Chinese Adults' Willingness to Pay for Mandatory Nutrients Reporting on Nutrition Facts Table.

The Chinese food industry has opposed the mandatory inclusion of increased nutrients in the Nutrition Facts Table (NFT), thus impeding its improvement. This poses a challenge to the endeavors aiming to assist consumers in cultivating healthy dietary habits that incorporate reduced saturated fatty acids and added sugars while ensuring the adequate intake of essential micronutrients. This study conducted a choice experiment to investigate Chinese consumers' preference for updated labeling schemes among 630 adults that were randomly selected from Central, North, East, South, Northwest, Southwest, and Northeast China. It revealed that respondents were willing to pay the highest premium for the most mandatory nutrients (22.575% of the food price per unit). Respondents preferred the NFT with the most mandatory nutrients if they met the following population characteristics: female; non-overweight or obese; without a college degree; possessed an annual household disposable income between 50,000 and 99,999 CNY; from North China; lived in rural areas and often cooked for family; cared about food nutrition. Two combinations of NFT information received the highest preference: (1) the NFT detailing the most mandatory nutrients and their content values and nutrient reference values (NRV%); (2) the NFT containing the most nutrients and the nutrients in 100 g/mL or a serving. The first and second combinations attracted a premium of 14.884% and 31.833% of the food price per unit, respectively.

Patients' willingness to accept adverse event and cost tradeoffs from oral nicotinamide for reduced risk of non-melanoma skin cancer.

BACKGROUND: Non-immunosuppressed patients with a history of multiple non-melanoma skin cancers (NMSCs) taking oral nicotinamide supplementation experienced a 23% decrease in annual NMSC risk in a randomized clinical trial. Patient preferences for risks and costs associated with nicotinamide are unknown. OBJECTIVES: To understand how patients prioritize NMSC reduction, infection risk, and cost. METHODS: A sample of adults with history of ≥2 NMSC within the past five years undergoing Mohs procedure completed a discrete-choice experiment comprising two hypothetical treatments-characterized by varying reductions in NMSC incidence, increased severe infection risk, and cost-and no treatment. The data were analyzed with random-parameters logit models. RESULTS: A total of 203 subjects (mean age 71.5 years, 65.5% males) participated. For a 23% annual reduction in NMSC incidence, a 26% [95% CI: 8%-45%] annual increase in severe infection risk and $8 [95% CI: $2-14] monthly cost was acceptable. Outcomes across analyzed subgroups (before vs. during COVID pandemic, site of interview, less vs. more prior NMSCs) were similar. CONCLUSIONS: Patients were unwilling to accept high severe infection risks to obtain the reduction in NMSC incidence observed in a nicotinamide trial, suggesting that routinely recommending nicotinamide may run counter to some patients' preferences.

Willingness to pay for a National Health Insurance Scheme in The Gambia: a contingent valuation study.

In pursuit of universal health coverage, many low- and middle-income countries are reforming their health financing systems and introducing health insurance schemes. As part of these reforms, lawmakers in The Gambia enacted 'The National Health Insurance Bill, 2021'. The Act will establish a National Health Insurance Scheme (NHIS) that pays for the cost of healthcare services for its members. This study assessed Gambians' willingness to pay (WTP) for a NHIS. Using multistage sampling design with no replacement, head/co-head of households were presented with a hypothetical health insurance scheme from July to August 2020. Their WTP and factors influencing WTP were elicited using a contingent valuation method. Descriptive statistics were used to describe sample characteristics. Lopez-Feldman's modified ordered probit model and linear regression were applied to estimate respondents' WTP as well as identify factors that influence their WTP. More than 90% of the respondents-677 (94.4%) were willing to join and pay for the scheme. Half of these respondents-398 (58.8%) agreed to pay the first bid of US dollars (US$) 20.78 or Gambian dalasi (GMD) 1000. The average WTP was estimated at US$23.27 (GMD1119.82), whereas average maximum amount to pay was US$26.01 (GMD1251.16). Results of the two models together showed that gender, level of education and household income were statistically significant, with the latter showing negative influence on WTP. The study found that Gambians were largely receptive to the scheme and have stated their willingness to contribute. Our findings can inform policymakers in The Gambia and other sub-Saharan countries when establishing contribution rates and exemption criteria during social health insurance scheme implementation.

Perceptions and Liking Distortion from Information about the Nutritional Upgrades in Biofortified Seafood Products.

(1) Background: As biofortified fish meat is becoming increasingly available, the use of supplements within fish feed may impact consumers' perceptions and their willingness to pay (WTP) for the product. This study focused on evaluating the sensory liking of, and WTP for, fish produced with fortified feed while understanding the role played by the acquired information on fish fortification. (2) Methods: Hedonic ratings and WTP were measured in an experimental bid. The participants (n = 91) were asked to rate pleasantness and WTP during two different rounds: (i) appearance-information-tasting and (ii) appearance-tasting-information. A total of three fish species (carp, seabream, and trout) were presented to the consumers as being either fortified (with iodine, selenium, and omega-3 fatty acids) or conventional products. (3) Results: For pleasantness, no significant differences were found between the fortified and conventional fish. In contrast, substantial differences emerged when information regarding the products was provided. Providing the relevant information before tasting affected how much the consumers liked the conventional fish, resulting in a preference for it over the fortified fish. Additionally, consumers are willing to pay more for fortified fish, especially when information with respect to fortification is available. Nevertheless, when information about fortification was provided before tasting, the consumer's expectations were not fulfilled. (4) Conclusions: The outcomes of this study clearly indicate that the presence of relevant information impacts how much people like fortified versus conventional fish, as well as their WTP.

Public willingness to pay for eradicating a harmful marine organism: the case of Aurelia aurita in South Korea.

Aurelia aurita (AA), a legally registered harmful marine organism in South Korea, is damaging marine human leisure activities, local residents' tourism income, fisheries, and cooling water intake at power plants. The government is therefore seeking to eradicate AA by removing AA-attached larvae (polyps). This article looks into the public willingness to pay (WTP) for the eradication, utilizing a contingent valuation. For the sake of eliciting the WTP response, the one-and-one-half-bounded (OB) model was adopted. For comparison, the single-bounded (SB) model, which uses only the response to the first question in the OB model, was also applied. A spike model with a considerable plausibility that could explicitly deal with zero WTP responses was employed. Consequently, the estimation results of the SB model were used for further policy analysis. The household average WTP was estimated as KRW 3,911 (USD 3.49) per year, securing statistical significance. The national value was KRW 80.46 billion (USD 71.71 million) per annum. This figure can be interpreted as public value of the AA eradication project and used as essential basic data to evaluate the economic feasibility of implementing the project. Some factors such as income and education level significantly positively affected the intention of paying a suggested bid.

Consumers' Willingness to Pay for Rice from Remediated Soil: Potential from the Public in Sustainable Soil Pollution Treatment.

Remediation of polluted soil on arable land is mostly funded by governments, with the understanding that the public's willingness to pay for food produced on remediated soil can help establish a soil remediation model with more stakeholders. In contrast to previous studies that have focused on soil-remediation technologies' diffusion, this study employs choice experiments to evaluate market preferences for crops grown from lands of varying quality that are reflected in consumers' willingness to pay (WTP). The results show that consumers are willing to pay a small premium for rice labeled with remediated-soil claims, but the WTP for remediated-soil claim is less than that of an uncontaminated-soil claim. Consumers' WTP for remediated-soil claim increases by 29.03% when combining with a well-known brand, and it increases by 71.17% when information is provided about the efficacy of cadmium and heavy-metal-pollution remediation; however, combining with the region-of-origin label does not increase WTP. We also find that, in early stages of promotion, online stores may reach target consumers more easily. Based on these results, we propose four implications for policymakers.

Preferences for oral nutritional supplement therapy among postoperative patients with gastric cancer: a discrete choice experiment.

PURPOSES: Patients after gastrectomy have poor compliance with oral nutritional supplement (ONS) therapy. Incorporating patient preferences into treatment decisions allows possible product improvements or treatment focus adjustments. The purpose of this research was to investigate the preferences for ONS therapy among postoperative patients with gastric cancer, and to provide person-centered oral nutrition management strategies. METHODS: A discrete choice experiment was designed and implemented within a Chinese cancer population. The survey was administered via paper-based questionnaires during face-to-face interviews with assistance from health professionals. A mixed logit model was used to estimate respondents' preferences for different levels of nutrition therapy attributes. RESULTS: One hundred ninety respondents valued "Adverse reactions-almost none" (ß 3.43 [SE, 0.28]) the most, followed by "Flavor-good taste" (ß 0.68 [SE, 0.13]) and "Follow-up frequency-once every 2 weeks" (ß 0.52 [SE, 0.13]), and were willing to pay more for these attribute levels. Respondents would be 93.73% more likely to accept a nutrition therapy program if there were almost no adverse reactions compared to the frequent adverse reactions. CONCLUSIONS: Health professionals should pay attention to the management and prevention of adverse reactions when prescribing nutritional products, and provide diversified ONS products when necessary to meet patient preferences. When formulating intervention strategies, health professionals should also consider the different characteristics of patients, acknowledge the importance of the role of nurse specialists in a novel model of multidisciplinary nutritional care, standardize ONS information, follow up regularly, and encourage patients' families to participate in daily nutrition care.

Cost of Traditional Herbal Medicines for Noncommunicable Diseases in Rural and Urban Communities in South Africa.

OBJECTIVES: This study assessed traditional herbal medicine (THM) and conventional medicine (CM) utilization among participants with noncommunicable disease in South Africa. METHODS: A cross-sectional study of the Prospective Urban and Rural Epidemiological study collected data through face-to-face interviews using structured questionnaires in 2014. Descriptive, bivariate, and multivariate logistic regression were used to determine the effect of sociodemographic and economic factors on THM and CM use. All statistical analyses were conducted using the statistical computing and graphics language "R." RESULTS: Of the total 417 randomly selected participants in this study, 85% were females, 95% with no health insurance, and 81% with monthly incomes of <2000 rand (R) ($137 equivalent) per month. Moreover, 73% spend 5% of their income on THM, and 10% say they are willing to pay >R500 per year on THM to feel better. Age was significantly associated with different spending patterns after controlling for other demographic factors, given that older adults were 82% (odds ratio 0.18; 95% confidence interval 0.02-0.93) less likely to pay >R100 for THM whereas younger adults were 59% (odds ratio 0.41; 95% confidence interval 0.17-0.97) less likely to pay for CM. CONCLUSIONS: The cost of using THM and CM largely differed by age. The economic insight into this study reveals individuals more willing to pay for THM to payors, which can ultimately clue payors into areas for medication optimization from potential drug-drug interactions and adverse events and, therefore, reduce healthcare costs.

Call (and pay) the midwife: A discrete choice experiment on mothers' preferences and their willingness to pay for midwifery care.

BACKGROUND: Mothers in Germany are entitled to midwifery care; however, they face a lack of skilled professionals. While the reliability of the access to midwifery is of great public interest, we know little about clients' preferences. OBJECTIVES: We conduct a discrete choice experiment to study preferences and willingness to accept copayment for the entire scope of midwifery care (pregnancy, delivery, and postnatal). Thereby, we aim to provide policy recommendations for priority settings in times of scarcity. Furthermore, we evaluate to what extent midwives' education matters to parents and assess the degree of support for the latest Midwifery Reform Act that transfers education from vocational schools to universities. DESIGN: Discrete choice experiment with separated adaptive dual response. SETTINGS: Online Survey promoted through Facebook to parents in Germany. RESPONDENTS: 2080 respondents completed the experiment. They all have or are expecting at least one natural child, mainly born between 2018 and 2020 (87%). The average respondent is female (99%), 33 years old, with a university degree (50%). METHODS: We use a d-optimal fractional factorial design and obtain individual parameter estimates through a Multinomial Logit analysis with Hierarchical Bayes estimation techniques. We calculate willingness to pay and importance weights and simulate uptake probabilities for different packages of care. To avoid extreme choice behavior, we apply separated adaptive dual response. RESULTS: Home visits during the postnatal phase are most important (importance weight 50%); online support is demanded when no personal support is available. We find that 1:1 care during delivery is highly preferred, but one midwife supporting two women intrapartum is still acceptable. The midwife´s education plays a minor role with an importance weight of 3%; however, we find a preference for midwives trained at vocational schools rather than at universities. CONCLUSIONS: In times of scarcity, postnatal care in the form of home visits should be prioritized over pregnancy counseling, and online services should be promoted as an add-on but not as a substitute for personal support. There is a high level of willingness to accept co-financing to ensure the availability of services usually covered by health insurance.

Economic valuation of ecosystem services: application of a choice experiment approach on mount Guna services, North West of Ethiopia.

Guna Mountain is the highest point with an elevation of 4,113 m above sea level and located in South Gondar Zone. It is surrounded by Estie, Lay Gayint, Begemidir Guna, and Farta Woredas and served as a source of livelihood for the nearby communities. However, the area of Mount Guna has been still unprotected because of a lack of suitable conservation measures and weak control of inappropriate practices. Moreover, empirical investigations on the value of the mountain in terms of its ecosystem service are scanty available. This study aims at valuing ecosystem services of Guna Mountain using the choice experiment method and hence identifying farmer's choices of ecosystem service attributes. By considering farmers' preferences, watershed protection service, harvesting of medicinal plants, and water supply together with the cost of management attribute were identified as ecosystem service attributes. Primary data were collected from randomly selected respondents and the Random Parameter Logit model (RPL) was employed for estimation. Results of this model revealed that revealed that the signs of attribute levels are positive except for watershed protection service level 25%, and harvesting of a medicinal plant 20%. In addition to this, socioeconomic variables were significant such as family size and farm distance with a negative sign, education, and land size with a positive sign. The estimated MWTP from the basic model of RPL for non-monetary attribute levels were Ethiopian Birr (ETB) 8.575 and 175.526 per household per year for watershed protection service level 25% and watershed protection service level 50%. It was ETB 1.190 and 24.487 per household per year for the harvesting of a medicinal plant at 10% and harvesting of a medicinal plant at 20%. The contribution was ETB 116.868, 112.042, and 26.776 for water supply at two seasons of the year, water supply at three seasons of the year, and water supply for all seasons of the year attribute levels respectively. Valuing watershed protection was more than water supply followed by harvesting of medicinal plants attribute. To improve the quality and quantity of protection and water supply service, the government and farmers should work together.

Is Korean society prepared for the financial burden of novel anticancer drugs? A survey of willingness to pay among National Health Insurance beneficiaries.

PURPOSE: Since South Korea's 5-year policy of increasing National Health Insurance (NHI) coverage began in 2017, related pharmaceutical expenditures have increased by 41%. Thus, there is a critical need to examine society's willingness to pay (WTP) for increased premiums to include new anticancer drugs in NHI coverage. METHODS: Participants aged 20-65 were invited to a web-based online survey. The acceptable effectiveness threshold for a new anticancer drug to be included in NHI coverage and the WTP for an anticancer drug with modest effectiveness were determined by open-ended questions. RESULTS: A total of 1817 respondents completed the survey. Participants with a family history of cancer or a higher perceived risk of getting cancer had significantly higher WTPs (RR [relative risk] = 1.17 and 1.21, both P = 0.012). Participants who agreed on adding coverage for new anticancer drugs with a life gain of 3 months had a higher WTP (RR = 1.70, P < 0.0001). These associations were greater among the employed and low-income groups. The adjusted mean of acceptable effectiveness for a new anticancer drug was 21.5 months (interquartile range [IQR] = 19.3 to 24.0, median = 21.9). The WTP for a new anticancer drug with a life gain of 3 months was $5.2 (IQR = 4.0 to 6.0, median = 4.6). CONCLUSION: The unrealistic expectations in Korean society for new anticancer agents may provoke challenging issues of fairness and equity. Although Korean society is willing to accept premium increases, our data suggest that such increases would benefit only a small proportion of advanced cancer patients.

Consumer Preferences and Willingness to Pay for Nutraceuticals: A Discrete Choice Experiment.

OBJECTIVES: Globally, nutraceuticals have been increasingly used. Nevertheless, the consumer preferences for nutraceuticals have not been quantitatively investigated. This study used discrete choice experiment (DCE) to examine consumer preferences and willingness to pay for nutraceuticals. METHODS: Four attributes (ie, the scientific proof of effectiveness, the scientific proof of safety, the source of recommendation, and cost) were identified from a systematic review and focus group interviews. They were used to develop a DCE questionnaire. Consumers at community pharmacies in Malaysia were asked to respond to 8 DCE choice sets. A conditional logit model was employed to obtain the relative importance of each attribute and to estimate respondents' WTP for nutraceuticals. RESULTS: A total of 111 valid responses were analyzed. A negative constant term in the developed model indicated that generally the respondents preferred not to use nutraceuticals before they considered the study attributes. The respondents preferred nutraceuticals with no side effect, clear evidence of effectiveness, and recommendation of a healthcare professional. The respondents were willing to pay $252/month more for nutraceuticals proven with no side effect than for those without proof of safety, and $102/month more for nutraceuticals proven with clear effectiveness than for those without proof of effectiveness. CONCLUSIONS: Consumers weighed relatively high on the availability of safety and effectiveness proofs when they chose nutraceuticals. The study highlights on the crucial need to inform consumers using clinical evidences of nutraceuticals as the information is highly preferred by consumers.

Willingness to pay for primary health care at public facilities in the Western Cape Province, Cape Town, South Africa.

BACKGROUND AND OBJECTIVES: As facilities are being prepared for the implementation of National Health Insurance (NHI) in South Africa, there is a pressing need to understand how the public equates the provision of health services at Primary Health Care (PHC) centres with monetary value. Accordingly, this exploratory study was designed to ascertain the willingness to pay (WTP) for public primary healthcare services in South Africa and to identify factors that influence the WTP. METHODS: The study was conducted in Cape Town, South Africa, among 453 persons presenting at two public primary health care centres, namely Bothasig Community Day Centre (CDC) and Goodwood CDC. The study used the contingent valuation range methodology. Descriptive statistics, multiple logistic and tobit regression analyses were conducted to assess demographics, socio-economic, and health access factors that influence WTP. RESULTS: Overall, 60% of participants were willing to pay for services offered at the PHC facilities. The average willingness to pay for all participants was 49.44 ZAR, with a median of 25 ZAR. The multiple logistic regression for grouped facilities showed unemployment, public transport, and the facility attended to be significant while public transport, facility visits, and facility attended were the only significant variables in the tobit model. There was less willingness to pay for those unemployed in comparison with students, those using public transport rather than walking, those frequenting the facilities more than first-time visitors and those attending Goodwood facility in comparison with Bothasig. CONCLUSION: This study revealed factors related to the participants' WTP and to their willingness to contribute towards the health service, though at very low amounts. Understanding the economic value placed upon a service provided in a facility is essential in decision-making for quality care improvements, especially as the South African health system is making the facilities ready for NHI.

Estimating the preferences and willingness-to-pay for colorectal cancer screening: an opportunity to incorporate the perspective of population at risk into policy development in Thailand.

AIMS: Colorectal cancer (CRC) is one of the public health burdens that can be lowered by early detection. This study aims to examine the preferences and willingness-to-pay of a population at risk for CRC screening in Thailand. Understanding the preferences for these individuals at risk would help Thailand, as an example of LMICs, to design effective population-based CRC screening programs. MATERIALS AND METHODS: A discrete choice experiment (DCE) was conducted among screening-naïve adults aged 50-75 years, who were at risk of CRC, in the out-patient department of a tertiary care hospital in Thailand. A DCE questionnaire was developed from six CRC screening attributes. Each questionnaire was composed of six choice sets and each contained two alternatives described by the different levels of attributes and an opt-out alternative. Participants were asked to choose one alternative from each choice set. A multinomial logit model was developed to determine the relative preference of each attribute. The willingness-to-pays for all attributes and screening modalities and the estimated preferred choices of the annual fecal immunochemical test (FIT), 10-yearly colonoscopy, 5-yearly double-contrast barium enema (DCBE), 5-yearly computed tomographic colonography (CTC), 5-yearly flexible sigmoidoscopy (FS), and no screening was calculated and compared. RESULTS: Four hundred participants were included. All attributes, except pain and less bowel preparation, were statistically associated with the participants' preference (p < .05). They preferred screenings with a high-risk reduction of CRC-related mortality, no complication, 5-year interval, and lower cost. The estimated preferred choices of FIT, colonoscopy, DCBE, CTC, and FS were 38.2%, 11.4%, 14.6%, 9.2%, and 11.4%, respectively. The willingness-to-pays for each screening modality was US$251, US$189, US$183, US$154, and US$142 (8,107, 6,105, 5,911, 4,974, and 4,587 THB) per episode, respectively. CONCLUSIONS: The risk reduction of CRC-related mortality, complication, screening interval, and cost influenced the CRC screening preferences of Thai adults. FIT was the most preferred. Policymakers can develop a successful CRC screening campaign using these findings, incorporating the perspective of the population at risk in policy formulation to accomplish their goals.

Treatment Preferences of Residents Assumed to Have Severe Chronic Diseases in China: A Discrete Choice Experiment.

OBJECTIVES: This study aims to elicit the relative importance of treatment attributes that influence residents' choice, assuming they are suffering severe non-communicable diseases (NCDs), to explore how they make trade-offs between these attributes and to estimate the monetary value placed on different attributes and attribute levels. METHODS: A discrete choice experiment (DCE) was conducted with adults over 18 years old in China. Preferences were evaluated based on four treatment attributes: care provider, mode of service, distance to practice and cost. A mixed logit model was used to analyze the relative importance of the four attributes and to calculate the willingness to pay (WTP) for a changed attribute level. RESULTS: A total of 93.47% (2019 of 2160) respondents completed valid questionnaires. The WTP results suggested that participants would be willing to pay CNY 822.51 (USD 124.86), CNY 470.54 (USD 71.41) and CNY 68.20 (USD 10.35) for services provided by experts, with integrated traditional Chinese medicine (TCM) and Western medicine (WM) and with a service distance <=30 min, respectively. CONCLUSIONS: The results suggested that mode of service, care provider, distance to practice and cost should be considered in priority-setting decisions. The government should strengthen the curative service capability in primary health facilities and give full play to the role of TCM in the prevention and treatment of severe chronic diseases.

Nutraceuticals: Some remarks by a choice experiment on food, health and new technologies.

Nowadays people are increasingly interested in health foods, which are foods considered beneficial to well-being in ways that go beyond a normal healthy diet required for human nutrition. This study aims at providing a better understanding of the main factors leading to the purchase of a relatively new category of technological foods, namely nutraceuticals. Based on data collected on a sample of Italian families through a cross-sectional survey, which included choice experiment questions and socio-demographic characteristics, two specifications of discrete choice models allowed us to formalise the behavioural response linked to that purchase and to preference heterogeneity across consumers, and the willingness to pay for these products. Findings show that not all nutraceutical features are equally important in shaping consumers' preferences for health-oriented foods. The role played by formal education in describing the behavioural response towards nutraceuticals and the significant preference heterogeneity across consumers in relation to specific nutraceutical features provide interesting insights to assist researchers and marketers in developing more market-oriented functional foods that gain consumer acceptance.

Personality traits and preferences for specialty coffee: Results from a coffee shop field experiment.

The market for specialty coffee is growing as consumer preferences for high quality coffee become more complex. Identifying the sources of heterogeneity in consumer preferences for specialty coffee is essential to optimizing producer marketing strategies to ensure they both fully capitalize on and satisfy consumer demand. One source of increasing interest is consumer personality profiles, specifically those categorized by the Big Six personality traits. We use the Midlife Development Inventory to investigate the effect of consumer personality traits on willingness to pay for coffee produced by farmer cooperatives. Results from a field experiment using a Becker-DeGroot-Marschak mechanism indicate that, on average, consumers are willing to pay a $1.31 premium for a cup of pour over coffee that was produced by a cooperative member farmer. Consumers exhibiting the extraversion and conscientiousness traits were, on average, willing to pay an even higher premium while those with higher levels of agency had a lower willingness to pay. Results further highlight that sociodemographic characteristics do not always drive consumer purchase decisions and, in the absence of significant sociodemographic influence, intrinsic consumer characteristics like personality traits can better explain preferences.

Patient Willingness to Pay for Reductions in Chronic Low Back Pain and Chronic Neck Pain.

Many recommended nonpharmacologic therapies for patients with chronic spinal pain require visits to providers such as acupuncturists and chiropractors. Little information is available to inform third-party payers' coverage policies regarding ongoing use of these therapies. This study offers contingent valuation-based estimates of patient willingness to pay (WTP) for pain reductions from a large (n = 1,583) sample of patients using ongoing chiropractic care to manage their chronic low back and neck pain. Average WTP estimates were $45.98 (45.8) per month per 1-point reduction in current pain for chronic low back pain and $37.32 (38.0) for chronic neck pain. These estimates met a variety of validity checks including that individuals' values define a downward-sloping demand curve for these services. Comparing these WTP estimates with patients' actual use of chiropractic care over the next 3 months indicates that these patients are likely "buying" perceived pain reductions from what they believe their pain would have been if they didn't see their chiropractor-that is, they value maintenance of their current mild pain levels. These results provide some evidence for copay levels and their relationship to patient demand, but call into question ongoing coverage policies that require the documentation of continued improvement or of experienced clinical deterioration with treatment withdrawal. PERSPECTIVE: This study provides estimates of reported WTP for pain reduction from a large sample of patients using chiropractic care to manage their chronic spinal pain and compares these estimates to what these patients do for care over the next 3 months, to inform coverage policies for ongoing care.

Approaches to Capturing Value in Oncology.

This article sets out to describe different value frameworks in the field of new developments in oncology. Since the costs of new oncological therapies follow a steep path, their implementation and financing demand a thorough assessment. This is an ambitious task due to the complex nature of oncological treatments within overall health policy. Five value frameworks were reviewed: European Society for Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale, American Society of Clinical Oncology (ASCO) Value Framework (version 2.0), National Comprehensive Cancer Network (NCCN) Evidence Blocks, Memorial Sloan Kettering Cancer Center DrugAbacus, and the Institute for Clinical and Economic Review Value Assessment Framework. They are all based on a large set of criteria. However, all these frameworks differ considerably in their outcomes. Among the main differences one has to cite are the inclusion of costs and the use of different outcomes, as well as the fact that they address different target stakeholders, etc. Despite these shortcomings, the value frameworks serve the necessity to introduce more rationality in health decision making seen from the perspective of physicians, patients, and financing bodies.

Constructed wetlands for water quality improvements: Benefit transfer analysis from Ohio.

Water resources provide many benefits that generate value for residents and recreation users alike but run-off from agricultural and impervious surfaces can impair water quality, reducing any generated value. A possible solution to this problem is the construction of treatment wetlands to remove excessive nutrients from water bodies. This study uses environmental and economic data to approximate the costs of constructing and operating free surface water wetlands to remove phosphorus and estimates the amenity and recreational benefits of the resulting improvements in water quality for 24 lakes in Ohio. A ten percent improvement in water quality from a decrease in phosphorus loadings generates positive net benefits for all lakes in the sample with a lifetime cost benefit ratio of 2.92. The study also examines the potential use of constructed wetlands as the sole strategy to achieve a reduction goal for phosphorus loadings and find that the costs of doing so are prohibitive. Constructed wetlands can be a cost-effective component of a comprehensive strategy for small-scale nutrient reduction and water quality improvements for surface water bodies, but other treatment methods would be required to achieve any proposed targeted improvements.