This study sought to contribute to the existing literature on pandemic influenza vaccination studies by providing additional evidences of households' willingness to pay (WTP) for protection against influenza during a pandemic situation from North America.
A standard dichotomous-choice contingent valuation survey was designed and completed in a sample of 306 individuals living in the Greater Toronto Area, Ontario, Canada.
This study shows that, on average, households are willing to pay $417.35 for immediate pandemic influenza (H1N1) vaccination. Results show that the vaccine price, age, gender, occupation, organisation, annual family income, receiving annual flu shot, having additional insurance, having someone with a serious illness in the house, knowledge about pandemics, trusting official information on pandemics, supporting government expenditure, and rating government pandemic planning have significant effects on the decision to accept the vaccine bids.
The results reconfirm the findings of similar studies that influenza vaccine programmes are highly cost-effective despite the high programme cost, because people's WTP (benefits) for this programme is much higher than the actual costs. Pandemic influenza vaccination programmes should consider the demographic and economic status of the target population as such characteristics have significant impacts on the benefits that people place on such programmes.
[Show abstract][Hide abstract] ABSTRACT: Decisions on how to mitigate an evolving pandemic are technically challenging. We present a real-time assessment of the effectiveness and cost-effectiveness of alternative influenza A/H1N1v vaccination strategies. A transmission dynamic model was fitted to the estimated number of cases in real-time, and used to generate plausible autumn scenarios under different vaccination options. The proportion of these cases by age and risk group leading to primary care consultations, National Pandemic Flu Service consultations, emergency attendances, hospitalisations, intensive care and death was then estimated using existing data from the pandemic. The real-time model suggests that the epidemic will peak in early November, with the peak height being similar in magnitude to the summer wave. Vaccination of the high-risk groups is estimated to prevent about 45 deaths (80% credibility interval 26-67), and save around 2900 QALYs (80% credibility interval 1600-4500). Such a programme is very likely to be cost-effective if the cost of vaccine purchase itself is treated as a sunk cost. Extending vaccination to low-risk individuals is expected to result in more modest gains in deaths and QALYs averted. Extending vaccination to school-age children would be the most cost-effective extension. The early availability of vaccines is crucial in determining the impact of such extensions. There have been a considerable number of cases of H1N1v in England, and so the benefits of vaccination to mitigate the ongoing autumn wave are limited. However, certain groups appear to be at significantly higher risk of complications and deaths, and so it appears both effective and cost-effective to vaccinate them. The United Kingdom was the first country to have a major epidemic in Europe. In countries where the epidemic is not so far advanced vaccination of children may be cost-effective. Similar, detailed, real-time modelling and economic studies could help to clarify the situation.
[Show abstract][Hide abstract] ABSTRACT: To compare four contingent valuation elicitation methods as a means to estimate the value of a pneumococcal vaccine in Bangladesh and to test if the elicitation methods are subject to bias and if they produce valid responses.
Three hundred sixty-one households with at least one child under 5 years of age were recruited in Dhaka, Bangladesh. Subjects were cluster-randomized to various elicitation methods: open-ended, dichotomous choice (at one of two asking prices), payment card (one of two cards with differing ranges). The dichotomous choice method was then followed up with a bidding game methodology, with the dichotomous choice price acting as the starting price for the bidding game. Analysis focused on summary statistics, demand curve estimation and multivariate regression analysis to test for validity and bias.
Thirty-one households refused to participate, leaving a total of 330 participating households (a 91.4 percent response rate). Willingness to pay estimates varied significantly across the methods (p < .001), with average estimates varying between $2.34 and $18 (US). The open-ended elicitation method was found to produce highly inflated values that were insensitive to construct validity tests. The dichotomous choice method produced quantity (demand) estimates rather than value estimates, and there was some evidence of yea-saying. The payment card elicitation method was found to be affected by range bias. The bidding game elicitation method was found to be less sensitive to starting point bias and yea-saying.
Different elicitation format do give rise to different demand curves; however, this may be partially due to the fact that they do not measure the same outcome. For example, the dichotomous choice format produces a demand curve, while the payment card, open-ended and bidding game produce inverse demand curves. All formats are prone to multiple biases. When choosing an elicitation format, it is important to first consider the purpose and use of the data. Each elicitation method has strengths and weaknesses and can be used for different purposes in technology assessment.
International Journal of Technology Assessment in Health Care 02/2008; 24(4):481-7. DOI:10.1017/S026646230808063X · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Contingent valuation (CV) is a survey-based method frequently used for placing monetary values on environmental goods and services not bought and sold in the marketplace. CV is usually the only feasible method for including passive use considerations in an economic analysis, a practice that has engendered considerable controversy. The issue of what a CV study tries to value is first addressed from the perspective of a policymaker and then the controversy over the inclusion of passive use is taken up in more detail. The major issues and positions taken in the technical debate over the use of CV are summarized from a user's perspective. Key design and implementation issues involved in undertaking a CV survey are examined and the reader is provided with a set of factors to examine in assessing the quality of a CV study.
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