Preferences of cancer patients as a guide to cancer prevention: a retrospective willingness to pay study in Nepal.

OBJECTIVE: In developing countries, like Nepal, with no population-based cancer registry and low level of awareness, it is difficult to communicate the significance of cancer preventative measures to the general population. Only patients, who have faced or facing the economic and mental burden of cancer, can better understand the importance of early diagnosis. This led us to study the retrospective preference of cancer patients in valuing an annual comprehensive cancer screening program in Nepal. STUDY DESIGN: This is a primary survey-based study of 600 diagnosed cancer patients (aged 18+ years) randomly sampled from five hospitals of Nepal during December 2015-February 2016. METHODS: Using the contingent valuation estimation methods, we modelled patients' willingness to pay (WTP) for early cancer screening through the Structural Equation Modelling framework. RESULTS: About 59% of our sampled patients did not receive education and 65% earned below $100/month. Among other findings, we saw that the Risk of re-occurrence impacted WTP through two opposing channels. The direct effect of Risk of re-occurrence on WTP was positive (ß = 0.20; p < 0.05), but higher the risk of cancer relapses, the higher was the Pessimism among patients, which indirectly impacted WTP negatively (ß = -0.16; p < 0.1). In addition, we found the effect of Income on WTP to be positive (ß = 0.15; p < 0.05), whereas, one belonging to the backward Dalit section of the society had lower WTP for screening. CONCLUSION: Cancer patients value the importance of early diagnosis with multiple psychosocial factors impacting this preference. This direct account of patients could be used as evidence in policymaking.

Measuring the societal burden of cancer: a case of lost productivity in Nepal.

OBJECTIVES: The global patterns of cancer incidences and mortality rates are slowly shifting towards low- and middle-income countries. Through our article, we highlight the societal cost associated with premature mortality and morbidity of cancer in Nepal. The monetary loss is indicative of the severity of the issue and it serves to motivate the policymakers realize the urgency in devising appropriate cancer control strategies. STUDY DESIGN: The study design is a cross-sectional study using the GLOBOCAN 2012 data. METHODS: Using the human capital approach, we measure the number of years of life lost (YLL) and the number of years of productive life lost (YPLL) due to cancer in Nepal. RESULTS: We found that following diagnosis, a Nepali patient with cancer is likely to lose out on 19.64 years of their life; the average number of YLL is higher for females (22.2 years vs 16.8 years in males). After adjusting for labor force participation rate and predicted growth rate of the economy, we found that cancer led to a total productivity loss of $149 million (males) and $121 million (females) in 2012. The burden of the top five cancers accounted for almost half of the total productivity loss in both the genders. Cervical and lung cancer incur the maximum cost to society, respectively, for females and males. CONCLUSIONS: The article highlighted the severity of the cancer issue and emphasized the urgency needed in devising cancer control policies in Nepal.

The impact of behavioural risk reduction interventions on willingness to pay to avoid sexually transmitted infections: a stated preference study of justice-involved youth.

Risky health behaviours, such as smoking, drinking and risky sex, are substantial contributors to US morbidity rates and healthcare costs. While economic models typically regard preferences as stable, a growing literature suggests that information, including how it interacts with intentions and attitudes, plays an important role in unhealthy behaviours. Relatedly, a large health literature demonstrates that theory-based behavioural interventions can successfully change risky behaviour. This study uses the contingent valuation survey method to investigate the impact of behavioural interventions on a novel outcome measure: the willingness to pay (WTP) to avoid the consequences associated with risky behaviour. Using novel pre- and post-intervention data from Project MARS (Motivating Adolescents to Reduce Sexual Risk) this study estimates the impact of the intervention on elicited WTP to avoid sexually transmitted infections (STI). It is found that after the intervention, participants' elicited WTP to avoid STIs were significantly higher, and more sensitive to differences in infection severity. These results suggest that the intervention may affect risky sexual behaviour by changing the perceived value of avoiding the consequences of risky sexual behaviour. Additionally, these findings contribute to an ongoing debate regarding the construct validity of contingent valuation studies in health economics.

A zero-inflated Poisson model of migration frequency.

"This paper shows that the frequency of migration can be best modeled by a zero-inflated Poisson process, because it takes into account the overwhelming presence of zeros (nonmigrants) in the data. A failure to do so can cause the coefficients to be biased and also result in poor prediction. The major finding is that by using a zero-inflated process, the performance of the model in predicting migration behavior is substantially improved. In addition, frequent movers tend to be white, nonunionized, and tend to have fewer children, less stable marriages, and more frequent occupational changes." Data are for the United States for the years 1977 to 1987 and are taken from the Panel Study of Income Dynamics.