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1.
Proc Natl Acad Sci U S A ; 120(18): e2217456120, 2023 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-37094166

RESUMO

Improvements to the quality of freshwater rivers and lakes can generate a wide array of benefits, from "use values" such as recreational boating, fishing, and swimming to "nonuse values" such as improved outcomes for aquatic biodiversity. Bringing these nonmarket values into decision-making is crucial to determining appropriate levels of investment in water quality improvements. However, progress in the economic valuation of water quality benefits has lagged similar efforts to value air quality benefits, with implications for water policy. New data sources, modeling techniques, and innovation in stated preference survey methods offer notable improvements to estimates of use and nonuse benefits of improved water quality. Here, we provide a perspective on how recent applications of stated preference techniques to the valuation of the nonmarket benefits of water quality improvements have advanced the field of environmental valuation. This overview is structured around four key questions: i) What is it about water quality that we seek to value? ii) How should we design and implement the surveys which elicit individuals' stated preferences? iii) How do we assess the validity of the findings provided by such studies? and iv) What are the contributions of these valuation exercises to public policy? In answering these questions, we make reference to the contributions provided by the papers in this Symposium.


Assuntos
Biodiversidade , Melhoria de Qualidade , Humanos , Lagos , Qualidade da Água , Inquéritos e Questionários
2.
Proc Natl Acad Sci U S A ; 120(18): e2120252120, 2023 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-37094134

RESUMO

Streams in urbanizing watersheds are threatened by economic development that can lead to excessive sediment erosion and surface runoff. These anthropogenic stressors diminish valuable ecosystem services and result in pervasive degradation commonly referred to as "urban stream syndrome." Understanding how the public perceives and values improvements in stream conditions is necessary to support efforts to quantify the economic benefits of water quality improvements. We develop an ecological production framework that translates measurable indicators of stream water quality into ecological endpoints. Our interdisciplinary approach integrates a predictive hierarchical water quality model that is well suited for sparse data environments, an expert elicitation that translates measurable water quality indicators into ecological endpoints that focus group participants identified as most relevant, and a stated preference survey that elicits the public's willingness to pay for changes in these endpoints. To illustrate our methods, we develop an application to the Upper Neuse River Watershed located in the rapidly developing Triangle region of North Carolina (the United States). Our results suggest, for example, that residents are willing to pay roughly $127 per household and $54 million per year in aggregate (2021 US$) for water quality improvements resulting from a stylized intervention that increases stream bank canopy cover by 25% and decreases runoff from impervious surfaces, leading to improvements in water quality and ecological endpoints for local streams. Although the three components of our analysis are conducted with data from North Carolina, we discuss how our findings are generalizable to urban and urbanizing areas across the larger Piedmont ecoregion of the Eastern United States.

3.
Proc Natl Acad Sci U S A ; 120(18): e2120259119, 2023 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-37094141

RESUMO

The US Environmental Protection Agency (EPA) uses a water quality index (WQI) to estimate benefits of proposed Clean Water Act regulations. The WQI is relevant to human use value, such as recreation, but may not fully capture aspects of nonuse value, such as existence value. Here, we identify an index of biological integrity to supplement the WQI in a forthcoming national stated preference survey that seeks to capture existence value of streams and lakes more accurately within the conterminous United States (CONUS). We used literature and focus group research to evaluate aquatic indices regularly reported by the EPA's National Aquatic Resource Surveys. We chose an index that quantifies loss in biodiversity as the observed-to-expected (O/E) ratio of taxonomic composition because focus group participants easily understood its meaning and the environmental changes that would result in incremental improvements. However, available datasets of this index do not provide the spatial coverage to account for how conditions near survey respondents affect their willingness to pay for its improvement. Therefore, we modeled and interpolated the values of this index from sampled sites to 1.1 million stream segments and 297,071 lakes across the CONUS to provide the required coverage. The models explained 13 to 36% of the variation in O/E scores and demonstrate how modeling can provide data at the required density for benefits estimation. We close by discussing future work to improve performance of the models and to link biological condition with water quality and habitat models that will allow us to forecast changes resulting from regulatory options.


Assuntos
Biodiversidade , Ecossistema , Estados Unidos , Humanos , Qualidade da Água , Rios , Lagos , Monitoramento Ambiental/métodos
4.
Future Oncol ; 20(28): 2059-2070, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38861284

RESUMO

Aim: Patient preferences for the features of targeted chronic lymphocytic leukemia (CLL) therapies may differ.Materials & methods: A discrete-choice experiment (DCE) survey was administered to 229 respondents recruited through the CLL Society.Results: Respondents placed most importance on increasing the chance of progression-free survival (PFS) at 2 years from 70 to 90% and confirming results with measurable residual disease (MRD) testing instead of routine testing. Respondents also preferred daily oral administration over intravenous infusion every 4 weeks, fixed-duration treatments over treat-to-progression treatments and treatments with lower side effect risks. Reducing risk of tumor lysis syndrome was least important relative to changes in other attributes.Conclusion: The combination of improving PFS combined with confirming results using MRD testing was more important than changes in all other study attributes included in the DCE. Results from this study can help inform shared decision-making when selecting therapies for CLL.


Several targeted treatments are available for people with chronic lymphocytic leukemia (CLL). These treatments target specific proteins present in CLL cancer cells. They differ in how long they keep cancer from progressing, how the results are measured and the side effects they cause. Some targeted CLL treatments are taken as a daily pill, and others are given by intravenous infusion. Some targeted treatments are given for a fixed amount of time, and others are given until CLL progresses. We surveyed 229 US patients with CLL to understand what features they most value in a targeted CLL treatment. Survey participants were recruited through the CLL Society, a nonprofit organization devoted to education, support, advocacy and research for the CLL community. Survey results indicated that participants placed the most importance on increasing the chance that the cancer would not progress after 2 years from 70 to 90% and confirming results with measurable residual disease testing (which can detect minute levels of leukemia cells) instead of routine testing. Participants also preferred taking a pill every day over receiving an intravenous infusion every 4 weeks and preferred treatments given for a fixed amount of time over treatments given until CLL progresses. Participants preferred treatments with lower chances of tumor lysis syndrome (a potentially organ-damaging condition that may result following treatment), irregular heartbeat and fatigue. It is important for doctors to understand the treatment features that matter to people living with CLL so that they can work with patients individually to choose the right treatment.


Assuntos
Leucemia Linfocítica Crônica de Células B , Preferência do Paciente , Humanos , Leucemia Linfocítica Crônica de Células B/terapia , Leucemia Linfocítica Crônica de Células B/diagnóstico , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Leucemia Linfocítica Crônica de Células B/mortalidade , Leucemia Linfocítica Crônica de Células B/psicologia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Adulto , Comportamento de Escolha , Intervalo Livre de Progressão , Inquéritos e Questionários , Idoso de 80 Anos ou mais , Neoplasia Residual , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
5.
Health Econ ; 33(9): 1929-1935, 2024 09.
Artigo em Inglês | MEDLINE | ID: mdl-38831492

RESUMO

Values that accompany generic health measures are typically anchored at 1 = full health and 0 = dead. Some health states may then be considered 'worse than dead' (WTD) and assigned negative values, which causes fundamental measurement problems. In this paper, we challenge the assumption that anchoring values at 'dead = 0' is necessary for quality-adjusted life year (QALY) estimation. We summarise the role of 'dead' in health state valuation and consider three critical questions: (i) whether the measurement properties of health state values require 'dead'; (ii) whether 'dead' needs to be valued relative to health states; and (iii) whether values for states WTD are meaningful or useful. We conclude that anchoring 0 at dead is not a requirement of health status measurement or cost-effectiveness analysis. This results from reframing QALYs as the relevant unit of measurement and reframing values as being derived from QALYs rather than the reverse.


Assuntos
Análise Custo-Benefício , Nível de Saúde , Anos de Vida Ajustados por Qualidade de Vida , Humanos , Qualidade de Vida
6.
J Asthma ; : 1-13, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39007899

RESUMO

OBJECTIVES: To estimate the preferences of patients with asthma and asthma-treating clinicians for attributes of biologic treatments, to compare patients' and clinicians' preferences, and to better understand the reasons for their preferences. METHODS: Adults with moderate-to-severe asthma and clinicians who treat asthma in the US completed a cross-sectional, online survey including a discrete choice experiment (DCE) that consisted of seven attributes spanning treatment efficacy, risk and convenience. Marginal utilities were estimated using a mixed logit model, and relative attribute importance scores calculated. Clinicians were also asked about the value of biomarker agnostic biologic treatments. The survey was followed by qualitative interviews targeting a sub-sample of survey participants, in which the rationale behind their survey responses was discussed. RESULTS: In the DCE, both patients and clinicians placed the most importance on exacerbation and hospitalization rate reduction, and risk of injection site reaction. Patients valued location of administration more than clinicians. Rationale for individual-level preferences varied, with patients and clinicians reporting their preference depended on event frequency and anticipated quality of life impacts. Clinicians mentioned compliance and financial impacts, while patients mentioned personal experience, particularly around site reactions. Most patients and clinicians would value a biomarker agnostic asthma treatment. CONCLUSIONS: Asthma treatment preferences are largely driven by treatment efficacy and minimizing the risk of site reactions, although preferences differ between patients and clinicians across other attributes, highlighting the need for shared decision-making and individualized care.

7.
J Environ Manage ; 351: 119821, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38169265

RESUMO

Offshore wind development is in its nascent stages in the United States. Recent research indicates that the visual impacts of offshore wind farms are viewed negatively by the general population. This North Carolina application is the first US-focused discrete choice experiment that explicitly asks respondents to consider the positive local and global benefits from offshore wind development, such as job creation and greenhouse gas emission reductions, simultaneously with their visual impacts. We find significant willingness to pay (WTP) for reducing the visual impacts of offshore wind farms, and that the extent of disamenity varies in the population and with placement along developed tourist towns (as much as $783/year for three years) or preserved coastlines (as much as $451/year for three years). We also find that some preference classes value projects that create permanent jobs and reduce carbon emissions. We use our estimates of preferences for the positive and negative attributes to explore specific wind farm configurations and locations that could achieve positive consensus in a heterogenous population.


Assuntos
Fontes Geradoras de Energia , Vento , Humanos , Estados Unidos , North Carolina , Fazendas
8.
Value Health ; 26(12): 1772-1781, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37741445

RESUMO

OBJECTIVES: This study aims to quantify the preferences of patients with advanced cancer for quality of life (QoL) outcomes versus survival extension in Malaysia. The secondary aim of this study is to explore the change in preferences over time. METHODS: A discrete choice experiment was developed to include 7 attributes valued in cancer management: physical, psychological and social functioning, pain control, survival, place of death, and cost. Patients were recruited via convenience sampling from 2 Malaysian public hospitals. The survey questionnaire was administered to patients within 6 months of their cancer diagnosis with a follow-up 3 months later. Conditional logit regression was used to estimate the preference weight, relative attribute importance, and willingness to pay. RESULTS: One hundred valid responses were collected at baseline and 45 at follow-up. Respondents placed higher values on QoL improvements from severe to moderate or mild levels and to achieve home death over survival extension from 6 to 18 months. However, additional improvements (from moderate to mild) in some of the QoL outcomes were not valued as highly as life extension from 12 to 18 months, showing that it was vital for patients to avoid being in "severe" health dysfunction. Improving physical dysfunction from severe to mild yielded 3 times as much value as additional 1-year survival. After 3 months, the respondents' preferences changed significantly, with increased relative attribute importance of physical functioning, pain control, and cost. CONCLUSIONS: As QoL outcomes are valued more than survival, palliative care should be introduced as early as possible to alleviate suffering related to advanced cancer.


Assuntos
Neoplasias , Qualidade de Vida , Humanos , Malásia , Inquéritos e Questionários , Neoplasias/terapia , Dor , Preferência do Paciente/psicologia , Comportamento de Escolha
9.
AIDS Behav ; 27(7): 2328-2359, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36809490

RESUMO

Stated preference (SP) methods are increasingly being applied to HIV-related research and continuously provide researchers with health utility scores of select healthcare products or services that populations consider important. Following PRISMA guidelines, we sought to understand how SP methods have been applied in HIV-related research. We conducted a systematic review to identify studies meeting the following criteria: SP method is clearly stated, conducted in the United States, was published between 01/01/2012 and 02/12/2022, and included adults aged 18 and over. Study design and SP method application were also examined. We identified six SP methods (e.g., Conjoint Analysis, Discrete Choice Experiment) across 18 studies, which were categorized into one of two groups: HIV prevention and HIV treatment-care. Categories of attributes used in SP methods largely focused on: administration, physical/health effects, financial, location, access, and external influences. SP methods are innovative tools capable of informing researchers on what populations consider most beneficial when deciding on treatment, care, or prevention options for HIV.


Assuntos
Infecções por HIV , Preferência do Paciente , Adulto , Humanos , Estados Unidos/epidemiologia , Adolescente , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Atenção à Saúde , Comportamento de Escolha , Pesquisa sobre Serviços de Saúde
10.
Gerodontology ; 2023 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-37309614

RESUMO

OBJECTIVES: To pilot an exploration of older adults' future preferences using discrete choice experiments to understand who should provide dental examinations and treatment, where these services should be provided, and participants' willingness to pay and willingness to travel. BACKGROUND: The proportion of older adults in the general population is increasing and is recognised as a pressing public health challenge. MATERIALS AND METHODS: Older people aged 65 years and over were recruited into this study from the UK, Switzerland and Greece. Drawing on earlier stakeholder engagement, a set of choice experiments are developed to explore the future preferences of older people for dental examinations and dental treatment, as they anticipated losing their independence. These were presented to the participants using a range of platforms, because of the COVID pandemic. Data were analysed in STATA using a random-effects logit model. RESULTS: Two hundred and forty-six participants (median age 70 years) completed the pilot study. There was a strong preference across all countries for a dentist to undertake a dental examination (Greece: ß = 0.944, Switzerland: ß = 0.260, UK ß = 0.791), rather than a medical doctor (Greece: ß = -0.556, Switzerland: ß = -0.4690, UK: ß = -0.468). Participants in Switzerland and the UK preferred these examinations to be undertaken in a dental practice (Switzerland: ß = 0.220, UK: ß = 0.580) while participants in Greece preferred the dental examination to be undertaken in their homes (ß = 1.172). Greek participants preferred dental treatment to be undertaken by a specialist (ß = 0.365) in their home (ß = 0.862), while participants from the UK and Switzerland preferred to avoid any dental treatment at home (Switzerland: ß = -0.387; UK: ß = -0.444). Willingness to pay analyses highlighted that participants in Switzerland and the UK were willing to pay more to ensure the continuity of future service provision at a family dental practice (Switzerland: ß = 0.454, UK: ß = 0.695). CONCLUSION: Discrete choice experiments are valuable for exploring older people's preferences for dental service provision in different countries. Future larger studies should be conducted to further explore the potential of this approach, given the pressing need to design services that are fit for purpose for older people. Continuity of dental service provision is considered as important by most older people, as they anticipate losing their dependence.

11.
Transp Res Rec ; 2677(6): 199-217, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38602969

RESUMO

The COVID-19 pandemic had a significant impact on travel mode choices in cities across the world. Driven by perceptions of risk and the fear of infection, the pandemic resulted in an increased preference for private vehicles and active modes and a reduced preference for public transit and ride-sourcing. As travel behavior and modal preferences evolve, a key question is whether the pandemic will result in long-term changes to travel mode choices. This study uses data from a web-based survey to examine the factors influencing mode choices for non-commuting trips in the post-pandemic era. Specifically, it uses stated preference data to develop a random parameter mixed logit model, which is used to compare the elasticity of key variables across different income and age groups. The results of the study highlight the influence of sociodemographic attributes and pre-pandemic travel habits on anticipated post-pandemic mode choices. Additionally, the results suggest that frequent users of private vehicles, public transit, and active modes are likely to continue to use these modes post-pandemic. Furthermore, the results highlight the potential for the perception of shared modes to influence post-pandemic mode choice decisions. The results of the study offer insights into policy measures that could be applied to address the increased use of private vehicles and reduced use of transit during the pandemic, while also emphasizing the need to ensure that certain segments of the population can maintain a sufficient level of mobility and access to transport.

12.
AIDS Behav ; 26(2): 328-338, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34304330

RESUMO

Community delivery of Antiretroviral therapy (ART) is a novel innovation to increase sustainable ART coverage for People living with HIV (PLHIV) in resource limited settings. Within a nested cluster-randomised sub-study in two urban communities that participated in the HPTN 071 (PopART) trial in Zambia we investigated individual acceptability and preferences for ART delivery models. Stable PLHIV were enrolled in a cluster-randomized trial of three different models of ART: Facility-based delivery (SoC), Home-based delivery (HBD) and Adherence clubs (AC). Consenting individuals were asked to express their stated preference for ART delivery options. Those assigned to the community models of ART delivery arms could choose ("revealed preference") between the assigned arm and facility-based delivery. In total 2489 (99.6%) eligible individuals consented to the study and 95.6% chose community models of ART delivery rather than facility-based delivery when offered a choice. When asked to state their preference of model of ART delivery, 67.6% did not state a preference of one model over another, 22.8% stated a preference for HBD, 5.0% and 4.6% stated a preference for AC and SoC, respectively. Offering PLHIV choices of community models of ART delivery is feasible and acceptable with majority expressing HBD as their stated preferred option.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Prevalência , Zâmbia/epidemiologia
13.
J Environ Manage ; 319: 115659, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35820310

RESUMO

While the imminent extinction of many species is predicted, prevention is expensive, and decision-makers often have to prioritise funding. In democracies, it can be argued that conservation using public funds should be influenced by the values placed on threatened species by the public, and that community views should also affect the conservation management approaches adopted. We conducted on online survey with 2400 respondents from the general Australian public to determine 1) the relative values placed on a diverse set of 12 threatened Australian animal species and 2) whether those values changed with the approach proposed to conserve them. The survey included a contingent valuation and a choice experiment. Three notable findings emerged: 1) respondents were willing to pay $60/year on average for a species (95% confidence interval: $23 to $105) to avoid extinction in the next 20 years based on the contingent valuation, and $29 to $100 based on the choice experiment, 2) respondents were willing to pay to reduce the impact of feral animals on almost all presented threatened species, 3) for few species and respondents, WTP was lower when genetic modification to reduce inbreeding in the remaining population was proposed.


Assuntos
Conservação dos Recursos Naturais , Espécies em Perigo de Extinção , Animais , Austrália , Inquéritos e Questionários
14.
J Environ Manage ; 320: 115724, 2022 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-35930877

RESUMO

Nature-based solutions may actively reduce hydro-meteorological risks in urban areas as a part of climate change adaptation. However, the main reason for the increasing uptake of this type of solution is their many benefits for the local inhabitants, including recreational value. Previous studies on recreational value focus on studies of existing nature sites that are often much larger than what is considered as new NBS for flood adaptation studies in urban areas. We thus prioritized studies with smaller areas and nature types suitable for urban flood adaptation and divided them into four common nature types for urban flood adaptation: sustainable urban drainage systems, city parks, nature areas and rivers. We identified 23 primary valuation studies, including both stated and revealed preference studies, and derived two value transfer functions based on meta-regression analysis on existing areas. We investigated trends between values and variables and found that for the purpose of planning of new NBS the size of NBS and population density were determining factors of recreational value. For existing NBS the maximum travelling distance may be included as well. We find that existing state-of-the-art studies overestimate the recreational with more than a factor of 4 for NBS sizes below 5 ha. Our results are valid in a European context for nature-based solutions below 250 ha and can be applied across different NBS types and sizes.


Assuntos
Mudança Climática , Inundações , Cidades , Meteorologia , Rios
15.
J Environ Manage ; 318: 115415, 2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-35752007

RESUMO

Green infrastructure (GI) has been gaining increasing attention due to its efficiency in controlling and purifying urban stormwater runoff, creating environmental amenities, and biodiversity conservation. Nevertheless, the existing knowledge of people's preferences for GI is not yet sufficient for evidence-based policymaking for enhancing GI. This study analyzes citizens' perceptions of the relative importance of six GI practices and estimates their willingness to pay (WTP) to enhance them. To this end, the study applies two types of stated preference methods (best-worst scaling and contingent valuation) to citizen survey data collected in Portland, Oregon. We found that GI practices that are more likely to lead to private benefits (e.g., rain barrels, urban trees) received relatively higher ratings, whereas the ratings of practices that do not offer such benefits (e.g., bioswales, rain gardens) were relatively lower. However, the diversity of preferences was large, as the relative importance varied widely among respondents. Heterogeneous preferences were also found in terms of citizens' WTP for hypothetical GI enhancement. Our comparison of uniform and variable payment schemes revealed that variable payment outperformed uniform payment because of the significant variation in citizens' WTP. The difference was large when the annual household payment was small.


Assuntos
Biodiversidade , Chuva , Jardins , Humanos , Oregon , Inquéritos e Questionários
16.
Value Health ; 24(10): 1531-1541, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34593177

RESUMO

OBJECTIVES: To systematically review studies eliciting monetary value of a statistical life (VSL) estimates within, and across, different sectors and other contexts; compare the reported estimates; and critically review the elicitation methods used. METHODS: In June 2019, we searched the following databases to identify methodological and empirical studies: Cochrane Library, Compendex, Embase, Environment Complete, Informit, ProQuest, PubMed, Scopus, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for reporting and a modified Consolidated Health Economic Evaluation Reporting Standards checklist to assess the quality of included studies. RESULTS: We identified 1455 studies, of which we included 120 in the systematic review. A stated-preference approach was used in 76 articles, with 51%, 41%, and 8% being contingent valuation studies, discrete-choice experiments, or both, respectively. A revealed-preference approach was used in 43 articles, of which 74% were based on compensating-wage differentials. The human capital approach was used in only 1 article. We assessed most publications (87%) as being of high quality. Estimates for VSL varied substantially by context (sector, developed/developing country, socio-economic status, etc), with the median of midpoint purchasing power parity-adjusted estimates of 2019 US$5.7 million ($6.8 million, $8.7 million, and $5.3 million for health, labor market, and transportation safety sectors, respectively). CONCLUSIONS: The large variation observed in published VSLs depends mainly on the context rather than the method used. We found higher median values for labor markets and developed countries. It is important that health economists and policymakers use context-specific VSL estimates. Methodological innovation and standardization are needed to maximize comparability of VSL estimates within, and across, sectors and methods.


Assuntos
Desejabilidade Social , Valor da Vida , Humanos
17.
AIDS Behav ; 25(10): 3074-3084, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33818643

RESUMO

Pre-exposure prophylaxis (PrEP) programs are planned for key populations in India. We examined PrEP awareness and willingness to use PrEP in order to support products and services for MSM. From December 2016 to March 2017, we conducted a survey and discrete choice experiment (DCE)-a technique to quantify the strength of participants' trade-off preferences among various product attributes-to assess willingness to use PrEP and related preferences. MSM were recruited from cruising sites and HIV prevention services in Mumbai and Chennai. DCE data were analyzed using mixed logit regression models and estimated marginal willingness-to-pay, the relative value participants' place on different PrEP attributes. Overall, 76.6% indicated willingness to use PrEP. Efficacy had the greatest effect on choice (high vs. moderate, aOR = 19.9; 95% CI 13.0-30.4), followed by dosing frequency (intermittent vs. daily regimen, aOR = 2.02; 95% CI 1.8-2.2). Participants preferred no (vs. minor) side-effects, subsidized (vs. market) price, and government (vs. private) hospitals. Findings suggest that educational and social marketing interventions should emphasize PrEP's high efficacy and minimal side effects, and programs should provide government-subsidized PrEP with choices of intermittent or daily dosing delivered by government and private hospitals/clinics in order to optimize PrEP uptake among MSM in India.


Assuntos
Infecções por HIV , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Índia , Masculino , Aceitação pelo Paciente de Cuidados de Saúde
18.
Health Econ ; 30(5): 923-931, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33569834

RESUMO

It is well established that the underlying theoretical assumptions needed to obtain a constant proportional trade-off between a quality adjusted life year (QALY) and willingness to pay (WTP) are restrictive and often empirically violated. In this paper, we set out to investigate whether the proportionality conditions (in terms of scope insensitivity and severity independence) can be satisfied when data is restricted to include only respondents who pass certain consistency criteria. We hypothesize that the more we restrict the data, the better the compliance with the requirement of constant proportional trade-off between WTP and QALY. We revisit the Danish data from the European Value of a QALY survey eliciting individual WTP for a QALY (WTP-Q). Using a "chained approach" respondents were first asked to value a specified health state using the standard gamble (SG) or the time-trade-off (TTO) approach and subsequently asked their WTP for QALY gains of 0.05 and 0.1 (tailored according to the respondent's SG/TTO valuation). Analyzing the impact of the different exclusion criteria on the two proportionality conditions, we find strong evidence against a constant WTP-Q. Restricting our data to include only respondents who pass the most stringent consistency criteria does not impact on the performance of the proportionality conditions for WTP-Q.


Assuntos
Financiamento Pessoal , Satisfação Pessoal , Análise Custo-Benefício , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Inquéritos e Questionários
19.
J Med Internet Res ; 23(10): e32365, 2021 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-34633290

RESUMO

Understanding the preferences of potential users of digital health products is beneficial for digital health policy and planning. Stated preference methods could help elicit individuals' preferences in the absence of observational data. A discrete choice experiment (DCE) is a commonly used stated preference method-a quantitative methodology that argues that individuals make trade-offs when engaging in a decision by choosing an alternative of a product or a service that offers the greatest utility, or benefit. This methodology is widely used in health economics in situations in which revealed preferences are difficult to collect but is much less used in the field of digital health. This paper outlines the stages involved in developing a DCE. As a case study, it uses the application of a DCE to reveal preferences in targeting the uptake of smoking cessation apps. It describes the establishment of attributes, the construction of choice tasks of 2 or more alternatives, and the development of the experimental design. This tutorial offers a guide for researchers with no prior knowledge of this research technique.


Assuntos
Comportamento de Escolha , Preferência do Paciente , Teorema de Bayes , Política de Saúde , Serviços de Saúde , Humanos
20.
J Environ Manage ; 293: 112831, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34082347

RESUMO

Recreational sea angling is a popular activity generating significant socio-economic benefits but can impact on fish stocks. The motivations of recreational sea anglers go beyond catch, with a diverse range of motivations relating to physical health and well-being. Heterogenous motives and the popularity of catch and release practices mean that applying commercial fisheries management goals (maximum sustainable yield) to recreational fisheries could result in reduced participation, increased non-compliance, and a subsequent loss of both market and non-market values generated through recreational angling activities. Hence, assessment of sea angler preferences for management is important for the development of appropriate management strategies. In this study, a choice experiment was conducted to assess sea anglers' preferences for changes in UK sea angling management measures. Stated preferences for catching, keeping, and releasing fish due to bag limits and minimum-landing sizes were assessed. Willingness to pay (WTP) estimates for marginal changes of catching the first sea bass on a trip were between £11 and £31 depending on whether the fish could be kept or released and between £11 and £28 for cod, respectively. WTP was much higher for fish caught and kept than caught and released suggesting that consumption of fish was an important motivation. Minimum size was the most considered choice attribute for respondents, while cost was less commonly considered. The implications of the findings are discussed in the context of future management of recreational fisheries.


Assuntos
Pesqueiros , Recreação , Animais , Peixes , Alimentos Marinhos , Reino Unido
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