Dual front-of-pack (FoP) labelling (i.e., presence of both nutrition and sustainability labels) can guide consumers towards healthier and more sustainable food choices. Despite growing interest, evidence on behavioural outcomes remains limited. This study aimed to review existing literature to understand the effects of dual FoP labelling on consumer behaviour. We searched seven databases for experimental studies published until May 2024 that assessed dual front-of-pack labels as interventions. Eligible studies measured the following outcomes: objective understanding, purchase intention, food choice, and/or willingness to pay (WTP). Risk of bias was assessed using the RoB 2 tool. Seven studies examined five nutrition and five sustainability labels, with three reporting on purchase intention, three on food choice, and one on WTP. None of the studies assessed objective understanding. Risk of bias assessment rated five studies as high quality, one moderate, and one low. Five studies testing congruent dual labelling (positive nutrition & sustainability scores) using interpretive formats (e.g., warning labels, Nutri-Score, Eco-Score) reported favourable effects of dual labelling. Two studies assessing congruent text-based or certification labels showed unfavourable outcomes. Incongruent labelling (positive nutrition & negative sustainability, and vice versa) produced mixed results, suggesting conflicting information may confuse consumers. Understanding how consumers respond to combined nutrition and sustainability information is essential for transitioning to healthy and sustainable food systems. This review shows that dual labelling can influence choices, but its effectiveness depends on label format and message framing, highlighting the need for careful design to avoid unintended effects and support informed decision-making.

Do we say what we do? Testing cheap talk to reduce hypothetical bias in moral choice experiments.

Gastroparesis (GP) is a chronic gastrointestinal motility disorder that imposes a substantial clinical and economic burden. For patients with refractory GP, gastric peroral endoscopic myotomy (G-POEM) and botulinum toxin injection (BTI) are emerging therapies with differing efficacy profiles and procedural costs. Given these differences, we evaluated the cost-effectiveness of G-POEM versus BTI for refractory GP. We conducted a cost-effectiveness analysis using a decision tree model informed by randomized trial data from a US health care system perspective over 3- and 12-month time horizons. Procedural costs, adverse events, and repeat BTI sessions were incorporated. Quality-adjusted life-years (QALYs) were estimated from the Gastrointestinal Quality of Life Index (GIQLI) and from Short Form-12 (SF-12) scores. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs) at a willingness-to-pay (WTP) threshold of $100,000/QALY. The base-case analysis was modeled on a 48.1-year-old patient with refractory GP-defined as persistent symptoms despite 6 months of medical therapy and a GP Cardinal Symptom Index score >2. At 3 months, G-POEM was associated with higher costs and marginally greater effectiveness than BTI (ICER $288,341/QALY), making BTI the cost-effective strategy in the short term. At 12 months, incorporating repeat BTI, G-POEM became the cost-effective option, with BTI yielding an ICER of $334,046/QALY relative to G-POEM. Sensitivity analyses identified clinical success rates and procedural costs as primary cost-effectiveness drivers. At 12 months, the cost-effectiveness acceptability curve showed G-POEM was cost-effective in most simulations at lower WTP thresholds, with BTI favored only at thresholds near $335,000/QALY. While BTI is more cost-effective in the short term, the cumulative costs of repeat sessions make G-POEM the more economically favorable strategy over 12 months. Improving clinical success rate by optimizing patient selection and refining procedural techniques could further improve cost-effectiveness profiles.

Cost-Effectiveness of Vaccine for the Prevention of Herpes Zoster in Kidney Transplant Recipients in Thailand.

This paper examines consumers' hypothetical willingness to pay (WTP) for sustainable fashion products, distinguishing between green attributes (e.g., natural fibers) and circular attributes (e.g., second-hand and recycled materials). It focuses on how economic considerations and environmental attitudes jointly influence consumers' valuation and purchasing behavior. Using original survey data from a sample of Italian consumers, we analyze stated WTP for identical t-shirts differing only in their production attributes: new (linear), second-hand (circular), made of natural fibers (green), and made of recycled materials (circular). Results reveal that while second-hand garments are perceived as highly sustainable, they display a significantly lower WTP, confirming the presence of a sustainability-related attitude-behavior gap. In contrast, t-shirts made of natural fibers and recycled materials receive positive and statistically significant green and circular premium, respectively. Regression results further show that pro-environmental behavior positively affects WTP only for second-hand products, whereas quality, comfort, and versatility negatively influence their valuation. Conversely, economic considerations significantly reduce WTP for green and recycled garments, highlighting the dominance of explicit economic preferences over environmental ones. Overall, the findings provide empirical evidence relevant to SDG 12, highlighting the challenges of promoting responsible consumption in the fashion industry.

Understanding the population's preferences for health insurance plays an important role in optimizing insurance scheme design and improving enrollment rate. This study aims to quantitatively investigate preference for supplementary voluntary health insurance (SVHI) from a multi-site survey and examine its heterogeneity in China. A discrete choice experiment was conducted in Shandong, Henan and Sichuan provinces using multi-stage stratified sampling method. Five SVHI attributes were identified: premium, benefit package, deductible, reimbursement rate, and reimbursement for pre-existing conditions. Choice sets were generated using a D-efficient design, grouped into two blocks randomly assigned to respondents, with each set comprising two SVHI options and an opt-out. Data were collected via face-to-face computer-assisted interviews. Mixed logit models was used to estimate preference weights, willingness-to-pay (WTP) and attribute importance scores. Preference heterogeneity was analyzed by disease-related financial risk awareness, numeracy, and health insurance knowledge, demographic, socioeconomic, and health characteristics. Of the 1326 respondents who completed the questionnaire, 1254 were included in the analysis. Reimbursement rate was the most important attribute (34.26%), followed by premium (25.06%), benefit package (17.60%), deductible (17.50%) and reimbursement for pre-existing conditions (5.58%). Overall, respondents expressed the highest WTP (USD 48.50) for improving the reimbursement rate from 50% to 90%, while they showed lowest WTP (USD 8.60) for decreasing deductible from USD 2777.78 to 1388.89. Heterogeneity analysis revealed stronger enrollment preferences among respondents with risk awareness, higher health insurance knowledge, higher numeracy, higher educational attainment, higher income, and those living in urban areas. In addition, higher levels of risk awareness, insurance knowledge, numeracy, income, and education were associated with increased WTP for SVHI attributes. Preference heterogeneity by risk awareness and insurance knowledge suggests need for targeted risk information communication and education campaign to promote SVHI uptake, and diverse insurance design tailored to socioeconomic differences in preferences for attributes.

Adherence to daily oral HIV PrEP wanes over pregnancy and postpartum and new long-acting injectable HIV PrEP (LAI-PrEP) methods may address barriers to effective use. Understanding changing LAI-PrEP preferences during the perinatal period could inform the integration into maternal healthcare. We used data from a randomized trial of pregnant women initiating daily oral HIV PrEP at five public maternal child health facilities in western Kenya, followed through 9 months postpartum (NCT04472884). Participants completed surveys on LAI-PrEP interest from the third trimester through postpartum. Latent Transition Analysis (LTA) examined underlying patterns of LAI-PrEP interest. Predictors of transitions between statuses were assessed using univariate logistic regression. Overall, 598 pregnant women were enrolled (median age: 25 years). We identified three preferences statuses: "No interest in LAI-PrEP", "Willing to pay (WTP) for LAI-PrEP", and "Prefers free LAI-PrEP". About 10% comprised the "No interest in LAI-PrEP" at each time point. In pregnancy, 36.8% belonged to the "Prefers free LAI-PrEP" status, with participants increasingly transitioning to "WTP for LAI-PrEP" through the postpartum period. The "WTP for LAI-PrEP" status grew from 53.2% in third trimester to 76.6% at nine months postpartum, however women who were primigravida had 5-fold higher odds of transitioning out of "WTP for LAI-PrEP" to "Prefers free LAI-PrEP" (95% CI: 5.29-5.39, p < 0.001). Most women remained interested in LAI-PrEP across pregnancy and postpartum, with willingness to pay for LAI-PrEP growing over time. Expanding cost-free LAI-PrEP within MCH systems, especially for postpartum and primigravida women, could improve PrEP use during this critical period.ClinicalTrials.gov registration number: NCT04472884.

ABSTRACT BACKGROUND This study estimated the cost-effectiveness of sacituzumab tirumotecan (Sac-TMT) versus pemetrexed-platinum chemotherapy as second-line therapy for advanced EGFR-mutated non-small cell lung cancer (NSCLC) in China. RESEARCH DESIGN AND METHODS A partitioned survival model based on the OptiTROP-Lung04 trial was developed from the Chinese healthcare perspective. The incremental cost-effectiveness ratio (ICER) was compared with a willingness-to-pay (WTP) threshold of $26,889.37/QALY. One-way, two-way, and probabilistic sensitivity analyses, together with scenario analyses, tested the robustness of the findings. RESULTS The base-case analysis results showed that over 10 years, Sac-TMT gained 0.86 additional QALYs at an incremental cost of $64,255.79, yielding an ICER of $75,704.42/QALY, exceeding the WTP threshold. Key drivers were patient body weight, the per-unit cost of Sac-TMT (180 mg), and the health utility value for the progressive disease state. The probability of Sac-TMT being cost-effective at the WTP threshold of $26,889.37/QALY was 0%. Patient assistance program reduced the ICER to $46,354.36/QALY. A price reduction exceeding 73.81% would bring the ICER below the WTP threshold. CONCLUSION At current prices, Sac-TMT is not cost-effective as second-line therapy for advanced EGFR-mutated NSCLC in China.

BackgroundPneumonia is preventable and treatable, yet it remains the leading infectious cause of illness and death among under-five children. Bubble continuous positive airway pressure (bCPAP) offers a promising option for oxygen therapy combined with appropriate antibiotics and other supportive care. However, the cost-effectiveness of bCPAP in resource-limited settings such as Ethiopia is not documented. We aimed to evaluate the cost-effectiveness of bCPAP in treating severe pneumonia and hypoxaemia in under-five children in Ethiopia.MethodsWe developed a decision-analytical model (decision tree) to determine the cost-effectiveness of a locally made bCPAP compared with the standard of care (WHO-recommended low-flow oxygen therapy) in general hospitals. Effectiveness was measured as the number of child deaths and disability adjusted life years (DALYs) averted. Cost data were extracted from published literature and local markets. The incremental cost-effectiveness ratio (ICER) was calculated and evaluated against the willingness-to-pay (WTP) thresholds set at multiples (0.34, 1, and 3) of Ethiopia’s GDP per capita. Sensitivity analyses were performed to test the robustness of the results.ResultsFor every 10,000 children with severe pneumonia and hypoxaemia, providing oxygen using locally made bCPAP will save an additional 31 children compared to the standard of care. A locally made bCPAP has an ICER of 139.5 USD per DALY averted. These results were robust in the sensitivity analysis performed, showing a 100% probability of being cost-effective at one times the GDP per capita of Ethiopia.ConclusionA locally made bCPAP is a highly cost-effective intervention for treating severe pneumonia and hypoxaemia in under-five children in Ethiopian general hospitals. These findings provide critical evidence for decision-makers to support and scale-up use of bCPAP in Ethiopia and other similar low and middle income countries.

Quantitative microbial risk assessment and cost-benefit analysis of Legionella contamination in the water system of a large hospital in Southern Italy.

Geographical indications (GIs) tags are types of certifications that identify products with unique characteristics and qualities linked to their geographical origin. This review article investigates consumer preferences and willingness to pay (WTP) for GI products in India, which is gaining importance with the rapid growth of GI registration in the country. Through an extensive review of the literature, this study aims to explore complex interrelations among factors that are relevant in forming behaviour- and decision-making about GI products. The review also highlights the significance of consumer-related factors, product-related factors and place-of-purchase factors in determining WTP for GI products. This study underlines the importance of effective marketing and policies for the development of the GI products market, along with its associated economic benefits, while ensuring rural development and the preservation of traditional knowledge. Overcoming challenges in promoting consumer awareness and understanding of GIs, as well as cultivating a supportive legal and policy environment, is critical for leveraging the potential of GIs as a catalyst for rural development. The results provide evidence that illustrates GI products of higher quality and authenticity can positively influence consumers’ WTP. The factors that influence consumer preference are quality and distinctiveness of their product, promotion tools with a good product differentiation by GI labelling and certification, traditional and sustainable production methods and personal attitude. Willingness to pay is influenced by quality perception, consumer knowledge and awareness of GIs, self-attitude and sociodemographic factors. Geographical indications products enhance consumer trust and enable premium pricing through perceived quality and authenticity. They support rural development, preserve traditional knowledge and strengthen market differentiation in emerging and competitive economies. This study is significant because it provides a comprehensive synthesis of the determinants influencing consumer behaviour towards GI products and offers policy-relevant insights for strengthening GI-based rural development.

Willingness to pay for influenza vaccination among the elderly in Vietnam: A triple-bounded dichotomous choice analysis of economic and behavioral determinants.

To determine the contemporary cost per quality-adjusted life year(QALY) gained for abdominal aortic aneurysm (AAA) repair in current practice and assess the optimal threshold for intervention. The widely accepted 5.5cm threshold for elective AAA repair in men remains largely consensus-based. However, contemporary evidence suggests that size-associated rupture risk may be lower than previously assumed, calling into question whether this threshold is cost-effective. A Markov-chain estimated the cost-utility of endovascular AAA repair(EVAR) and open surgical repair(OSR) compared with surveillance. Social Security Administration lifetables informed survival, while Vascular Quality Initiative and Medicare data informed complication rates, reinterventions, and late rupture. Quality-adjusted life years(QALYs) were derived from published estimates. Two willingness-to-pay(WTP) thresholds were evaluated:$100,000/QALY(U.S.) and $40,000/QALY(UK-NICE equivalent). Given uncertainty in size-specific rupture risk, a range of annual rupture probabilities was modeled. The base-case analysis considered a 70-year-old man over a 10-year time horizon. At a WTP threshold of $100,000/QALY, immediate EVAR became cost-effective when annual rupture risk was ≥2.2%, whereas OSR became cost-effective at ≥3.4%. At a $40,000/QALY threshold, the rupture risk thresholds were ≥5.0% for EVAR and ≥6.8% for OSR. Assuming an annual rupture risk of 0.4% (as reported in a contemporary study), the cost per QALY gained with EVAR was $1,233,000, while OSR was associated with a loss of QALYs. The cost-effectiveness of AAA repair is highly dependent on rupture risk. Given that contemporary data suggest lower rupture rates than previously assumed, the current 5.5cm repair threshold in men may not be optimally cost-effective from a population health perspective.

Background. Policies on telehealth coverage and reimbursement have been evolving. To support national decisions on telehealth use and delivery, this study assessed patient preferences on care delivery modalities and value of time for primary care in outpatient settings. Design. Discrete choice experiments were designed to calibrate care visits by 1 price attribute and 3 nonprice attributes: delivery mode (phone, video, in-person), time costs, and waiting time. Mixed logistic regression models were used to estimate patient preferences and willingness to pay (WTP). Sample. A total of 110 respondents were recruited from a state representative cohort in the Midwestern United States with oversampling of Black and Hispanic minorities. Results. Patients were willing to pay $23.2 (95% confidence interval [CI] 13.3, 37.9) for a primary care visit and $30.3 extra (95% CI 21.1, 44.0) for in-person care but discounted the value of care by $8.7 for a video visit and $21.6 for a phone visit. Reducing time costs from 45 to 30 min increased patients’ WTP by $4.0 (1.8, 7.3). Patients’ WTP was $4.1 higher (or $2.2) if care visits were scheduled on the same day (or within 3 d) rather than in 7 d. Patients who were non-White minorities, older than 65 y, did not own a property, or were Medicaid beneficiaries valued care visits lower than the average ($11–$18 v. $23) but valued same-day visits more ($6.2–$6.3 v. $4.1). Conclusions. Patients discounted care delivered by phone or video visits but preferred to have such options for flexibility and timely access. The benefits of telehealth such as reducing time costs and providing timely care access increased its desirability and the potential to avoid missed or delayed care for preventive and care maintenance purposes.HighlightsPatients are willing to pay about $23 for a typical primary care visit on prevention and maintenance.Patients discount video or phone visits by $8 to $20 but prefer to have such options for flexibility and timely access.Patients are willing to pay $4 to $6 for shorter time cost obtaining care or same-day timely access to care.Non-White minorities and older and low-income patients have lower valuation for a care visit but a higher price premium for same-day visits than the general population, suggesting high potential of telehealth to help avoid missed or delayed care for these subpopulations.

ObjectivesPopulation aging and the weakening of traditional care systems pose growing challenges to China’s eldercare system, creating increasing demand for technology-assisted healthcare solutions. This study aimed to examine the preferences and willingness to pay (WTP) of old aged Chinese adults for assistive healthcare technologies.MethodsA discrete choice experiment with six attributes (service location, service function, technology difficulty, technology security, out-of-pocket payments and quality of life) was conducted with 235 older adults. The conditional logit and mixed logit models were used to assess the utility, relative importance score, and WTP for attributes and preference heterogeneity.ResultsAll six attributes had a significant impact on older people’s preferences. Participants preferred assistive technologies that could be used at home, focused on daily living assistance, featured low technology difficulty, ensured high security, improved quality of life, and incurred lower out-of-pocket payments, with the maximum WTP of $129.747 per month. Notable preference heterogeneity was observed, with females placing greater value on security, rural residents showing stronger preferences for home-based care, and individuals with chronic diseases prioritizing quality-of-life improvements.ConclusionsChinese older adults prioritized assistive technology with high technology security, better quality of life, home-based, low technology difficulty, lower out-of-pocket costs and offering daily living assistance services. We recommend policymakers build secure assistive technology systems; develop and promote low-difficulty and user-friendly technology solutions; implement differentiated pricing strategies to enhance the affordability and accessibility of assistive technology.

Interactive comics driven by Generative AI, as a representative emerging medium, are reshaping the narrative relationship and emotional connection between humans and AI: users actively co-create “their own stories” in real-time through natural language. A randomized controlled trial and PLS-SEM analysis conducted on 494 interactive comic users revealed: (a) At the motivational level, the initiative of interaction has a significant direct positive effect on willingness to pay (WTP). (b) At the emotional level, AI interaction quality drives consumption decisions through a chained mediation path of “AI Interaction Quality (AIQ) → Flow Experience (FE) → Interactive Character Symbiosis (ICS) → WTP.” (C) Multi-group analysis confirms that this mechanism remains robust across different contexts. This study not only proposes and validates a new construct called ICS, applicable to scenarios of limited interaction but high emotional investment, thereby expanding the understanding of Consumer-AI relationships in HCI.

Obesity affects 1 in 5 US children, with the global prevalence projected to double by 2035. Among adolescents with severe obesity, metabolic and bariatric surgery (MBS) yields durable weight loss and comorbidity improvement, although its long-term cost-effectiveness remains uncertain. To evaluate the 10-year cost-effectiveness of MBS for adolescents with severe obesity using recently published results from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. This economic evaluation used a microsimulation model of a cohort of 100 000 simulated adolescents in the US health care sector to project health and cost outcomes of no surgery, Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy over 10 years among adolescents with severe obesity. Model inputs, including longitudinal clinical performance, were derived from Teen-LABS study data, published literature, and national databases. Data were analyzed from April 2023 to October 2025. Quality-adjusted life-years (QALYs), costs (2022 US dollars), and incremental cost-effectiveness ratios (ICERs), with future costs and QALYs discounted at 3.0% annually. A willingness-to-pay (WTP) threshold of $100 000 per QALY gained was used to assess cost-effectiveness. The population was a hypothetical cohort of 100 000 adolescents with the following baseline characteristics: age 17 years, body mass index 52.1, 75.0% female, 13.3% with type 2 diabetes, 4.9% with low ferritin, 37.2% with low vitamin D, and 0.4% with low vitamin B12. At 10 years, sleeve gastrectomy was projected to be the cost-effective strategy, with an ICER of $41 164 per QALY gained when compared with no surgery. RYGB yielded the most QALYs, although with a less favorable ICER of $557 751 per QALY gained compared with sleeve gastrectomy. However, in a direct comparison with no surgery, RYGB was estimated to be cost-effective, with an ICER of $50 271 per QALY gained. In sensitivity analyses, sleeve gastrectomy was consistently the cost-effective strategy. In this economic evaluation of bariatric surgery for adolescents with severe obesity, both RYGB and sleeve gastrectomy were determined to be cost-effective when compared with no surgery. However, sleeve gastrectomy was estimated to be the cost-effective strategy over a 10-year time horizon when simultaneously comparing all 3 interventions. These findings complement established clinical evidence of the long-term benefits of MBS, supporting its economic value.

Land degradation is a critical threat to agricultural productivity in Ghana, reducing soil fertility and deepening rural poverty. Efforts to promote Sustainable Land Management (SLM) have increased, but adoption remains uneven, with persistent gender disparities in access to land, training, and decision-making. This study draws on survey data from 1,036 farming households across five municipalities in Ghana’s Volta Region to examine how SLM training and farm size affect farmers’ willingness to pay (WTP) for SLM practices, with a focus on gender differences. A Tobit regression model is used to estimate both main and interaction effects. The results support the study hypotheses. SLM training (β = 0.164, p < 0.01) significantly increases WTP, with stronger effects among male farmers, confirming H1. Farm size (β = 0.058, p < 0.01) is positively associated with WTP, as larger landholdings increase farmers’ investment capacity, supporting H2. Gender differences are evident: male farmers show higher baseline WTP, while female farmers show large increases in WTP as access to land and SLM training improves, partially supporting H3 and suggesting that disparities are driven mainly by structural constraints. The three-way interaction between SLM training, gender, and farm size is positive and significant (β = 0.375, p < 0.05), confirming H4 and indicating that the effect of SLM training on WTP depends jointly on gender and resource endowment. Overall, the findings suggest that gender is central to understanding investment decisions in SLM and highlight the need for gender-responsive policies that address inequalities in access to land, training, and productive resources.

ABSTRACT This study investigates how deeply rooted collectivist culture, stemming from historical rice farming practices, shapes individuals’ willingness to pay (WTP) for environmental protection in China. Using data from the China General Social Survey (CGSS), we examine the relationship between the proportion of rice farming in a province – a proxy for collectivism – and stated environmental WTP. Our findings reveal that regions with a higher prevalence of rice farming exhibit a significantly greater environmental WTP, consistent with the hypothesis that collectivism fosters stronger pro-environmental preferences. The effect is strongest among individuals with low intrinsic public spirit, revealing a ‘cultural compensation’ mechanism whereby external norms of shared responsibility substitute for weak internal altruism. It is further amplified in regions facing more severe pollution pressures but weakens in areas with a higher share of migrants from low-collectivism regions, underscoring both the persistence of historical cultural influences. These findings extend the ‘rice theory’ to contemporary environmental behaviour and highlight the enduring role of culture in shaping environmental preferences. For policymakers, this suggests that while collectivist cultural values should be recognized as important contextual factors in environmental policy design, formal environmental policies also play a crucial role in complementing or even substituting the influence of collectivist culture.

Outpatient specialist physicians in France can work either in the regulated sector, where they charge the regulated fee, or in the unregulated sector, where they set their own fees above the regulated fee. This context provides a unique opportunity to estimate the extent to which patients value services provided under balance billing. In January 2021, we carried out a contingent valuation method (CVM) survey on a sample of 1051 individuals who were representative of France's adult population. Results highlighted that willingness-to-pay (WTP) for a specialist consultation in the unregulated sector was higher than for a consultation in the regulated sector, with a significant WTP difference of €4.30 (almost 15% of the regulated fee). This difference was significant across all respondent subgroups (i.e., gender, age, education level, marital status, income, health status, insurance coverage, and area of residence) and was not fully driven by differences in income. Moreover, this preference for the unregulated sector was associated with the perception that specialists in this sector provide better quality medical care, better quality non-medical services, and that making an appointment with them is easier. Finally, we estimated the patient net welfare gain generated by specialist consultations in the unregulated sector in France at approximately €165 million per year. This is the first study to provide an estimation of patients' benefits associated with balance billing.