Willingness To Pay Research Articles

Are Consumers Equally Willing to Pay More for Brands That Aim for Sustainability, Positive Societal Contribution, and Inclusivity as for Brands That Are Perceived as Exclusive? Generational, Gender, and Country Differences

This study explores consumer preferences for brands that emphasize sustainability and inclusivity, and for brands perceived as exclusive and trendy. Consumer data obtained via a large-scale survey involving 24,798 participants across 20 countries and one special administrative region (SAR) are used to understand how willingness to pay (WTP) for these brand types varies globally, accounting for demographic factors like generation, gender, and country. A substantial body of literature highlights growing consumer interest in brands that stand for sustainability and inclusivity, challenging traditional notions that luxury and exclusivity primarily drive brand value. Despite persistent skepticism among some business executives about consumers’ actual versus claimed willingness to spend more for sustainable and inclusive brands, academics and commercial researchers increasingly signal a shift in purchasing behavior that is influenced by socio-ecological factors. This research aims to provide empirical data on consumer WTP across different demographics and countries/regions, thereby contributing to academic discussions and offering insights for managerial decision making. The study frames its investigation around four research questions, to explore how consumers’ WTP for exclusive and inclusive brands varies across generations, genders, and countries/regions. It employs a robust methodological approach, using confirmatory factor analysis (CFA) and structural equation modeling (SEM) to analyze the data. This ensures that the constructs of brand inclusiveness and exclusivity are comparable across diverse cultural contexts. Significant gender, generational, and country/region differences are observed. When comparing generations, the findings indicate that GenZ consumers have a higher WTP for sustainable/inclusive brands (compared to older, GenX, and Baby Boomer generations). Similar patterns are found when considering WTP for exclusive, on-trend brands. In terms of gender, women are observed to have a higher WTP for sustainable/inclusive brands, but a lower WTP for exclusive, on-trend brands compared to men. Finally, compared to consumers originating from certain European countries, we find that consumers living in certain Asian countries/regions have a significantly higher WTP for inclusive and sustainable brands, as well as for exclusive/on-trend brands. The study underscores the complexities of consumer behavior in the global market, highlighting the coexistence of traditional preferences for exclusive, trendy brands and preferences for brands that embrace sustainability and inclusivity.

How do households living in arsenic-contaminated regions value safe drinking water in western Bihar, India?

Access to safe drinking water is a critical concern, particularly in areas affected by arsenic contamination. In Bihar, an Indian state, 13 districts are facing groundwater contamination. The report of Ministry of Jal Shakti, Government of India (2021), reveals that about 24 habitations from five districts of Bihar are affected by arsenic groundwater contamination, impacting about 71,946 population and their health and economic conditions. The objectives of the present study are to determine factors that impact households' WTP for arsenic-free drinking water and estimate the mean willingness to pay (WTP) for arsenic-free drinking water. The primary data from 300 households was collected following simple random sampling, and villages were selected through a multi-stage sampling method. The study uses a single-bound dichotomous choice method for WTP elicitation and applies a probit model to determine factors affecting households' WTP for arsenic-free safe drinking water. The mean WTP is estimated to be ₹ 216.68 per household/month, and results find that education, income, health expenditure, awareness level and high-risk exposure to arsenic are the most influential determinants of households’ WTP for arsenic-free drinking water. The influence of education and awareness level is positive, calling for conducting more awareness programs in the arsenic-contaminated areas in Bihar.

A cost-benefit analysis of mass prostate cancer screening

BackgroundProstate cancer (PCa) causes a substantial health and financial burden worldwide, underscoring the need for efficient mass screening approaches. This study attempts to evaluate the Net Cost-Benefit Index (NCBI) of PCa screening in Iran to offer insights for informed decision-making and resource allocation.MethodThe Net Cost-Benefit Index (NCBI) was calculated for four age groups (40 years and above) using a decision-analysis model. Two screening strategies, prostate-specific antigen (PSA) solely and PSA with Digital Rectal Examination (DRE), were evaluated from the health system perspective. A retrospective assessment of 1402 prostate cancer (PCa) patients’ profiles were conducted, and direct medical and non-medical costs were calculated based on the 2021 official tariff rates, patient records, and interviews. The monetary value of mass screening was determined through Willingness to Pay (WTP) assessments, which served as a measure for the benefit aspect.ResultThe combined PSA and DRE strategy of screening is cost-effective, yields up to $3 saving in costs per case and emerges as the dominant strategy over PSA alone. Screening for men aged 70 and above does not meet economic justification, indicated by a negative Net Cost-Benefit Index (NCBI). The 40–49 age group exhibits the highest net benefit, $13.81 based on basic information and $13.54 based on comprehensive information. Sensitivity analysis strongly supports the cost-effectiveness of the combined screening approach.ConclusionThis study advocates prostate cancer screening with PSA and DRE, is economically justified for men aged 40–69. The results of the study recommend that policymakers prioritize resource allocation for PCa screening programs based on age and budget constraints. Men’s willingness to pay, especially for the 40–49 age group which had the highest net benefit, leverages their financial participation in screening services. Additionally, screening services for other age groups, such as 50–54 or 55–59, can be provided either for free or at a reduced cost.

Determinants of farmers’ willingness to pay for irrigation improvements in Northcentral Ethiopia

Investing in agricultural water management by improving irrigation schemes helps to establish climate-resilient and sustainable agri-food systems, thus contributing to sustainable poverty reduction. The purpose of this study was to identify the determinants of farmers’ willingness to pay (WTP) for irrigation water improvements in Northcentral Ethiopia. Primary data collected from a random sample of 132 households were analyzed using the double-bounded contingent valuation method and binary logit regression model to identify what determines farmers’ WTP for irrigation improvement. The findings show that farmers’ mean WTP for irrigation water improvements is 141.60 Birr/ha/year (2.50 USD/ha/year). The results of bivariate Probit model revealed that crop type, education, relative location to the irrigation scheme, irrigated plot size, and perceived drought risk statistically and positively determine farmers’ WTP for irrigation water improvement. These findings offer valuable policy implications on how best to guide practical agricaltural water management. Policy interventions aimed at enhancing farmers' behavior, awareness, and perception of drought-related issues, while also promoting cash crop production, are likely to drive more farmers towards a positive WTP for irrigation water improvement.

Does willingness to pay for the traditional flood control measures kasumitei vary by river section of residential area?

Kasumitei (open levees) comprise a traditional flood mitigation measure used in Japan. Kasumitei allow floodwater to flow into surrounding paddy fields, which act as temporary flood mitigation basins. After flooding, debris accumulated in paddy fields often brings crop damage and debris removal costs. Therefore, in some areas, the disaster mitigation functions of kasumitei may bring about conflicts between beneficiaries (downstream residents) and burden bearers (midstream residents). Ensuring the continued use of kasumitei in the future requires a mechanism to support the burden bearers. This study aimed to test the hypothesis that the willingness to pay (WTP) for maintaining the kasumitei would be lower for midstream residents (potential burden bearers) than for upstream (irrelevant) and downstream residents (potential beneficiaries). The results showed that contrary to the hypothesis, WTP for maintaining kasumitei was not affected by the river sections of the respondents' residence. Thus, a financial support scheme for maintaining kasumitei might be acceptable regardless of the beneficiary or bearer in the surveyed respondents. In addition, respondents with higher interest in ecosystem conservation tended to have higher WTP. Therefore, to gain support for the maintenance and use of the kasumitei (a type of ecosystem-based disaster risk reduction), the authorities would promote awareness of the measure's contribution to ecosystem conservation. Based on the results, we discussed the potential financial support schemes for maintaining the kasumitei.

Does spending time with nature affect people’s desire to protect it? A case study of Nigerian beachgoers

ABSTRACT This study explores the intricate relationship between beach conservation and human behaviour, focusing on beachgoers in Lagos State, Nigeria. It underlines the importance of nature connection in determining people’s willingness to pay (WTP) for the management and preservation of coastal ecosystems. As well as providing spaces for recreation, beaches provide vital ecosystem services such as flood protection and contributions to biodiversity, but they are often threatened by human-induced actions such as pollution. The research investigates pathways through which individuals connect with nature, highlighting beauty, compassion, emotion, contact and meaning. It reveals that participants primarily establish their connection through the aesthetic appeal of beaches. Additionally, the study uncovers a positive WTP for beach management, with most participants willing to contribute modest amounts. The study’s implications point to the need for holistic beach management strategies in Nigeria that balance economic development and environmental conservation. Ultimately, this research underscores the importance of strengthening connections between individuals and the natural world to foster pro-environmental behaviour and financial contributions to conservation efforts.

Experience Counts: Unveiling Patients’ Willingness to Pay for Remote Monitoring and Patient Self-Measurement

ObjectivesThis study aimed to (1) estimate patients’ willingness to pay (WTP) for remote monitoring (RM) and patient self-measurement (PSM) for pregnant women at risk of gestational hypertensive disorders, (2) assess the impact of experience with these technologies on WTP, and (3) determine their impact on health-related quality of life (HRQoL). MethodsData collection was part of a multicentric randomized controlled trial, Pregnancy Remote Monitoring II, with 2 interventions: RM and PSM. A contingent valuation survey, combining a payment card and open-ended question, was completed twice by 199 participants. Two-part models analyze the impact of experience on WTP, regression models estimated using ordinary least squares the impact of RM and PSM on HRQoL. ResultsThe mean WTP amount was approximately €120 for RM and €80 for PSM. Compared with having no experience, WTP RM was €63 higher after a long-term exposure to RM (P = .01) and WTP PSM was €26 lower after a short-term exposure to RM (P = .07). No significant impact of RM or PSM on HRQoL was found. ConclusionsThis study contributes to the discussion on the impact of experience on WTP. Those who had a long-term experience with RM, were willing to pay more for RM than those without experience. This confirms our hypothesis that involving patients without experience with the valued treatment, possibly underestimates WTP. A long-term experience has, however, no impact on the WTP for technologies for which the potential benefits are apparent without experiencing them, such as PSM.

Consumer willingness to pay for improved drinking water in District Buner

AbstractThis study investigates households' willingness to pay (WTP) for better water systems, clean water availability, and water quality in Gadaizi tehsil, District Buner, Pakistan. This research aims to shed light on various aspects of water quality, health impacts, and socioeconomic factors influencing households' ability to pay for superior water services. This research also looks into waterborne infection and water purification methods residents utilize to mitigate the risk of water pollution. Utilizing a mixed‐method approach with a structured questionnaire, data from 62 households were collected. SPSS was used for data analysis. Findings reveal awareness of water contamination issues, primarily attributed to marble industries. Most households use untreated water, boiling, chemicals, or candle filters. Water purification methods are influenced by media exposure and higher income. Common waterborne diseases, such as typhoid and diarrhea, are treated in private hospitals. Consumer WTP for better water systems depends on income, education, and media exposure, in which income has a statistically significant positive effect on WTP for improved water services. Although 76% of households do not use any water purification method. 84% of households are willing to adopt a private sector‐provided system. Importantly, this study highlights the necessity for public health initiatives and a thorough understanding of socioeconomic issues to guide political choices for better water delivery. These insights can inform policies that prioritize public health and ensure better access to clean water for all.

Willingness to Pay Estimation for the Restoration of Water Quality of a Eutrophic Lake

Lakes are recognized as highly susceptible to the impacts of various anthropogenic activities, making them one of the most vulnerable aquatic ecosystems. These ecosystems frequently experience degradation due to the lack of policies recognizing the importance of their often overlooked regulating ecosystem services. A contingent valuation approach was employed to assess the stakeholders’ willingness to pay (WTP) for the restoration of the water quality of a eutrophic lake using the case of Tadlac Lake, situated within the municipality of Los Baños, Laguna Province, Philippines. The findings of the study revealed that households in the area expressed a WTP of Php 95.88/household/month or Php 1,150.56/household/year (1 USD=55.89 Php), with 72.30% of respondents indicating their readiness to support efforts to improve the water quality of Tadlac Lake. The likelihood of a positive response significantly varied depending on factors such as the offered price, gender, educational attainment, duration of residency, household size, income, and the method of questionnaire administration (cheap talk vs. non-cheap talk). These results underscore the community’s favorable disposition towards investing in improving Tadlac Lake’s water quality. This valuation study contributes a fresh perspective on lake management strategies. Moreover, it emphasizes the importance of environmental education regarding social-ecological dynamics as a crucial requirement for crafting comprehensive policies that will steer sustainable management of natural lake resources.

On ferry users’ willingness to pay for improving environmental quality: A case study for the Canary Islands

This study, using a contingent valuation framework, provides an initial assessment of the environmental benefits derived from the hypothetical adoption of a low-carbon fuel path, and onshore power supply, by the ferry sector in the Canary Islands in compliance with the FuelEU Maritime Initiative. To this end, a sample of 502 respondents was asked about their willingness to pay (WTP) for the increase in their well-being resulting from improvements in air quality and noise pollution. Special attention was paid to the problem of zero responses and the possible presence of self-selection due to protest responses. The results show that about 75% of the respondents expressed their WTP extra for a single ferry ticket between the most populated cities in the archipelago, with an estimated mean WTP of €13.12. This would represent a 33% increase in current ferry tickets. Aggregating the mean WTP across the population affected, has resulted in a conservative estimate of the total benefits derived from this policy of €65.9 million over a 30-year horizon time, and €94.2 million over a longer horizon time (100 years). In short, this study aims to fill an existing research gap while providing a quantitative basis for decision-making in densely populated port cities connected by ferry.

Willingness to Pay for a Quality-Adjusted Life Year among Gastrointestinal Cancer Patients at a Tertiary Hospital of Vietnam, 2022.

Gastrointestinal (GI) cancer burden in Asia is increasing, and Vietnam is no exception. Assessing the affordability of achieving a quality-adjusted life year (QALY) in gastrointestinal cancer patients Vietnam, as well as identifying predictors of willingness to pay (WTP) per QALY, is crucial to decision-making around medical intervention prioritization and performing medical technology assessments for these cancers. Our study aimed to estimate WTP/QALY gained and associated factors among patients diagnosed with GI cancer at a tertiary hospital in Hue, Vietnam. A cross-sectional descriptive study, using contingent valuation methodology was conducted among 231 patients at tertiary hospital in 2022. A double limited dichotomous choice and the EQ-5D-5L were utilised to estimate WTP and QALY, respectively. Quantile regression was applied to determine predictors of WTP/QALY. The mean and median maximum WTP/QALY gained among GI patients was $15,165.6 (42,239.6) and $4,365.6 (IQR: 1,586.5-14,552.0), respectively, which was equal to 3.68 times the 2022 gross domestic product (GDP) per capita in Vietnam. Additionally, cancer severity was found to have a significant impact on WTP per QALY gained, with a higher amount identified among patients with earlier stages of GI cancer. Furthermore, living in an urban dwelling and patients' treatment modalities were significantly associated with WTP/QALY. Evidence from our study can be used to inform how decision-makers in Vietnam to determine the cost-effectiveness of GI cancer interventions.

Willingness to Pay for Lusi Island Ecotourism Development and Mangrove Conservation

Lusi Island is a small island formed from sedimentation at the estuary of the Porong River and has an area of 94 hectares on the border between Sidoarjo Regency and Pasuruan Regency. The mudflow dumped into the Porong River due to a mud volcano 15 years ago became the cause of the formation of the new island. The mangrove forest is one of the attractions of ecotourism on the island that could attract tourists. However, the determination of Lusi Island as a conservation area, and the increasing number of tourists do not damage the environmental sustainability of the island. Economic valuation could identify the interest and willingness of tourists to participate in preserving the mangrove forest on Lusi Island. The Contingent valuation approach is used to measure people’s preferences through direct interviews about how much respondents are willing to pay (WTP) to get an amenity and comfortable environment. The economic valuation method uses WTP (willingness to pay) as a technique for assessing the ability of tourists to contribute to the development of ecotourism. The results of this study become input in the development of ecotourism and mangrove conservation by considering the involvement of tourists in preserving Lusi Island.

Right prefrontal activation associated with deviations from expected lipstick texture assessed with functional near-infrared spectroscopy.

There is a continuous consumer demand for ever superior cosmetic products. In marketing, various forms of sensory evaluation are used to measure the consumer experience and provide data with which to improve cosmetics. Nonetheless, potential downsides of existing approaches have led to the exploration of the use of neuroimaging methods, such as functional near-infrared spectroscopy (fNIRS), to provide addition information about consumers' experiences with cosmetics. The aim of the present study was to investigate the feasibility of a real-time brain-based product evaluation method which detects the incongruency between a product, in this case lipstick, and a consumer's expectations. Thirty healthy, female, habitual lipstick users were asked to apply six different lipsticks varying in softness and to rate the softness of and their willingness to pay (WTP) for each lipstick. Cerebral hemodynamic responses in frontal areas were measured with fNIRS during lipstick application and analyzed using the general linear model (GLM). Incongruency scores between softness and expectation were calculated in order to understand how far removed each lipstick was from a participant's optimal softness preference. The correlation between brain activation (beta scores) during the application of each lipstick and the respective incongruency scores from each participant were acquired using semi-partial correlation analysis, controlling for the effects of WTP. We revealed a significant intra-subject correlation between incongruency scores and activation in the right inferior frontal gyrus (IFG). This confirms that as the texture incongruency scores increased for the lipstick samples, activation in each individual's right IFG also increased. The correlation observed between incongruency perceived by participants and activation of the right IFG not only suggests that the right IFG may play an important role in detecting incongruity when there is a discrepancy between the perceived texture and the consumer's expectations but also that measuring activity in the IFG may provide a new objective measurement of the consumer experience, thus contributing to the development of superior cosmetics.

Cost-effectiveness of Rapid On-site Evaluation During Navigational Bronchoscopy

BackgroundPeripheral pulmonary lesions (PPL) are common, with more than 1.6 million PPLs incidentally identified in the United States annually. Navigational bronchoscopy (NB) is a cornerstone of the diagnostic evaluation of PPLs. Intraprocedural rapid on-site evaluation (ROSE) of biopsies obtained during NB is widely used, but the data for its utility are contradictory. The cost-effectiveness of ROSE has yet to be established and as such, ROSE currently has variable implementation between institutions and is not adequately reimbursed by payors. Research QuestionIs ROSE cost-effective during NB for PPL from a third-party payor perspective? Study Design and MethodsA cost-effectiveness model was constructed comparing NB for PPL with versus without ROSE from a third-party payor perspective. The base case is a 60-year-old operative candidate with a 2 cm pulmonary nodule without radiographic mediastinal or hilar lymphadenopathy referred for NB. Cost per quality adjusted life-year gained was the primary outcome. Inputs for the model were estimated from published literature. One-way deterministic sensitivity analyses were conducted on all parameters. Probabilistic sensitivity analysis was performed. ResultsThe use of ROSE resulted in a gain of 0.01 quality-adjusted life years and cost an additional $466. At a willingness to pay (WTP) threshold of $100,000/life-year, ROSE was cost-effective with an incremental cost effectiveness ratio (ICER) of $44,465.88. Sensitivity analyses on the sensitivity of NB with and without ROSE show that ROSE must increase the diagnostic sensitivity of the procedure by 3% to become cost-effective. InterpretationThe use of ROSE during navigational bronchoscopy for PPL is cost-effective for third-party payors at a WTP threshold of $100,000/life year and should be reimbursed at a higher rate. The cost-effectiveness of ROSE hinges on the additional diagnostic sensitivity gained by using ROSE.

ASSESSING THE WILLINGNESS TO PAY FOR CONSERVATION AND MANAGEMENT OF WETLANDS AT JAGDISPUR RESERVOIR IN KAPILVASTU DISTRICT OF NEPAL

Wetlands are one of the world's most productive ecosystems. They have significant ecological, economic, cultural, and recreational significance. However, wetlands are being misused and degraded; therefore, wise and sustainable use of wetlands, conservation and management of wetlands resources are critical at the local level. Community-based conservation is a method of managing wetlands near settlements sustainably. The objective of this study was to determine local people's willingness to pay (WTP) for community-based conservation and management activities, as well as the factors which influence it, at the Jagdispur Reservoir in Nepal's Kapilvastu district. A total of 62 households were surveyed. Household surveys and key informant interviews were conducted. Contingent valuation was used to elicit WTP, while regression analysis identified significant determinants. Thirteen provisioning, regulating, cultural and supporting services were identified, including irrigation, fisheries, tourism and biodiversity. Of 62 households, 67% expressed WTP averaging NRs 3,351 (US $ 25.38) annually. WTP was higher for proximal households, reflecting greater dependence. Cash payments dominated, but labor contributions were also substantial. Age, income, participation in conservation, and distance from wetlands positively and significantly influenced WTP. Whereas education, gender, ethnicity and number of family members did not. The findings indicate a high value placed on sustaining wetland services, justifying investment in conservation and wise use. Follow-up research on governance, benefit sharing and sustainable financing is recommended to translate WTP into effective action. Overall, the results provide important baseline data to guide policies and collective action for wetland stewardship.

Factors Affecting the Willingness to Pay for Environmental Improvements during the COVID-19 Pandemic in Taean-gun, Chungcheongnam-do

Background and objective: This study aimed to assess satisfaction with environmental factors during the COVID-19 pandemic and key factors affecting the willingness to pay (WTP) for environmental improvements using logistic regression analysis.Methods: Cross-sectional survey data of 504 residents of Taean-gun in Chungcheongnam-do (South Chungcheong Province), taken from July to August 2020, were used.Results: The assessment of their satisfaction with five environmental factors found that their satisfaction with the natural ecology had the highest score, while their satisfaction with the waste factor had the lowest score. With respect to overall environmental satisfaction, it was found that regardless of gender, age, and income, most residents were highly satisfied with the overall environment of Taean-gun (Taean County). In addition, the WTP for environmental improvements was slightly higher among males than among females. Residents in their 60s or older and with a monthly income of 4 - 4.99 million won were most likely to express WTP for environmental improvements. A binominal logit analysis found that increased environmental concerns (EC), satisfaction with environmental health (EHS) and income were crucial factors in determining the WTP for environmental health. The variables of increased EC and income, have a positive (+) relationship with WTP, while the variable of EHS has a significantly a negative (-) relationship with WTP.Conclusion: In other words, the higher the EC, the lower the EHS, and the higher the income, the more likely residents were to express WTP for environmental improvements. This study has significance in that it can provide primary data for sustainable local environmental plans to improve public environmental awareness for sustainability, and environmental strategies to prepare for post-pandemic life.

ASSESSING PREFERENCES AND WILLINGNESS TO PAY FOR RENEWABLE ENERGY INVESTMENT AMONG MANUFACTURING SECTORS IN MALAYSIA: A CHOICE EXPERIMENT METHOD

Green energy has become a hot debate among countries. Most countries prefer green energy over fossil resources that can violate the environment and health. The manufacturing sector was the most energy-intensive sector in Malaysia, and Johor was the fastest-growing industrial state and the biggest user of fuel energy. The cost factor has become one of the reasons why renewable energy is less used in this country. If not curbed, this situation will thwart the government’s target to reduce the dependency on non–renewable energy. Thus, participation from the manufacturing sector is important to support government efforts to empower renewable energy. Support from the manufacturing sector and their Willingness to Pay (WTP) for energy production from renewable energy resources remain key ingredients for a successful energy policy. This study aims to estimate the WTP for renewable energy investment attributes among the manufacturing sectors in Johor, Malaysia. A series of stated Choice Experiments (CE) was used in which the Multinomial Logit (MNL) model was valued to ascertain manufacturing sectors’ WTP based on their preferences for the attributes. The results revealed that the manufacturing sector values project location and annual GHG reduction.

Older adults preferences for long-term caregivers in China: a discrete choice experiment

ObjectiveUnderstanding the preferences of old-age adults for their long-term caregivers can improve person-centred health care and the quality of long-term care (LTC). This study examines Chinese older adults’ preferences for long-term caregivers. Study designThis is a cross-sectional study. MethodsA national representative discrete choice experiment (DCE) surveyed 2031 adults aged 50–70 across 12 provinces in China. Each DCE scenario described five attributes: type of caregivers, place of LTC, contents of LTC, out-of-pocket payments, and quality of life (QoL). Preferences and the marginal willingness to pay (WTP) were derived using mixed-logit and latent class models. ResultsOlder adults displayed higher preferences for long-term caregivers who improve their QoL, incur lower out-of-pocket payments, and provide medical LTC services at home, with the maximum WTP of $22.832 per month. QoL was rated as the most important LTC factor, followed by the place of LTC and the type of caregivers. When the level of QoL improved from poor to good, respondents would be willing to pay $18.375 per month more (95% confidence interval: 16.858 to 20.137), and the uptake rate increased by 76.47%. There was preference heterogeneity among older people with different sex, education, family size, and knowledge of LTC insurance. ConclusionQoL was the most important factor in older Chinese adults' preference for caregivers. Home care and medical care from formal caregivers was preferred by older adults. We recommend training family caregivers, raising older people's awareness of LTC insurance, and guiding policymakers in developing people-oriented LTC and a multi-level LTC system.

Cost-Utility Analysis of Early Detection with Ultrasonography of Differentiated Thyroid Cancer: A Retrospective Study on a Korean Population.

There is debate about ultrasonography screening for thyroid cancer and its cost-effectiveness. This study aimed to evaluate the cost-effectiveness of early screening (ES) versus symptomatic detection (SD) for differentiated thyroid cancer (DTC) in Korea. A Markov decision analysis model was constructed to compare the cost-effectiveness of ES and SD. The model considered direct medical costs, health outcomes, and different diagnostic and treatment pathways. Input data were derived from literature and Korean population studies. Incremental cost-effectiveness ratio (ICER) was calculated. Willingness-to-pay (WTP) threshold was set at USD 100,000 or 20,000 per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted to address uncertainties of the model's variables. In a base case scenario with 50 years of follow-up, ES was found to be cost-effective compared to SD, with an ICER of $2,852 per QALY. With WTP set at $100,000, in the case with follow-up less than 10 years, the SD was cost-effective. Sensitivity analysis showed that variables such as lobectomy probability, age, mortality, and utility scores significantly influenced the ICER. Despite variations in costs and other factors, all ICER values remained below the WTP threshold. Findings of this study indicate that ES is a cost-effective strategy for DTC screening in the Korean medical system. Early detection and subsequent lobectomy contribute to the cost-effectiveness of ES, while SD at an advanced stage makes ES more cost-effective. Expected follow-up duration should be considered to determine an optimal strategy for DTC screening.

Valoración Contingente Dicotómica de tres servicios ecosistémicos de la Reserva de Producción de Fauna Chimborazo, Ecuador

The moorland or paramo is a threatened ecosystem. The indiscriminate advance of the agricultural frontier is producing the loss of ecosystem services, especially water service. This research estimated the willingness to pay (WTP) of the water users corresponding to the Municipality of Riobamba for the conservation of 3 ecosystem services: water service, soil conservation and scenic beauty of the Chimborazo Fauna Production Reserve (RPFCH). Four hundred and six surveys were applied by means of the double limit dichotomous contingent valuation method, using a maximum likelihood model in the Stata software. Four models were developed: simple limit, simple limit with other explanatory variables, double limit, and double limit with other explanatory variables, the latter being statistically more significant. As a result, it was determined that the WTP for the ecosystem service of water production is USD 0.84, for soil conservation USD 0.88 and for scenic beauty USD 0.81 per month that they would be willing to pay for the care of these services.