What consumers think, do and say about antibiotic use

Objective The objectives of this study were to investigate (1) the attitudes and behaviours of Australian consumers in antibiotic use, and (2) their understanding of antibiotic resistance. Methods Semi-structured interviews were conducted with consumers in May/June 2015. Convenience sampling was used to recruit consumers between 18–54 years old. Thirty-two consumers were interviewed. Transcripts were analysed to identify themes. Lessons Learned Dominant themes for attitudes and behaviours regarding antibiotics were (a) avoidance of antibiotic use unless clinically warranted; (b) antibiotics were useful but “weakened the body”; and (c) use of complementary medicines as adjuncts to antibiotics or to strengthen the immune system. Key information needs were (a) unambiguous instructions from GPs when prescribed antibiotics, to avoid inappropriate medicine-taking behaviour; (b) rationale for antibiotic selection; and (c) treatment duration. Antibiotic resistance was conceptualised in three ways: as a property of the body (body becomes resistant to antibiotics); the medication (antibiotic no longer effective); and the bacteria (bacteria is resistant). Antibiotic resistance was perceived as an issue that would only affect the wider community in the future, although most recognised that it is a current challenge for hospitals. Personal good health and/or avoidance of antibiotics were perceived as insurance against being adversely affected by antibiotic resistance. Implications A structured survey (discrete choice experiment) will be developed from these findings to investigate how consumers trade-off on factors influencing antibiotic use. Public health campaigns promoting conservation of antibiotics can benefit from these findings.

Valuing maternity care: a comparison of stated preference methods with an application to cost-benefit analysis

This research investigates whether a reconfiguration of maternity services, which collocates consultant- and midwifery-led care, reflects demand and value for money in Ireland. Qualitative and quantitative research is undertaken to investigate demand and an economic evaluation is performed to evaluate the costs and benefits of the different models of care. Qualitative research is undertaken to identify women’s motivations when choosing place of delivery. These data are further used to inform two stated preference techniques: a discrete choice experiment (DCE) and contingent valuation method (CVM). These are employed to identify women’s strengths of preferences for different features of care (DCE) and estimate women’s willingness to pay for maternity care (CVM), which is used to inform a cost-benefit analysis (CBA) on consultant- and midwifery-led care. The qualitative research suggests women do not have a clear preference for consultant or midwifery-led care, but rather a hybrid model of care which closely resembles the Domiciliary Care In and Out of Hospital (DOMINO) scheme. Women’s primary concern during care is safety, meaning women would only utilise midwifery-led care when co-located with consultant-led care. The DCE also finds women’s preferred package of care closely mirrors the DOMINO scheme with 39% of women expected to utilise this service. Consultant- and midwifery-led care would then be utilised by 34% and 27% of women, respectively. The CVM supports this hierarchy of preferences where consultant-led care is consistently valued more than midwifery-led care – women are willing to pay €956.03 for consultant-led care and €808.33 for midwifery-led care. A package of care for a woman availing of consultant- and midwifery-led care is estimated to cost €1,102.72 and €682.49, respectively. The CBA suggests both models of care are cost-beneficial and should be pursued in Ireland. This reconfiguration of maternity services would maximise women’s utility, while fulfilling important objectives of key government policy.

Do You Want to Hear the Bad News? The Value of Diagnostic Tests for Alzheimer's Disease.

OBJECTIVE: The diagnosis of Alzheimer's disease (AD) remains difficult. Lack of diagnostic certainty or possible distress related to a positive result from diagnostic testing could limit the application of new testing technologies. The objective of this paper is to quantify respondents' preferences for obtaining AD diagnostic tests and to estimate the perceived value of AD test information. METHODS: Discrete-choice experiment and contingent-valuation questions were administered to respondents in Germany and the United Kingdom. Choice data were analyzed by using random-parameters logit. A probit model characterized respondents who were not willing to take a test. RESULTS: Most respondents indicated a positive value for AD diagnostic test information. Respondents who indicated an interest in testing preferred brain imaging without the use of radioactive markers. German respondents had relatively lower money-equivalent values for test features compared with respondents in the United Kingdom. CONCLUSIONS: Respondents preferred less invasive diagnostic procedures and tests with higher accuracy and expressed a willingness to pay up to €700 to receive a less invasive test with the highest accuracy.

Valuing conservation benefits of an offshore marine protected area

Increasing anthropogenic pressure in the offshore marine environment highlights the need for improved management and conservation of offshore ecosystems. This study scrutinises the applicability of a discrete choice experiment to value the expected benefits arising from the conservation of an offshore sandbank in UK waters. The valuation scenario refers to the UK part of the Dogger Bank, in the southern North Sea, and is based on real-world management options for fisheries, wind farms and marine protection currently under discussion for the site. It is assessed to what extent the general public perceive and value conservation benefits arising from an offshore marine protected area. The survey reveals support for marine conservation measures despite the general public’s limited prior knowledge of current marine planning. Results further show significant values for an increase in species diversity, the protection of certain charismatic species and a restriction in the spread of invasive species across the site. Implications for policy and management with respect to commercial fishing, wind farm construction and nature conservation are discussed.

Valuation of ecological and amenity impacts of an offshore windfarm as a factor in marine planning

Integrated marine planning, which must take into consideration environmental and social impacts, is being introduced widely in Europe, the USA, Australia and elsewhere. Installation of offshore windfarms creates impacts both on local marine ecosystems and the view of the seascape and is one of multiple activities in the marine area that must be addressed by marine planning. The impacts on people's values (and hence welfare) of changes in ecology and amenity that could arise from the installation of a windfarm in the Irish Sea were assessed using a discrete choice experiment administered through an online survey. The ecological changes investigated were: increased species diversity resulting from artificial reef effects, and the effect of electromagnetic fields from subsea cables on marine life; whilst the amenity change was the visibility of offshore turbines from land. Respondents expressed preferences for ecological improvements but had less clear preferences regarding the height and visibility of the turbines. In particular distance decay effects were observed with respondents further away from the coast being less concerned about visual impact created by offshore turbines. Understanding ecological and amenity impacts and how they are valued by people can support the decisions made within marine planning and licensing.

Assessing non-market benefits of seagrass restoration in the Gulf of Gdańsk

Seagrass meadows (Zostera marina) are an important ecosystem in the coastal environment of the Baltic Sea. This study employs a discrete choice experiment to value a set of non-market benefits provided by seagrass meadows in the Gulf of Gdańsk, Poland. The benefits valued in this study are a reduction of filamentous algae in the water and on the beach; access to seagrass meadows for boaters and divers; and improved water clarity. Results show significant willingness to pay for each attribute and differences of value estimates across different groups of survey respondents. It is discussed how to link choice attributes and estimated values with established ecosystem benefit categories in order to facilitate value transfer.

Willingness to Pay for Rural Landscape Improvements: Combining Mixed Logit and Random-Effects Models

This paper reports the findings from a discrete-choice experiment designed to estimate the economic benefits associated with rural landscape improvements in Ireland. Using a mixed logit model, the panel nature of the dataset is exploited to retrieve willingness-to-pay values for every individual in the sample. This departs from customary approaches in which the willingness-to-pay estimates are normally expressed as measures of central tendency of an a priori distribution. Random-effects models for panel data are subsequently used to identify the determinants of the individual-specific willingness-to-pay estimates. In comparison with the standard methods used to incorporate individual-specific variables into the analysis of discrete-choice experiments, the analytical approach outlined in this paper is shown to add considerable explanatory power to the welfare estimates.

The role of regret minimisation in lifestyle choices affecting the risk of coronary heart disease

This paper introduces the discrete choice model-paradigm of Random Regret Minimisation (RRM) to the field of health economics. The RRM is a regret-based model that explores a driver of choice different from the traditional utility-based Random Utility Maximisation (RUM). The RRM approach is based on the idea that, when choosing, individuals aim to minimise their regret–regret being defined as what one experiences when a non-chosen alternative in a choice set performs better than a chosen one in relation to one or more attributes. Analysing data from a discrete choice experiment on diet, physical activity and risk of a fatal heart attack in the next ten years administered to a sample of the Northern Ireland population, we find that the combined use of RUM and RRM models offer additional information, providing useful behavioural insights for better informed policy appraisal.

Trading off dietary choices, physical exercise and cardiovascular disease risks

Despite several decades of decline, cardiovascular diseases are still the most common causes of death in Western societies. Sedentary living and high fat diets contribute to the prevalence of cardiovascular diseases. This paper analyses the trade-offs between lifestyle choices defined in terms of diet, physical activity, cost, and risk of cardiovascular disease that a representative sample of the population of Northern Ireland aged 40-65 are willing to make. Using computer assisted personal interviews, we survey 493 individuals at their homes using a Discrete Choice Experiment (DCE) questionnaire administered between February and July 2011 in Northern Ireland. Unlike most DCE studies for valuing public health programs, this questionnaire uses a tailored exercise, based on the individuals’ baseline choices. A “fat screener” module in the questionnaire links personal cardiovascular disease risk to each specific choice set in terms of dietary constituents. Individuals are informed about their real status quo risk of a fatal cardiovascular event, based on an initial set of health questions. Thus, actual risks, real diet and exercise choices are the elements that constitute the choice task. Our results show that our respondents are willing to pay for reducing mortality risk and, more importantly, are willing to change physical exercise and dietary behaviours. In particular, we find that to improve their lifestyles, overweight and obese people would be more likely to do more physical activity than to change their diets. Therefore, public policies aimed to target obesity and its related illnesses in Northern Ireland should invest public money in promoting physical activity rather than healthier diets.

The value of water quality improvements in the region Berlin-Brandenburg as a function of distance and state residency

This study uses a discrete choice experiment (DCE) to elicit willingness to pay estimates for changes in the water quality of three rivers. As many regions the metropolitan region Berlin-Brandenburg struggles to achieve the objectives of the Water Framework Directive until 2015. A major problem is the high load of nutrients. As the region is part of two states (Länder) and the river sections are common throughout the whole region we account for the spatial context twofold. Firstly, we incorporate the distance between each respondent and all river stretches in all MNL and RPL models, and, secondly, we consider whether respondents reside in the state of Berlin or Brandenburg. The compensating variation (CV) calculated for various scenarios shows that overall people would significantly benefit from improved water quality. The CV measures, however, also reveal that not considering the spatial context would result in severely biased welfare measures. While the distance decay effect lowers CV, state residency is connected to the frequency of status quo choices and not accounting for residency would underestimate possible welfare gains in one state. Another finding is that the extent of the market varies with respect to attributes (river stretches) and attribute levels (water quality levels).

Méthode pour l’établissement d’une liste de médicaments remboursables dans le cadre du nouveau programme d’assurance-médicaments en Côte d’Ivoire

Contexte général La Côte d'Ivoire est un pays de l’Afrique de l’Ouest qui a décidé, depuis 2001, d'étendre la couverture des prestations de santé à toute sa population. En effet, cette réforme du système de santé avait pour but de fournir, à chaque ivoirien, une couverture médicale et pharmaceutique. Toutefois, la mise en œuvre de cette réforme était difficile car, contrairement aux pays développés, les pays en développement ont un secteur « informel » échappant à la législation du travail et occupant une place importante. En conséquence, il a été recommandé qu’il y ait deux caisses d'assurance santé, une pour le secteur formel (fonctionnaires) et l'autre pour le secteur informel. Ces caisses auraient légitimité en ce qui a trait aux décisions de remboursement de médicaments. D’ores-et-déjà, il existe une mutuelle de santé appelée la Mutuelle Générale des Fonctionnaires et Agents de l'État de Côte d'Ivoire (MUGEFCI), chargée de couvrir les frais médicaux et pharmaceutiques des fonctionnaires et agents de l’Etat. Celle-ci connaît, depuis quelques années, des contraintes budgétaires. De plus, le processus actuel de remboursement des médicaments, dans cette organisation, ne prend pas en considération les valeurs implicites liées aux critères d'inscription au formulaire. Pour toutes ces raisons, la MUGEFCI souhaite se doter d’une nouvelle liste de médicaments remboursables, qui comprendrait des médicaments sécuritaires avec un impact majeur sur la santé (service médical rendu), à un coût raisonnable. Dans le cadre de cette recherche, nous avons développé une méthode de sélection des médicaments pour des fins de remboursement, dans un contexte de pays à faibles revenus. Cette approche a ensuite été appliquée dans le cadre de l’élaboration d’une nouvelle liste de médicaments remboursables pour la MUGEFCI. Méthode La méthode de sélection des médicaments remboursables, développée dans le cadre de cette recherche, est basée sur l'Analyse de Décision Multicritère (ADM). Elle s’articule autour de quatre étapes: (1) l'identification et la pondération des critères pertinents d'inscription des médicaments au formulaire (combinant revue de la littérature et recherche qualitative, suivies par la réalisation d’une expérience de choix discrets); (2) la détermination d'un ensemble de traitements qui sont éligibles à un remboursement prioritaire; (3) l’attribution de scores aux traitements selon leurs performances sur les niveaux de variation de chaque critère, et (4) le classement des traitements par ordre de priorité de remboursement (classement des traitements selon un score global, obtenu après avoir additionné les scores pondérés des traitements). Après avoir défini la liste des médicaments remboursables en priorité, une analyse d’impact budgétaire a été réalisée. Celle-ci a été effectuée afin de déterminer le coût par patient lié à l'utilisation des médicaments figurant sur la liste, selon la perspective de la MUGEFCI. L’horizon temporel était de 1 an et l'analyse portait sur tous les traitements admissibles à un remboursement prioritaire par la MUGEFCI. En ce qui concerne la population cible, elle était composée de personnes assurées par la MUGEFCI et ayant un diagnostic positif de maladie prioritaire en 2008. Les coûts considérés incluaient ceux des consultations médicales, des tests de laboratoire et des médicaments. Le coût par patient, résultant de l'utilisation des médicaments figurant sur la liste, a ensuite été comparé à la part des dépenses par habitant (per capita) allouée à la santé en Côte d’Ivoire. Cette comparaison a été effectuée pour déterminer un seuil en deçà duquel la nouvelle liste des médicaments remboursables en priorité était abordable pour la MUGEFCI. Résultats Selon les résultats de l’expérience de choix discrets, réalisée auprès de professionnels de la santé en Côte d'Ivoire, le rapport coût-efficacité et la sévérité de la maladie sont les critères les plus importants pour le remboursement prioritaire des médicaments. Cela se traduit par une préférence générale pour les antipaludiques, les traitements pour l'asthme et les antibiotiques indiqués pour les infections urinaires. En outre, les résultats de l’analyse d’impact budgétaire suggèrent que le coût par patient lié à l'utilisation des médicaments figurant sur la liste varierait entre 40 et 160 dollars américains. Etant donné que la part des dépenses par habitant allouées à la santé en Côte d’Ivoire est de 66 dollars américains, l’on pourrait conclure que la nouvelle liste de médicaments remboursables serait abordable lorsque l'impact économique réel de l’utilisation des médicaments par patient est en deçà de ces 66 dollars américains. Au delà de ce seuil, la MUGEFCI devra sélectionner les médicaments remboursables en fonction de leur rang ainsi que le coût par patient associé à l’utilisation des médicaments. Plus précisément, cette sélection commencera à partir des traitements dans le haut de la liste de médicaments prioritaires et prendra fin lorsque les 66 dollars américains seront épuisés. Conclusion Cette étude fait la démonstration de ce qu’il est possible d'utiliser l’analyse de décision multicritère pour développer un formulaire pour les pays à faibles revenus, la Côte d’Ivoire en l’occurrence. L'application de cette méthode est un pas en avant vers la transparence dans l'élaboration des politiques de santé dans les pays en développement.

Social responsibility as a tool for destination competitiveness

Máster en Economía del Turismo, Transporte y Medio Ambiente

Analisi delle preferenze per le diverse categorie di pomodoro trasformato nel food service

Il pomodoro è una delle colture principali del panorama agro-alimentare italiano e rappresenta un ingrediente base della tradizione culinaria nazionale. Il pomodoro lavorato dall’industria conserviera può essere trasformato in diverse tipologie merceologiche, che si differenziano in base alla tecniche di lavorazione impiegate ed alle caratteristiche del prodotto finito. la percentuale di spesa totale destinata all’acquisto di cibo fuori casa è in aumento a livello globale e l’interesse dell’industria alimentare nei confronti di questo canale di vendita è quindi crescente. Mentre sono numerose le indagine in letteratura che studiano i processi di acquisto dei consumatori finali, non ci sono evidenze di studi simili condotti sugli operatori del Food Service. Obiettivo principale della ricerca è quello di valutare le preferenze dei responsabili acquisti del settore Food Service per diverse tipologie di pomodoro trasformato, in relazione ad una gamma di attributi rilevanti del prodotto e di caratteristiche del cliente. La raccolta dei dati è avvenuta attraverso un esperimento di scelta ipotetico realizzato in Italia e alcuni mercati esteri. Dai risultati ottenuti dall’indagine emerge che i Pelati sono la categoria di pomodoro trasformato preferita dai responsabili degli acquisti del settore Food Service intervistati, con il 35% delle preferenze dichiarate nell'insieme dei contesti di scelta proposti, seguita dalla Polpa (25%), dalla Passata (20%) e dal Concentrato (15%). Dai risultati ottenuti dalla stima del modello econometrico Logit a parametri randomizzati è emerso che alcuni attributi qualitativi di fiducia (credence), spesso impiegati nelle strategie di differenziazione e posizionamento da parte dell’industria alimentare nel mercato Retail, possono rivestire un ruolo importante anche nell’influenzare le preferenze degli operatori del Food Service. Questo potrebbe quindi essere un interessante filone di ricerca da sviluppare nel futuro, possibilmente con l'impiego congiunto di metodologie di analisi basate su esperimenti di scelta ipotetici e non ipotetici.

Is less more? Patients' preferences for drug information leaflets

Present package information leaflets do not fulfil the needs of many patients. The objective of this study was to investigate patients' preferences towards content and presentation of drug information leaflets using prepared medication brochures in a discrete choice experiment.

Dangers of ‘Facebook Login’ for Mobile Apps: Is There a Price Tag for Social Information?

Social networks offer horizontal integration for any mobile platform providing app users with a convenient single sign-on point. Nonetheless, there are growing privacy concerns regarding its use. These vulnerabilities trigger alarm among app developers who fight for their user base: While they are happy to act on users’ information collected via social networks, they are not always willing to sacrifice their adoption rate for this goal. So far, understanding of this trade-off has remained ambiguous. To fill this gap, we employ a discrete choice experiment to explore the role of Facebook Login and investigate the impact of accompanying requests for different information items / actions in the mobile app adoption process. We quantify users’ concerns regarding these items in monetary terms. Beyond hands-on insights for providers, our study contributes to the theoretical discourse on the value of privacy in the growing world of Social Media and mobile web.