respectively. Household income and assets appeared as the major determinants of WTP for cataract surgeries. However, we did not find any significant association with gender, occupation, and household size among other socioeconomic characteristics. Comparisons between market prices and average WTP suggest it is possible to have a viable market for SICS, but a subsidy-based model for phacoemulsification will be financially challenging because of low WTP and high costs. Our findings suggest lower-cost SICS can potentially provide patients access to surgeries to treat cataract conditions. Moreover, price discrimination and cross-subsidization could be a viable strategy to increase the service-uptake as well as ensure financial sustainability.

This paper reports the results of a research designed to assess the impact of Barcelonais airport extension in terms of noise increase. A contingent valuation (CV) approach was carried out in order to extract the stated preference for noise reduction for a representative sample of neighbor residential areas; using this technique the participants revealed their willingness to pay (WTP) for a proposed noise reduction. One of the main problems of CV is the protest answers, it is to say, the people that do not reveal their WTP, although they do value positively the good offered. For this reason two approaches were tested: the first is the conventional one where people state directly their WTP for a specific noise reduction; the second one the interviewed people state their hypothesis of real estate revalorization in case that such noise reduction would occur. The results reveals that direct WTP has a protest rate of 37.19%, meanwhile the second indirec t WTP has only a protest rate of 7.8%. Furthermore, the data analysis based on logistic models suggest two conclusions: 1) as higher is the knowledge of the problem related with noise source higher is the WTP, controlling the rest of variables, and 2) also higher is the level of protest rate. It is to say, people aware of the airport problems are more skeptical about the valuation process (e.g.: the solution proposed to reduce the noise, the payment vehicle, or the noise reduction offered), this skepticism drive to boycott the experiment and consequently it masks the WTP. Both effects produce a reduction on the aggregated mean WTP. For this reason the opinion and valuation of an environmental good (as silence) is not only influenced by the individual perception, but also is influence by the knowledge about it, and the social perception; for this latter reason the predictive capacity of models is improved when the socio-spatial correlation interactions are solved. Finally the results also suggest that the impact of airport noise is! also in fluenced by the existence of other environmental noises and the configuration of urban fabrics.

Introduction: Non-adherence to antidepressants is common and limits the effectiveness of antidepressants. Pharmacists are in an ideal position to help patients cope with antidepressant treatment and, as experts in pharmacotherapy, can provide complementary skills to other health professionals. Pharmacists' interventions are effective in the improvement of adherence to antidepressants. However, little is known about the efficiency of such interventions. The study aimed to evaluate the cost-effectiveness and cost-utility of a community pharmacist intervention (CPI) in comparison with usual care (UC) in depressed patients initiating treatment with antidepressants in primary care. Methods: The economic evaluation was conducted alongside a randomized controlled trial with 6 months follow-up. Patients were recruited by general practitioners and randomized to CPI and UC. The intervention consisted of an educational programme focused on improving knowledge about medication, making patients aware of the importance of compliance, reducing stigma, reassuring World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116658– http://www.ijic.org/ patients about side-effects and stressing the importance of carrying out general practitioners' advice. Adherence to antidepressants, clinical symptoms, Quality-Adjusted Life-Years (QALYs), use of healthcare services and productivity losses were measured at baseline, 3 and 6 months. Results: A total of 179 patients were randomized to UC (92) and CPI (87). Although overall costs were higher in the CPI group than in UC patients, there were no significant differences between groups at baseline. From a societal perspective, the incremental cost-effectiveness ratio (ICER) was for the CPI compared with UC was €9,872 per extra QALY and €1,866 for extra adherent patient. In terms of remission of depressive symptoms, the UC dominated the CPI. If willingness to pay (WTP) is €30,000 per extra adherent patient, remission of symptoms or QALYs, the probability of the CPI being cost-effective was 0.71, 0.46 and 0.75, respectively from the societal perspective. From a healthcare perspective, the probability of the CPI being cost-effective in terms of adherence, QALYs and remission was of 0.71, 0.76 and 0.46, respectively, if WTP is €30,000. Discussion and conclusions: A low intensity CPI addressed to depressed patients initiating antidepressant treatment showed a probability of being cost-effective of 0.71 and 0.75 in terms of improvement of adherence and QALYs, respectively, when compared to IC. Regular implementation of the CPI is not recommended. Sample size calculation was based on the effectiveness analysis and the study could have been underpowered to detect differences. Only 74% of the patients in the CPI group received at least one intervention in the pharmacy and this may have limited its impact. A 6-month follow-up is a short period to evaluate long term costs and effects of the intervention. Future research needs to evaluate more complex and intensive pharmacist interventions in community pharmacy. It will be necessary to improve the collaborative relationship between the pharmacist and the practitioner, and the integration of the pharmacist into the primary care team. Also needed will be development of strategies that facilitate the attachment of the patient to the pharmacy and the establishment of a relationship between the pharmacist and the patient.

For many years, open sun drying (OSD) has been the common way of preserving fish among the fishing households in Malawi. The main limitations of this technique have been increased fish quality deterioration and microbial contamination. Two fish solar dryers (FSD) were constructed under the SEEDFISH project along the Western Shore of Lake Malawi (WSLM) as a way of minimizing the effects of using OSD and provide a better way of drying fish in the area. The FSD though adopted, the fishing households have been seeking alternatives for its sustenance. This study estimates the households’ willingness to pay (WTP) and their influencing factors while using contingent valuation (CV) approaches. A wide range of data collection methods (exploratory surveys, focus group discussions, key informant interviews, and field observations) was employed. A total of 200 fishing households were randomly interviewed. The results showed that 144 (72.4%) of the respondents were willing to pay because the FSD was seen as a way of mitigating the climate change impact, improving livelihoods, and reducing post-harvest losses. The mean annual aggregate WTP amount was estimated at MK3,648,750 (US$4,865). Those households (27.6%) not willing to pay argued that they had a low level of income while others could not see any value of the FSD. The regression coefficients of age and gender of household head (GHH) were negative (β =-6.02 andWald of 5.34, β = -6.92, Wald of 2.01) and significant (p<0.05) suggesting that young people were more WTP than their counterpart. Males also coded as 0 were more willing to pay than females. On the other hand, household literacy level (HLL), household involved in fish processing (HIVFP), household social trust (HST), household institutional trust (HIT), household level of income (HLI), household experienced fish post-harvest losses (HEFPL), household access to extension services (HAE) and household social network (HSN) were positive (β = 2.97, Wald of 7.11, β = 6.37 andWald of 5.41, β = 3.03 and Wald of 6, β = 11.2, Wald 9.02, β = 2.42, Wald of 8, β = 0.93, Wald of 4,81 and β = 2.50, Wald 2.10) and significant (p<0.05) suggesting that those HIVFP, had high HLL, HLI, HST, HIT, HSN and HEFPL were more willing to pay than their counterpart. These findings provide comprehensive baseline data for local government and communities in the development of more effective and holistic approaches to improving communities’ climate change resilience. Key words: Contingent valuation, Fish solar dryer, Lake Malawi, Willingness to pay