Socioeconomic Differences in Preferences and Willingness-to-Pay for Insulin Delivery Systems in Type 1 and Type 2 Diabetes

Background: An evaluation of patients' preferences is necessary to understand the demand for different insulin delivery systems. The aim of this study was to investigate the association between socioeconomic status (SES) and patients' preferences and willingness to pay (WTP) for various attributes of insulin administration for diabetes management. Methods: We conducted a discrete choice experiment (DCE) to determine patients' preferences and their WTP for hypothetical insulin treatments. Both self-reported annual household income and education completed were used to explore differences in treatment preferences and WTP for different attributes of treatment across different levels of SES. Results: The DCE questionnaire was successfully completed by 274 patients. Overall, glucose control was the most valued attribute by all socioeconomic groups, while route of insulin delivery was not as important. Patients with higher incomes were willing to pay significantly more for better glucose control and to avoid adverse events compared to lower income groups. In addition, they were willing to pay more for an oral short-acting insulin ($Can 71.65 [95% confidence interval, $40.68, $102.62]) compared to the low income group ($Can 9.85 [95% confidence interval, 14.86, 34.56; P < 0.01]). Conversely, there were no differences in preferences when the sample was stratified by level of education. Conclusions: This study revealed that preferences and WTP for insulin therapy are influenced by income but not by level of education. Specifically, the higher the income, the greater desire for an oral insulin delivery system, whereas an inhaled route becomes less important for patients.

Investigating the value dairy farmers place on a reduction of lameness in their herds using a willingness to pay approach

A survey was conducted to elicit dairy farmers’ willingness to pay (WTP) to reduce the prevalence of lameness in their herds. A choice experiment questionnaire was administered using face-to-face interviews of 163 farmers in England and Wales. Whole herd lameness assessments by trained researchers recorded a mean lameness prevalence of nearly 24% which was substantially higher than that estimated by farmers. Farmers’ responses to a series of attitudinal questions showed that they strongly agreed that cows can suffer a lot of pain from lameness and believed that they could reduce lameness in their herds. Farmers’ mean WTP to avoid lameness amounted to UK£411 per lame cow but with considerable variation across the sample. Median WTP of UK£249 per lame cow was considered a better measure of central tendency for the sample. In addition, the survey found that farmers had a substantial WTP to avoid the inconvenience associated with lameness control (a median value of UK£97 per lame cow) but that they were generally prepared to incur greater inconvenience if it reduced lameness. The study findings suggest that farmers need a better understanding of the scale and costs of lameness in their herds and the benefits of control. To encourage action, farmers need to be convinced that lameness control measures perceived as inconvenient will be cost effective.

Willingness-to-pay for a probabilistic flood forecast: a risk-based decision-making game

Probabilistic hydro-meteorological forecasts have over the last decades been used more frequently to communicate forecastuncertainty. This uncertainty is twofold, as it constitutes both an added value and a challenge for the forecaster and the user of the forecasts. Many authors have demonstrated the added (economic) value of probabilistic over deterministic forecasts across the water sector (e.g. flood protection, hydroelectric power management and navigation). However, the richness of the information is also a source of challenges for operational uses, due partially to the difficulty to transform the probability of occurrence of an event into a binary decision. This paper presents the results of a risk-based decision-making game on the topic of flood protection mitigation, called “How much are you prepared to pay for a forecast?”. The game was played at several workshops in 2015, which were attended by operational forecasters and academics working in the field of hydrometeorology. The aim of this game was to better understand the role of probabilistic forecasts in decision-making processes and their perceived value by decision-makers. Based on the participants’ willingness-to-pay for a forecast, the results of the game show that the value (or the usefulness) of a forecast depends on several factors, including the way users perceive the quality of their forecasts and link it to the perception of their own performances as decision-makers.

Consumer willingness to pay for in-flight service and comfort levels: A choice experiment

In the competitive aviation market as a result of the emergence of low cost carriers, charter airlines have had to reconsider their approach to service provision. Specifically, the reduction in service and comfort levels offered by the low cost airlines provides charter carriers with an opportunity to differentiate their product based on the quality of the offering. To consider this strategic option we employ an on-line choice experiment to examine consumer choices with respect to the bundle of services on offer when deciding to purchase a flight, With these data we use the Bayesian methods to estimate a mixed logit specification. Our results reveal that in principle passengers are willing to pay a relatively large amount for enhanced service quality. (C) 2008 Elsevier Ltd. All rights reserved.

Farmers’ willingness to pay for a tuberculosis cattle vaccine

We use contingent valuation (CV) and choice experiment (CE) methods to assess cattle farmers’ attitudes to and willingness to pay (WTP) for a bovine tuberculosis (bTB) cattle vaccine, to help inform vaccine development and policy. A survey questionnaire was administered by means of telephone interviews to a stratified sample of 300 cattle farmers in annually bTB-tested areas in England and Wales. Farmers felt that bTB was a major risk for the cattle industry and that there was a high risk of their cattle getting the disease. The CE estimate produced a mean WTP of £35 per animal per single dose for a vaccine that is 90% effective at reducing the risk of a bTB breakdown and an estimated £55 for such a vaccine backed by 100% insurance of loss if a breakdown should occur. The CV estimate produced a mean WTP of nearly £17 per dose/per animal/per year for a vaccine (including 100% insurance) which, given the average lifespan of cattle, is comparable to the CE estimate. These WTP estimates are substantially higher than the expected cost of a vaccine which suggests that farmers in high risk bTB ‘hotspot’ areas perceive a substantial net benefit from buying the vaccine.

A valuation of patients` willingness-to-pay for insulin delivery in diabetes

Objectives: The aim of this study was to determine the insulin-delivery system and the attributes of insulin therapy that best meet patients` preferences, and to estimate patients` willingness-to-pay (WTP) for them. Methods: This was a cross-sectional discrete choice experiment (DCE) study involving 378 Canadian patients with type 1 or type 2 diabetes. Patients were asked to choose between two hypothetical insulin treatment options made up of different combinations of the attribute levels. Regression coefficients derived using conditional logit models were used to calculate patients` WTP. Stratification of the sample was performed to evaluate WTP by predefined subgroups. Results: A total of 274 patients successfully completed the survey. Overall, patients were willing to pay the most for better blood glucose control followed by weight gain. Surprisingly, route of insulin administration was the least important attribute overall. Segmented models indicated that insulin naive diabetics were willing to pay significantly more for both oral and inhaled short-acting insulin compared with insulin users. Surprisingly, type 1 diabetics were willing to pay $C11.53 for subcutaneous short-acting insulin, while type 2 diabetics were willing to pay $C47.23 to avoid subcutaneous short-acting insulin (p < .05). These findings support the hypothesis of a psychological barrier to initiating insulin therapy, but once that this barrier has been overcome, they accommodate and accept injectable therapy as a treatment option. Conclusions: By understanding and addressing patients` preferences for insulin therapy, diabetes educators can use this information to find an optimal treatment approach for each individual patient, which may ultimately lead to improved control, through improved compliance, and better diabetes outcomes.

Effects of a change in abundance of elephants on willingness to pay for their conservation

This paper explores the way in which the stated willingness to pay for the conservation of Asian elephants in Sri Lanka varies with hypothetical variations in their abundance. To do that, it relies on results from a sample of residents of Colombo. The willingness to pay function is found to be unusual. It increases at an increasing rate for hypothetical reductions in the elephant population compared to its current level (a level that makes the Asian elephant endangered) and also increases at a decreasing rate for increases in this population from its current level. Rational explanations are given for this relationship. The relationship is, however, at odds with relationships suggested in some of the literature for total economic value as a function of the abundance of a wildlife species. It is suggested that willingness to pay for conservation of a species rationally includes a strategic element and may not always measure the total economic value of a species. Nevertheless, willingness to pay is still policy relevant in such cases.

Knowledge and willingness to pay for the conservation of wildlife species: Experimental results evaluating Australian tropical species

The nature of an experiment involving 204 residents is outlined and the results are reported and analysed. Two consecutive surveys of the respondents provide data about their stated knowledge of 23 wildlife species present in tropical Australia, most of which exclusively occur there. In addition, these surveys provide data about the willingness of respondents to pay for the conservation of those species belonging to three taxa; reptiles, mammals, and birds. Thus it is possible to compare the respondents’ stated knowledge of the species with their willingness to pay for their conservation, and to draw relevant inferences from this. From the initial survey and these associations, interesting relationships can be observed between those variables (knowledge and willingness to pay). The second survey was completed after the respondents’ knowledge of the species was experimentally increased and became more balanced. This is shown to result in increased dispersion (greater discrimination) in willingness to contribute to conservation of the different species in the set of wildlife species considered. Both theoretical and policy conclusions are drawn from the results.

Knowledge of birds and willingness to pay for their conservation: An Australian case study

This case study concentrates on the extent of knowledge of members of the Australian public of Australia’s tropical bird species and their willingness to pay for their conservation. In order to place this issue in context, it first provides background information on the status of Australian bird species, focusing attention on species that occur in tropical Australia. Then, using survey results, this study considers the hypothesis that the public’s relative support for the conservation of different bird species depends on its comparative knowledge of their existence and status. Based on experimental results from a sample of residents of Brisbane, Queensland (Australia), it is found that their knowledge of bird species that occur exclusively in the Australian tropics (including tropical Queensland) is very poor compared to those that also occur in the Brisbane area and are relatively common. Experimental results indicate that when respondents in the sample had an option to allocate $1,000 between ten bird species listed in the survey, it resulted in a greater allocation of funds to the better known and more common species than when they were provided with balanced information about all the selected species. With balanced information the average allocation to bird species confined mostly to the Australian tropics, particularly those threatened or endangered, increased. The general consequences of this for policies for the conservation of birds are discussed.

Individual and household willingness to pay for public goods

The issue of whether willingness to pay (WTP) for the benefits generated by a public good should be elicited on an individual or on a household basis is addressed. Differences between individual and household WTP may arise when members of the household are mutually altruistic. It is shown that, for general specifications of altruism, household WTP is less than the sum of household members' individual WTP. Implications for the choice between household and individual measures of WTP are considered, and issues in the elicitation of household WTP are addressed.

Willingness to pay for conservation of the Asian elephant in Sri Lanka: A contingent valuation study

Results from a CVM survey of willingness to pay for the conservation of the Asian elephant of a sample of urban residents in three selected housing schemes in Colombo, the capital of Sri Lanka, are reported. Face– to–face surveys were conducted using an interview schedule. A non-linear logit regression model was constructed to analyse the respondents’ responses for the payment principle questions and to identify the factors that influence their responses. We investigate whether urban residents’ WTP for the conservation of elephants is sufficient to compensate farmers for the damage caused by elephants, and consequently to raise farmers’ tolerance of the presence of elephants on the farming fields. We find that beneficiaries (the urban residents) could compensate losers (the farmers in the HEC affected areas) and be better off than in the absence of elephants in Sri Lanka. This suggests that there is a strong economic case for the conservation of the wild elephant population in Sri Lanka. However, we have insufficient data to determine Sri Lanka’s optimal elephant population in the Kaldor-Hicks sense.

Willingness to pay for different degrees of abundance of elephants

This paper presents an application of the contingent valuation method (CVM) to determine how the willingness to pay (WTP) for conservation of Asian elephants varies with hypothetical variations in their population. Results from a CVM survey of a sample of urban residents in Colombo, the capital of Sri Lanka are used for this purpose. We find, consistent with the basic principles of consumer demand theory, the marginal change in the respondents’ WTP amounts is positive but appears to diminish in parallel to the increases in the current wild elephant population (CWEP). In contrast to theoretical expectations, however, we find that the WTP for preserving this species increases at an increasing rate in relation to decreases in the CWEP. This is probably because respondents perceive that extinction becomes more imminent as the abundance of the elephant is reduced and therefore it becomes more urgent to act. However, this adds a new complication to the interpretation of the WTP findings.