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Research on the factors that may affect the future uptake of autonomous Mobiliyt on Demand (MoD) services are today more than ever relevant. In this paper, we attempt to investigate all aspects of acceptability of a proposed Autonomous-MoD service (AMoD). More specifically, we develop mode choice models and identify the factors that affect it in both sunny and rainy weather conditions, using state-of-the-art Machine Learning models and interpretation techniques, such as the permutation feature importance and partial dependence. Furthermore, we estimate the willingness of the service’s potential users to pay for reduced travel time and propose an on-board negotiation scheme of the travel time and cost for sharing one’s ride. For the above purposes, we conducted a questionnaire survey with 1600 participants in the city of Athens, Greece just after alleviation of the lockdown and measures related with the COVID-19 first wave. The models developed are capable of predicting the mode choice and acceptability of the negotiation scheme with an accuracy of over 80%. Except for the cost, travel and walking time of each alternative mode, the users’ mobility profile, attitude towards autonomous vehicles and demographic characteristics are identified as the most important factors affecting the respondents’ choices. Moreover, the willingness to pay for reduced travel time varies from 0.18 to 0.62€, depending on the mode and about 0.53€ for the on-board negotiation.

This paper models and investigates risk and security perception of metro travelers, in cases of malevolent, man-made incidents. Data is collected through an extensive survey in Athens, Greece; the survey includes an image-based stated-preference experiment, depicting different risk and security conditions. Econometric models are developed for estimating willingness to pay for mitigating perceived risk and for improving security in the Athens metro system. Results highlight the value that travelers attribute to improving security and avoiding threatening conditions in the Athens metro system, which is estimated to a 25%–30% of the system’s fare level. The paper provides useful insights on acceptable fare changes for improving security and risk perception in the Athens metro system.

In the last few years there has been an increasing attempt to find solutions on how to mitigate the environmental impacts of air travel. Behavioral change has hereby been identified as the measure with the most significant impact. One way to encourage behavioral change is the use of eco-labels. Eco-labels have, to date, received scant attention in the aviation industry, and their effect on air travel behavior is still largely unknown. This study explores the effect of an eco-label on the booking decisions of passengers. We conduct a stated choice experiment with 553 air passengers. Our findings show that providing passengers with an eco-label leads to behavioral change, as the label makes them avoid the most polluting flights while it also increases their willingness to pay for less polluting flights. We find, however, that it is environmentally minded passengers who are more likely to select green-labeled flights. In addition, our results show that providing additional information on the purpose and goals of the eco-label is crucial for its adoption, because this added information increases the preference for more environmentally friendly flights significantly. Based on our results, we provide recommendations to the industry and for further research.

Automated vehicles (AVs) have the potential to change the way we travel within our cities. However, the conditions under which consumers will adopt AVs are poorly understood. An internet-based survey was conducted in the Greater Toronto and Hamilton Area to understand how consumers will respond to automated vehicles. This study estimates the effect of demographic characteristics, travel characteristics, and built-environment variables on respondent’s willingness to pay for private autonomous vehicles and frequency of use for shared autonomous vehicles under different pricing levels. The results indicate that having a higher household income and owning a more expensive vehicle are good predictors of interest in PAVs, whereas individuals who experienced more car accidents as a passenger and individuals who commute using public transit or walk/cycle are more interested in SAVs. Regional rail users, Uber users, and younger respondents were interested in both ownership models. This provides insight to help policymakers advance transportation policies and collective social goals.

PURPOSE: Knowledge, attitudes, and patient preferences about genetic testing and subsequent risk management for cancer prevention among average risk populations are understudied, especially among Hispanics. This study was to assess these items by conducting an in-person survey in this understudied population. METHODS: We conducted in-person surveys using a self-administered, structured questionnaire among young women in 2017. Survey questions were adapted from other validated surveys. This study had 677 participants in the final analyses. Data were collected in 2017 and analyzed in 2018 and 2019. RESULTS: Participants had little knowledge about genes or breast cancer risk, but most felt that genetic testing for cancer prevention is “a good idea” (87.0%), “a reassuring idea” (84.0%), and that “everyone should get the test” (87.7%). Most (64.0%) of these women would pay up to $25 for the test, 29.3% would pay $25-$500, and

OBJECTIVE Lumbar discectomy is a frequently performed procedure to treat sciatica caused by lumbar disc herniation. Multiple surgical techniques are available, and the popularity of minimally invasive surgical techniques is increasing worldwide. Clinical outcomes between these techniques may not show any substantial differences. As lumbar discectomy is an elective procedure, patients’ own preferences play an important role in determining the procedure they will undergo. The aims of the current study were to determine the relative preference weights patients apply to various attributes of lumbar discectomy, determine if patient preferences change after surgery, identify preference heterogeneity for choosing surgery for sciatica, and calculate patient willingness to pay for other attributes. METHODS A discrete choice experiment (DCE) was conducted among patients with sciatica caused by lumbar disc herniation. A questionnaire was administered to patients before they underwent surgery and to an independent sample of patients who had already undergone surgery. The DCE required patients to choose between two surgical techniques or to opt out from 12 choice sets with alternating characteristic levels: waiting time for surgery, out-of-pocket costs, size of the scar, need of general anesthesia, need for hospitalization, effect on leg pain, and duration of the recovery period. RESULTS A total of 287 patients were included in the DCE analysis. All attributes, except scar size, had a significant influence on the overall preferences of patients. The effect on leg pain was the most important characteristic in the decision for a surgical procedure (by 44.8%). The potential out-of-pocket costs for the procedure (28.8%), the wait time (12.8%), need for general anesthesia (7.5%), need for hospitalization (4.3%), and the recovery period (1.8%) followed. Preferences were independent of the scores on patient-reported outcome measures and baseline characteristics. Three latent classes could be identified with specific preference patterns. Willingness-to-pay was the highest for effectiveness on leg pain, with patients willing to pay €3133 for a treatment that has a 90% effectiveness instead of 70%. CONCLUSIONS Effect on leg pain is the most important factor for patients in deciding to undergo surgery for sciatica. Not all proposed advantages of minimally invasive spine surgery (e.g., size of the scar, no need of general anesthesia) are necessarily perceived as advantages by patients. Spine surgeons should propose surgical techniques for sciatica, not only based on own ability and proposed eligibility, but also based on patient preferences as is part of shared decision making.

Introduction: The body of literature on telehealth perception among commercial members is limited. Therefore, we administered a patient-experienced survey (Clinician and Group Consumer Assessment of Healthcare Providers and Systems [CG-CAHPS]) to determine member perceptions of telehealth, including willingness to pay for it and the likelihood to access it again. Methods: This study used a cross-sectional design, and members were assigned into two groups: those who had a telehealth visit with their primary care provider (PCP) or a provider in the same practice and those who had a telehealth visit with a provider outside of their PCP's practice. Logistic regression models were used to observe group differences in telehealth perception. Results: A total of 444 members replied to the CG-CAHPS survey and had a virtual visit; 21.1% had a telehealth visit with a provider outside of their PCP's practice, and 78.8% had a telehealth visit with their PCP or a provider in the same practice. Compared with members who saw a provider outside of their PCP's practice, members who saw their PCP or a provider in the same practice had 3.76 higher odds (confidence interval [95% CI]: 1.49-9.44) of rating in-person care as no different than virtual care; 2.29 higher odds (95% CI: 1.30-4.04) of reporting they would likely use telehealth again in the future; and 1.70 higher odds (95% CI: 0.99-2.91) of responding that they would be willing to pay an in-office visit copay for a telehealth visit. Conclusion: These results suggest that the familiarity of a member's PCP extends to the provider's practice and impacts member outlook on telehealth.

The Bitcoin payment system involves two agent types: users that transact with the currency and pay fees and miners in charge of authorizing transactions and securing the system in return for these fees. Two of Bitcoin’s challenges are (i) securing sufficient miner revenues as block rewards decrease, and (ii) alleviating the throughput limitation due to a small maximal block size cap. These issues are strongly related as increasing the maximal block size may decrease revenue due to Bitcoin’s pay-your-bid approach. To decouple them, we analyze the “monopolistic auction” [ 16 ], showing (i) its revenue does not decrease as the maximal block size increases, (ii) it is resilient to an untrusted auctioneer (the miner), and (iii) simplicity for transaction issuers (bidders), as the average gain from strategic bid shading (relative to bidding one’s value) diminishes as the number of bids increases.

Even though PV rooftop technology is popular, currently the levelized cost of electricity (LCOE) is more expensive than the grid electricity price, especially in developing countries. However, the solar panel price is decreasing, which make the LCOE of PV rooftop in the near future would decrease to the same level as grid electricity price. This condition is defined as grid parity. In this research, the grid parity condition in Jakarta and Surabaya (Indonesia) is calculated and compared to the willingness to pay (WTP) data. Then, the effect of the PV rooftop installation on the generation cost is investigated under various sizes of PV rooftop aggregation. The grid parity analysis is evaluated by calculating LCOE at different capacities then comparing it to electricity tariff. After that, grid generation cost is investigated using unit commitment procedure. The result shows that the larger the installed capacity, the faster the grid parity condition is achieved. In addition, the PV rooftop system in Surabaya has a lower LCOE value than Jakarta due to the greater potential for solar energy. Furthermore, the PV rooftop installation effect on the power system would reduce the energy production from the conventional generating unit. On contrary, the average generation cost for Java Bali electric system would increase to 6.4% because of the inefficiency of the existing generating unit operation.

The majority of pediatric burns in Mongolia occur within the home, particularly in the spaces dedicated to cooking. This makes home environment modification a priority for injury prevention. Many of these injuries are caused by electric appliances used in traditional tent-like dwellings (called a ger). In the present study, we designed and provided a context appropriate kitchen rack to 50 households with children aged 0-3 years living in gers and investigated parental views on the acceptability of the rack and willingness-to-pay (WTP) through face-to-face structured individual and group interviews and the contingent valuation method. We used the DCchoice package of R to estimate the median WTP and its 95% confidence interval by the household income, previous experience of childhood burn injury, and the number of children in the household. There was a total of 89 children aged

Background Laparoscopic liver resection is increasing operate. In the early stage of hepatocellular carcinoma (HCC), many studies supported that laparoscopic liver resection was a safe procedure and showed some clinical benefits. However, the full economic evaluation has not been fully investigated. Methods A hybrid model of decision tree and Markov state transition model was constructed. Health outcomes were life-year gained (LYs), and quality-adjusted life years (QALYs). A deterministic sensitivity analysis was performed and a probabilistic sensitivity analysis was conducted by 1,000 micro-simulation. The incremental cost-effectiveness ratio (ICER) was reported and the willingness to pay (WTP) was defined at 160,000 THB per QALY gained. Results Laparoscopic liver resection in the early stage of HCC was not cost-effective. In the base-case analysis, the total lifetime cost of laparoscopic approach was an average of 413,377 THB (US$13,214) higher than open approach by 55,474 THB (US$1,773) with a small QALY gained. The resulting ICER was 1,356,521 THB (US$43,362) per QALY gained. Conclusion Laparoscopic liver resection is not considered as a cost-effective alternative to open liver surgery in the early stage of HCC. In the Thai healthcare perspective, the results from this study may inform policymakers for the future policy implementation and healthcare resource allocation.

Autonomous driving technologies are expected to affect shared mobility; therefore, the discussions on new business models using shared autonomous vehicles (SAVs) and their feasibilities are underway. This study analyzes consumer preference and willingness to pay for an SAV service, focusing on the automation level of the shared vehicle and liability for an accident, to investigate who will use the SAV service and how much. For this, we conducted a conjoint survey with 1,000 South Koreans and estimated the consumer utility function for an SAV service using a multiple discrete–continuous extreme value (MDCEV) model. The results show that consumer utility increases when the SAV automation level is higher and the liability for an accident lies with the SAV service provider. Moreover, we find that potential consumers have different preferences regarding the liability of a car accident according to their sociodemographic characteristics. We also analyze choice probability and usage of SAV services according to autonomous driving technology levels and who is held liable for an accident. The results show that people with a higher income prefer to use SAV service if service providers are responsible for an accident. Contrarily, older people, drivers, and people with a low income prefer to use SAV service if the accident’s liability lies with the automobile manufacturer. We also find that SAV service usage increases when the level of autonomous driving technology is high or liability for an accident lies with the SAV service provider or automobile manufacturer.

Since 2015, Zorginstituut Nederland (ZIN) has linked disease severity ranges of 0.10 to 0.40, 0.41 to 0.70, and 0.71 to 1.00 with willingness-to-pay (WTP) reference values of €20 000, €50 000, and €80 000 per quality-adjusted life year gained, respectively. We sought to review whether these changes have affected ZIN health technology assessment (HTA) outcomes for specialist and outpatient drugs.ZIN recommendations for specialist and outpatient drugs published between January 1, 2012, and December 31, 2020, that included a pharmacoeconomic report were reviewed. Data were extracted on disease severity, proportional shortfall calculation, reported WTP reference value, outcomes related to the cost-effectiveness of the product, budget impact, and ZIN's recommendation including rationale for their advice.A total of 51 HTAs were included. Of the 20 HTAs published before June 2015, a total of 9 received positive recommendations, 7 were conditionally reimbursed, and 4 received negative recommendations. None reported WTP reference values. Of the 31 evaluations published after June 2015, a total of 4 products received positive recommendations, 1 was conditionally approved, and 26 received negative recommendations initially. Most products (65%) reported disease severity to be0.70.Since 2015, most products have fallen within the highest category of disease severity. Although pre-2015 outcomes were varied, post-2015 products overwhelmingly received negative recommendations, and the proportion of products for which price negotiations were recommended has increased. These differences in outcomes may result from the introduction of an explicit WTP reference value, whether or not in combination with the severity-adjusted ranges, but may also reflect other national policy changes in 2015.

Although lung cancer screening with low-dose CT (LDCT) can reduce lung cancer mortality by 20%, without an appropriate eligibility criteria, it may result in a waste of medical resources and a degree of unnecessary damage to participants' health. This study aims to give the optimal screening strategy in China based on cost-effectiveness analysis on pros and cons of different situations. From the perspective of primary healthcare system, a Markov model was built to simulate LDCT screening of 100,000 heavy smokers (>30 pack years) aged 40 in different situations. Model parameters mainly came from screening programs conducted in China and other countries, official public data, and published literature. Two indicators of primary outcome, incremental cost-effectiveness ratio (ICER) and net health benefits (NHB), were compared with those of no screening. Sensitivity analysis was conducted to evaluate model uncertainties. We defined the optimal strategy as the one with both acceptable cost effectiveness and maximal NHB. Base-case analysis results showed that for all screening strategies, ICERs were less than three times of GDP per capita. As for NHB results, it showed that when the willingness to pay for screening was less than three times of GPD per capita, the largest NHB was obtained in the strategy which started screening at 50 years old and this strategy showed stable performance in univariate and probabilistic sensitivity as well. Prevention Relevance: LDCT screening is cost effective in heavy smokers in China, and the optimal age to start screening is suggested to be 50 years old.

This study investigates whether shareholders are willing to pay for higher levels of corporate financial, social, and environmental disclosure. We conduct a choice-based conjoint experiment wherein 65 shareholders are asked to make 12 choices, choosing each time between two predetermined randomized combinations of different levels of investment returns, financial disclosure, environmental disclosure, and social disclosure. Results indicate that whereas shareholders are willing to pay for financial disclosure and environmental disclosure, they are unwilling to pay for social disclosure. Hence, the latter finding does not provide conclusive evidence on the overall question. However, the result that investors are willing to pay for non-financial disclosures—such as environmental information—constitutes our main contribution as prior research has not been able to provide strong evidence that investors are willing to forfeit investment returns in order to gain access to more corporate disclosures. The use of a choice-based conjoint experiment to examine these matters is novel and potentially opens avenues for future research. We believe our theoretical and practical contributions to be of interest to various stakeholders, including firms in making decisions about disclosure levels and regulators in assessing the need for financial disclosure regulation.

The purpose of this study is to identify the willingness to pay (WTP) and trade-off that Vietnamese generation Z consumers could make when purchasing eco-friendly apparel. This research uses the Discrete Choice Experiment methodology to measure consumers' WTP and how consumers trade off among different attributes, including eco-friendly, origin, manufacturing technology, and materials. The results show that generation Z consumers are willing to pay for organic label products at a higher price of 21.22% and eco-friendly label items at a higher price of 37.72%. Consumers who have a higher level of corporate social responsibility (CSR) awareness and higher income are willing to pay more for organic and ecofriendly label apparel. They were least willing to purchase apparel that is made in China, while they see no difference between T-shirts made in Vietnam and in other countries except China. Consumers in the current study were more willing to purchase eco-friendly as compared to organic apparel. The findings suggest that enterprises should consider the language used when communicating with consumers. Also, consumers prefer products made in Vietnam, suggesting the promotion of domestic manufacturing through in-depth branding, product positioning, and promotions. The results also confirm that the application of CSR in enterprises is the right and necessary step to be taken for businesses to develop in a sustainable integration world.

This study explores small-scale Vietnamese shrimp farmers’ preferences for good aquaculture practices and proactive aquaculture development policy to encourage wastewater treatment and antibiotic use. Data were collected through a survey of farmers using two discrete choice experiments with a sample size of 450 respondents. The results of mixed logit and latent class models indicated that the farmers preferred good aquaculture practices in shrimp farming to conventional types, and the risk reduction and economic benefits of good aquaculture practices attracted shrimp farmers. However, many small-scale farmers did not prefer the integration of proactive aquaculture practices in development policy, despite the availability of a concessional loan to cover the initial investment cost, and they expressed less willingness to pay for wastewater treatment and antibiotic use regulations. To increase the adoption of good aquaculture practices, in addition to concessional funding policy, small-scale farmers also expressed a need for other support policies, such as the aquaculture insurance provision, subsidies for wastewater treatment, and compliance with regulations on antibiotic use.

Food safety is vital for public health, influencing a country's economic development and international reputation. In recent years, Taiwan has encountered several food quality problems, with consequent public questioning and mistrust of food safety. If consumers are unaware of the quality of a product, their perception and demands can be influenced by the credibility of the food safety certification labels. This study uses the contingent valuation method (CVM) to analyze the factors influencing consumer willingness to pay (WTP) for food safety certification labels of packaged rice. Questionnaires are randomly adopted and assigned to 434 participants. The results indicate that product factors should be presented clearly on their packaging and advertisements. Consumers focus on certification labels for food safety perception. Gender, education level, place of purchase, certification cognition, and health cognition are all found to affect willingness to pay. These significant results indicate that women were more willing to pay than men; people were willing to pay a higher amount for purchases of packaged rice at supermarkets or hypermarkets; health cognition was estimated to be negative and significant, showing that health cognition negatively affected WTP, perhaps because participants did not sufficiently trust the foundation's assurance that the rice was safe. In the valuation of WTP for food safety certification, each person was willing to pay on average NT31.07 annually to reduce the risk of food safety problems.

We review the literature on the motivators of consumers’ purchasing decisions regarding autonomous vehicles (AVs), focusing on environmental awareness, vehicle types, concerns about accidents, and merits. The willingness to buy (WTB) and willingness to pay (WTP) for AVs have been extensively studied. However, it is imperative to broaden the outlook and consolidate the existing knowledge base. Although the WTB and WTP for AVs have been studied, automation-level preferences have been underresearched. Based on more than 150,000 observations, we construct a choice model and calculate the WTP for each level of automation. Our results show that there is a disparity between people's WTB and WTP according to the automation level. In particular, we find that the coefficients regarding FAVs’ benefits and accidents significantly exceed those related to environmental concerns. Such results indicate that practical benefits and concerns influence AV demand and WTP to a greater extent than environmental awareness. Our model results indicate a disparity between WTB and WTP for AVs that mostly derives from the different types of environmental concerns, concerns about accidents, and perceived benefits from these automobiles. Our results urge policies according to which governments and companies closely examine consumers who exhibit WTB-WTP disparities. Issues relating to demand patterns, WTP, and a suitable policy framework are discussed.

The effect of introducing or increasing user fees for health services in low- and middle-income countries is controversial. While user fees are advocated as an effective means of generating revenue and enabling health service quality improvement, they constitute a financial barrier to access health services for the poorer. This paper contributes to the literature on the demand-side financing in health by providing evidence on the medium-term effects of introducing user fees on the utilisation of family planning, antenatal and delivery care services, women’s access to health care, and child health status in a middle-income country setting. Using a difference-in-differences identification approach to establish causality, we find that the introduction of user fees in Egypt had no negative effect on the utilisation of family planning and delivery care services. Further, fees did not hinder women’s access to care and did not harm child health outcomes. Positive effects were even observed with respect to the utilisation of antenatal care services. Our findings are compatible with the hypothesis that the potential decrease in demand due to the user fee imposition might have been offset by an increased willingness to pay for a health care quality that could be, at least partly, perceived as higher.

This study aims to examine if the pricing strategy “Pay What You Want” can be the best option for the industry of digital products’ distribution, when compared with other fixed prices policies. To verify the adequacy of Pay What You Want Pricing strategy, we conducted an online survey using a sample of online consumers, to evaluate their buying intention and the willingness to pay regarding a set of digital products. Results show that, in some instances, the Pay What You Want Pricing strategy yields a greater sales revenue through the reduction of the individual amounts paid, which is counter-balanced by the increasing number of transactions. We conclude that this pricing strategy is as much suitable for companies, as they may potentially increase their sales revenue.

This correlational study explored the relationship between informal lender’s practices and profitability of fifty-three (53) rice retailers in city of Borongan using a researcher-made-three part questionnaire on the business profile, level of practices among informal lenders and weekly income of the respondents. Data were sourced out from rice retailers who lent sum of money from “5-6†informal lenders, and were utilized using descriptive and inferential analysis test at .05 level of significance. Findings revealed that Majority of the respondents had been in the middle years of retailing business, used an average initial capital sourced out from their personal savings and are earning an average weekly income. The respondents’ perceived that informal lenders assess clients’ financial needs and willingness to pay without requiring collateral from them and that rice-retailers reloan due to fast processing of funds and the great customer service. Using regression analysis, year in business was found to be a significant predictor of increase in the profitability of rice retailing services. While, no significant relationship was seen between the rice retailers’ weekly net income and the level of practice among informal lenders. The researcher recommends that government and non-government agencies to provide intervention that will improve the microbusiness enterprise in the market using the help of informal and formal lending institutions and that wider scope of the study should be made to include other small business sectors that are affected by informal lenders.

Patients with obstructive sleep apnea (OSA) most commonly receive positive airway pressure therapy (PAP) as primary treatment, which is highly effective when used consistently. Little is known about the preferences for and relevance of attributes of OSA treatments, especially of non-PAP alternatives. The aim of this study was to evaluate treatment preferences and willingness to pay (WTP) among patients with and without previous experience of OSA therapies.A discrete choice experiment and a structured survey were applied to patients presenting for overnight polysomnography at a tertiary sleep center. Medical variables were obtained from hospital case records.Over a period of 4 months, 241 subjects were enrolled and answered the questionnaire (61.8% with an existing diagnosis, 38.2% with a new diagnosis). The most preferred treatment among all patients was PAP therapy (51.1%), followed by mandibular advancement devices (18.1%), hypoglossal nerve stimulation (17.2%), and medication (13.7%). Approval for the different treatments varied by gender as well as by OSA therapy experience. The importance of attributes of OSA treatment varied too, with low rates of treatment-related side effects being equally important, independent of the preferred therapy. The most often stated monthly WTP for optimal sleep was € 50, with increasing age leading to lower WTP values.Preferences for OSA therapies vary among patients and patient subgroups. PAP therapy is the most preferred treatment, though non-PAP interventions receive high approval ratings too, particularly in treatment-naïve patients. The importance of treatment attributes varies as well, depending on the choice of preferred treatment.Patienten mit obstruktiver Schlafapnoe (OSA) werden standardmäßig mit PAP-Therapie („positive airway pressure“) versorgt, welche bei kontinuierlicher Anwendung die Krankheitslast effektiv reduziert. Bisher ist zu Patientenpräferenzen und Bedeutung einzelner Therapiemerkmale bei der Behandlung der OSA wenig bekannt, insbesondere hinsichtlich alternativer Nicht-PAP-Therapien. Studienziel war die Ermittlung von Therapiepräferenzen und der Zahlungsbereitschaft bei Patienten mit OSA mit und ohne Therapieerfahrung.Ein diskretes Entscheidungsexperiment sowie ein strukturierter Fragebogen wurden entwickelt und Patienten vorgelegt, die sich in einem Zentrum der Tertiärversorgung zur Polysomnographie vorstellten. Medizinische Daten wurden den elektronischen Patientenakten entnommen.Insgesamt wurden 241 Patienten in die Studie eingeschlossen (61,8 % mit und 38,2 % ohne Therapieerfahrung). Die häufigste präferierte Therapie war die PAP-Beatmung (51,1 %), gefolgt von der Behandlung mit der Unterkieferprotrusionsschiene (18,1 %), der Hypoglossusnervstimulation (17,2 %) sowie der medikamentösen Therapie (13,7 %). Die Zustimmung zu den einzelnen Behandlungsformen unterschied sich erheblich nach Geschlecht sowie Erfahrungen mit OSA-Therapie. Die Bedeutung einzelner Behandlungsmerkmale war ebenfalls unterschiedlich, dabei waren unabhängig von der bevorzugten Behandlung geringe Raten des Auftretens therapiebezogener Nebenwirkungen gleichermaßen wichtig. Die am häufigsten genannte Zahlungsbereitschaft für guten Schlaf lag bei € 50 pro Monat, mit niedrigeren Werten bei höherem Lebensalter.Die Präferenzen von Patienten und Patientenuntergruppen in Bezug auf verschiedene OSA-Therapien unterscheiden sich erheblich. PAP-Beatmung wird am häufigsten bevorzugt, jedoch gibt es auch hohe Zustimmungswerte für Nicht-PAP-Verfahren, insbesondere bei Patienten ohne Therapieerfahrung. Ebenso variiert die Bedeutung der einzelnen Behandlungsmerkmale in Abhängigkeit von der präferierten Primärtherapie.

Introduction: The high cost of health services along with the unpredictability of health needs and the inadequacy of personal savings is the primary reason for the growing importance of insurance as a means of financing health services. Health insurance ensures easy access, high quality, sustainability and affordability of care. This study was undertaken in an attempt to generate some scientific data on awareness and willingness to pay (WTP) for health insurance in our country perspective. Objective: To determine awareness and demand or willingness to pay for health insurance in order to ascertain the feasibility of such schemes and establishing prices. Materials and Methods: This descriptive cross-sectional study was carried out from 1st July 2015 to 30th June 2016 in two governments and two non-government organizations. Randomly 200 government and 200 non-government employees were taken in the sample. A semi structured questionnaire designed to elicit WTP by Contingent Valuation Method (CVM) was used to collect data. Results: Among 400 respondents, 82.8% were male and 17.2% were female. Most of them (85.5%) heard about health insurance earlier and 2.5% subscribed for health insurance. Majority (58.7%) expressed WTP Tk 100-200 (Mean Tk 261.3 ± 196.3) and by percentage of monthly income, average WTP of a formal sector employee was 1.2%. Coverage of health expenditure from employer (10.6%) or insurance (1.1%) side was less and 88.8% of employees had to spend 100% from out of pocket (OOP). Conclusion: Introduction of health insurance, appropriately designed for each population group is imperative for achieving Universal Health Coverage. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 9-13

Background Although Chinese government has dedicated the past decades to treating chronic diseases by primary healthcare system, many more residents are apt to choose higher-tier facilities to treat minor chronic diseases. Understanding residents’ preferences for chronic disease management in primary care facilities can bridge the gap between residents’ choices and policy implementation. This study aims to elicit residents’ preferences for chronic disease management in primary care facilities in the hypothetical minor chronic disease scenario. Methods Six hundred eighty residents were administered a discrete choice experiment that elicited preferences for chronic disease management in primary care facilities. Services attributes were service mode, treatment measure, out-of-pocket expenditure (OOP), traveling time to healthcare facility and title of physician. Mixed logit models were used to estimate stated preferences and willingness to pay for attributes. WTP confidence intervals were estimated by the delta method. Results A total of 94.44% of the completed questionnaires were valid (680 of 720 respondents). The participants preferred chronic disease management service with modern medicine, traveling time ≤ 30mins, and less OOP expenditure. Compared with Traditional Chinese Medicine (TCM), residents prefer modern medicine, willing to pay 155.53 CNY ($21.97) to change from TCM to modern medicine. Compensation about 86.02 CNY ($12.15) was needed to enable residents to change the choice of the nearer primary care facility to a further one. Integrated medicine in community clinics by experts was residents’ most preferred scenario while TCM in the tertiary hospital was their least preferred one. Conclusion In order to increase the utilization of primary healthcare services in chronic diseases management, policy makers need to concern more about the services of medical treatment type, price and convenience. Therefore, we advise policy makers to provide nearer primary healthcare services for residents especially for residents in surrounding areas. Furthermore, balancing the resource allocation between Traditional Chinese Medicine and modern medicine is worthy of consideration.

While energy consumption in the United States residential sector has a complex relationship with users’ physical, demographic, and behavioral characteristics, academic research has recognized the role of social acceptance in the immediate and long-term use of renewable energy. This study sought to understand how users’ physical, demographic, socioeconomic, and behavioral characteristics impact their acceptance of renewable energy in the residential sector in the U.S. Specifically, this study tested the theory of planned behavior (TPB) research model and included the “willingness to pay” construct to predict consumers’ intentions to use renewable energy. Twenty-two states, which are responsible for over 20% of the total energy produced from renewable sources, were included in the study. The findings showed that the average household income in the residential sector has an important effect on consumers’ intentions to use renewable energy. Furthermore, the study’s results are consistent with the TPB structural equation model. In this case, the subjective norm (perceived behavioral control) and the willingness to pay construct significantly affected consumers’ intentions to use renewable energy, while attitudes toward the behavior did not. Limitations of the study and suggestions for future research are also discussed.

PURPOSE: Complementary and integrative medicine (CIM) services are more prevalent in cancer centers but continue to be underutilized by patients. This study examines perspectives from patients and caregivers about these services being offered at a comprehensive cancer center. METHODS: Patients and caregivers were surveyed about their familiarity, interest, and experience with five CIM therapies: acupuncture, massage, meditation, music therapy, and yoga. Respondents were asked about their interest in and/or paying for these services at baseline, when recommended by their medical team, and when offered in a clinical trial. Respondents were also asked about perceived barriers to accessing these services. Chi-squared tests were performed to explore associations between past experience, interest levels, and willingness to pay. RESULTS: A total of 576 surveys were obtained (464 patients and 112 caregivers). Most respondents identified as White or Caucasian (65.6%), female (57.2%), had been a patient for < 3 years (74.2%), had some college education (73.8%), and made > $40,000 in US dollars as their annual household income (69.1%). Respondents were most familiar with therapeutic massage (34.2%) and least familiar with acupuncture (20.0%). The average interest in these services increased from 53.3% to 64.1% when recommended by a medical professional. Respondents were most willing to pay $1-60 for therapeutic massage (62.3%) and least willing to pay for meditation (43.7%). The main barriers to accessing CIM services were cost (56.0%) and lack of knowledge (52.1%). CONCLUSION: Overall, a significant proportion of patients and caregivers were unfamiliar with these five integrative therapies. Increasing education, decreasing cost, and a recommendation by medical professionals would improve CIM usage.

This study examines the relationship between housing satisfaction and low-income tenants’ willingness to pay rental fees in government-owned rental apartments (GORAs), a form of social housing in I...

This paper proposes a first monetary measure of the private costs of celiac disease, including intangible costs (physical symptoms, logistical constraints, etc.) in Switzerland. This auto-immune disease damages the intestine when patients ingest gluten. The only treatment currently available is a gluten-free diet, which implies great nutritional constraints. To get a monetary equivalent of the costs borne by celiac patients, we used a contingent valuation. The scenario suggested to celiac patients a treatment in form of a daily pill, which would allow them to eat normally and avoid any physical pain from celiac disease. Mean Willingness To Pay (WTP) for the treatment is found to be around CHF 87 (approx. USD 87) per month. WTP is positively influenced by direct and indirect costs of the disease. Oppositely, individuals, who find the gluten-free diet healthier are willing to pay less. Finally, unlike symptoms before diagnostic, the current presence or intensity of physical symptoms are found to be insignificant. The latter result can be explained by the fact that, individuals facing stronger symptoms are more likely to adhere strictly to the GFD and hence to reduce their frequency.

Cattle farmers in Gunungkidul Regency face several cattle diseases such as Helminthiasis, Anthrax, Downer Cow Syndrome, and Intoxication in which these diseases mostly attack female cows. To prevent financial loss for the farmers, the government facilitates them with cattle insurance. This study aims to determine the reasons and the cattle farmers’ willingness-to-pay for the cattle insurance by conducting a survey addressed to 100 cattle farmers and identifying the factors related to it. This study used a Contingent Valuation Method in estimating the cattle farmer's WTP. The various factors that influence the farmer's WTP were analyzed by using natural logarithm regression models. Based on the results of the study, it was found that the willingness-to-pay for cattle farmers who did not participate in cattle insurance are 22,600 IDR and farmers who participate in cattle insurance are 36,320 IDR. Education, household income, and farmers’ interest in the insurance were positively effecting toward the farmers' willingness-to-pay. However, age and the number of families showed the negative ones toward the farmers’ willingness-to-pay.

Background A recent randomized controlled trial (RCT), performed by the authors, comparing early surgical microdiscectomy with 6 months of nonoperative care for chronic lumbar radiculopathy showed that early surgery resulted in improved outcomes. However, estimates of the incremental cost-utility ratio (ICUR), which is often expressed as the cost of gaining one quality-adjusted life year (QALY), of microdiscectomy versus nonsurgical management have varied. Radiculopathy lasting more than 4 months is less likely to improve without surgical intervention and may have a more favorable ICUR than previously reported for acute radiculopathy. Question/purpose In the setting of chronic radiculopathy caused by lumbar disc herniation, defined as symptoms and/or signs of 4 to 12 months duration, is surgical management more cost-effective than 6 months of nonoperative care from the third-party payer perspective based on a willingness to pay of less than CAD 50,000/QALY? Methods A decision analysis model served as the vehicle for the cost-utility analysis. A decision tree was parameterized using data from our single-center RCT that was augmented with institutional microcost data from the Ontario Case Costing Initiative. Bottom-up case costing methodology generates more accurate cost estimates, although institutional costs are known to vary. There were no major surgical cost drivers such as implants or bone graft substitutes, and therefore, the jurisdictional variance would be minimal for tertiary care centers. QALYs derived from the EuroQoL-5D were the health outcome and were derived exclusively from the RCT data, given the paucity of studies evaluating the surgical treatment of lumbar radiculopathy lasting 4 to 12 months. Cost-effectiveness was assessed using the ICUR and a threshold of willingness to pay CAD 50,000 (USD 41,220) per QALY in the base case. Sensitivity analyses were performed to account for the uncertainties within the estimate of cost utility, using both a probabilistic sensitivity analysis and two one-way sensitivity analyses with varying crossover rates after the 6-month nonsurgical treatment had concluded. Results Early surgical treatment of patients with chronic lumbar radiculopathy (defined as symptoms of 4 to 12 months duration) was cost-effective, in that the cost of one QALY was lower than the CAD 50,000 threshold (note: the purchasing power parity conversion factor between the Canadian dollar (CAD) and the US dollar (USD) for 2019 was 1 USD = 1.213 CAD; therefore, our threshold was USD 41,220). Patients in the early surgical treatment group had higher expected costs (CAD 4118 [95% CI 3429 to 4867]) than those with nonsurgical treatment (CAD 2377 [95% CI 1622 to 3518]), but they had better expected health outcomes (1.48 QALYs [95% CI 1.39 to 1.57] versus 1.30 [95% CI 1.22 to 1.37]). The ICUR was CAD 5822 per QALY gained (95% CI 3029 to 30,461). The 2-year probabilistic sensitivity analysis demonstrated that the likelihood that early surgical treatment was cost-effective was 0.99 at the willingness-to-pay threshold, as did the one-way sensitivity analyses. Conclusion Early surgery is cost-effective compared with nonoperative care in patients who have had chronic sciatica for 4 to 12 months. Decision-makers should ensure adequate funding to allow timely access to surgical care given that it is highly likely that early surgical intervention is potentially cost-effective in single-payer systems. Future work should focus on both the clinical effectiveness of the treatment of chronic radiculopathy and the costs of these treatments from a societal perspective to account for occupational absences and lost patient productivity. Parallel cost-utility analyses are critical so that appropriate decisions about resource allocation can be made. Level of evidence Level III, economic and decision analysis.

Purpose The purpose of this study was to assess patient interest and willingness to pay (WTP) for teleophthalmology services, whose benefits include improved healthcare access and potential cost savings. Patients and Methods Cross-sectional study of 215 patients attending a single tertiary center to assess their interest in teleophthalmology. Comparisons between those interested and those not interested were conducted; logistic regression was used to evaluate the effect of price on interest. Results Two thirds (66.5%) of patients were interested in teleophthalmology instead of in-person clinic visits. Those interested were significantly younger than uninterested patients (48.8±22.7 vs 62.4±18.3 years) and were more likely to miss work to attend clinic, own both a computer and smartphone, have experience with video conferencing, and use the internet frequently (all P$28) price points. Higher level of education was associated with WTP (OR=2.31, 95% CI 1.05–5.06; P=0.037). Conclusion Most patients were interested in teleophthalmology services, especially if they were young, would otherwise miss work, and were familiar with electronics, video conferencing, and internet use. Most interested patients expressed WTP out-of-pocket. Targeting factors related to teleophthalmology interest may increase patient use and enhance communication, thereby improving healthcare access and follow-up.

Bats populations and their habitats are currently threatened globally, but particular declines have been seen across Europe. The contingent valuation method is commonly used to assign an economic value to species conservation through a willingness to pay (WTP) surveys. We carried out face-to-face interviews of a representative to the Greek population sample (n = 1131) and used a multiple-bounded discrete choice approach to estimate WTP for bat conservation. More than half of the Greek population was supportive of bat conservation (54.6%). Mean WTP was estimated at €21.71, and the total amount that could be collected was €105.6 million, after considering the number of taxpayers and the proportion of supportive people. There was an interplay between emotions, with likeability being the most important positive predictor of support, and fear the most important negative predictor of WTP for bat conservation. Among sociodemographics, older participants, with higher education, farmers, and pet owners showed the highest support, while those with higher education, farmers, and consumptive recreationists offered the highest bid for bat conservation. Participants drew information about bats mostly from informal sources, such as friends, movies, novels, and comics. Our study allowed for the estimation of public support and necessary funds for bat conservation, which are valuable for successful conservation management. Findings will also be critical for the design and implementation of effective education and outreach programs, aimed at increasing knowledge about bats and ultimately support for bat conservation actions.

The value of travel time savings (VTTS) representing the willingness to pay to reduce travel time, consists of two components: the value of liberating time [equal to the value of leisure (VoL)] and the value of time assigned to travel (VTAT), representing the travel conditions of a trip. Their relative values indicate which dimension to emphasize when investing in transport: speed or comfort. In this paper, we formulate and estimate a framework aimed at the improvement in the estimation of the VoL. By introducing a novel treatment of time assigned to domestic work, we consider that unpaid labor should be assigned a wage rate as a measure of the expenses avoided when assigning time to those chores. We use state-of-the-art data on time use and expenses as well as online data on gig workers collected in Austria, and apply the time-use and expenditure model of Jara-Diaz et al. (Transp Res Part B 42(10):946–957, 2008). The wage rates for paid and unpaid work were combined to re-formulate the budget constraint, which affected women more than men due to the higher involvement of the former in domestic activities. Compared against the original estimation, the VoL changed from €10/h for men and €6/h for women to €9/h for both genders, which in turn yields a larger average VTAT, which becomes positive for public transport. As a conclusion, the novel treatment of domestic labor contributes to closing the gap in the VoL between genders and highlights the power of unveiling the components behind the VTTS. The empirical findings imply that investments in travel time reductions rather than in comfort should be prioritized, given the very good conditions of public transport in Austria., Transportation, 49, ISSN:0049-4488, ISSN:1572-9435

The COVID-19 pandemic has fundamentally disrupted travel behavior and consumer preferences. To slow the spread of the virus, public health officials and state and local governments issued stay-at-home orders and, among other actions, closed nonessential businesses and educational facilities. The resulting recessionary effects have been particularly acute for U.S. toll roads, with an observed year-over-year decline in traffic and revenue of 50% to 90% in April and May 2020. These disruptions have also led to changes in the types of trip that travelers make and their frequency, their choice of travel mode, and their willingness to pay tolls for travel time savings and travel time reliability. This paper describes the results of travel behavior research conducted on behalf of the Virginia Department of Transportation before and during the COVID-19 pandemic in the National Capital Region of Washington, D.C., Maryland, and Northern Virginia. The research included a stated preference survey to estimate travelers’ willingness to pay for travel time savings and travel time reliability, to support forecasts of traffic and revenue for existing and proposed toll corridors. The survey collected data between December 2019 and June 2020. A comparison of the data collected before and during the pandemic shows widespread changes in travel behavior and a reduction in willingness to pay for travel time savings and travel time reliability across all traveler types, particularly for drivers making trips to or from work. These findings have significant implications for the return of travelers to toll corridors in the region and future forecasts of traffic and revenue.

Pork salami with a high content of polyunsaturated fatty acids (PUFA) may be unappealing for consumers as it is more prone to the development of off-flavors and a “greasy” texture. In Switzerland, a share of more than 15.5% PUFA in back fat is penalized with a payment deduction of minimally CHF 0.10 per kilogram carcass weight. In this study, we aimed to assess the effect of different PUFA levels and organic labeling on Swiss consumers’ acceptance of pork salami. We conducted a sensory consumer experiment, following a two-factorial treatment structure, crossing the factor “PUFA level” (15.4% PUFA in back fat vs. 18.3% PUFA in back fat) and the factor “information on production system” (blind vs. non-organic vs. organic). Consumer acceptance was captured using a 9-point hedonic scale for overall liking and an open-ended willingness to pay question. Furthermore, participants had the opportunity to comment on their sensory experience for each product in an open text question. An increased PUFA content in back fat of 18.3% vs. 15.4% did not lead to a significant difference in consumer acceptance of pork salami in either of the three information conditions, even though, as identified in the analysis of open comments, the high-PUFA salami tended to be more often perceived as “softer” and/or “more greasy”. In contrast, consumer acceptance of both the high- and low-PUFA salami was significantly higher under the “organic” than under either the “non-organic” or blind tasting conditions. Based on this study, a PUFA content in back fat of up to 18% is not expected to have a negative impact on consumer acceptance of pork salami. Therefore, and based on previous findings, we recommend to adapt the Swiss pork fat quality grading system to account for this higher acceptable PUFA limit of 18%. Future research should further explore trade-offs between sensory quality, sustainability, and healthiness while taking consumers’ heterogeneity into account.

Public opinion about climate change is well documented, but policymaker attitudes are less known. To examine the foundations for policymaking, we analyze congruence in policymaker-citizen attitudes concerning climate change. We use surveys conducted among the Finnish policymaking elite (n = 675) and a representative sample of the Finnish voting-age population (n = 1,701) in 2018–19, which included identical items of climate change concern and willingness to reduce personal living standards to curb climate change. Policymakers demonstrate much more concern for climate change and willingness to pay, suggesting a significant attitudinal disconnect between policymakers and citizens. The incongruence remains when taking personal income into account. In terms of party support, policymaker opinion aligns with opinions of voters of the green party in Finland. We speculate as to whether the observed opinion incongruence could restrict policymakers’ possibilities to make climate-friendly policies and whether climate-skeptic populist parties could use it for political gain. acceptedVersion

In our rapidly changing world, consumers are being exposed to an increasing amount of product information day by day, while they are trying to make the best choice in the light of this information. This provides a broad scope for marketers involved in marketing practice or research processes to examine the impact of different product information on consumption behavior. The country-of-origin information is seen as a point in consumers mind that has an impact on the quality perception of the relevant products, purchasing preferences and other issues. Consumers may have tendencies to prefer the products of certain countries or have positive perceptions of that country's product. Although it is a crucial issue for both marketing practitioners and academicians, there is still a lack of literature about the impact of consumers’ perceptions towards country of origin of the products on their willingness to pay more and purchase intentions. The aim of the study is to determine the relationship between country of origin (COO), willingness to pay more and purchase intention. Within the scope of the research, the data obtained from 720 consumers were analyzed and then the research model was tested. As a result of the analysis, a significant and positive relationship between the quality perception of the country of origin (COO) and the purchase intention is found. In addition, it was determined that willingness to pay more has an intermediary role in the effect of the quality perception of COO on the purchase intention.

Many countries use a fee-for-service model for hepatitis B vaccination, which amplifies health disparities across socioeconomic statuses and contributes to inequalities in HBV vaccination rates. We examined the role of household income on women’s willingness to pay and the amount they are willing to pay for HBV vaccination to identify a more optimized payment scheme and equitable access across all income groups., Key Findings Most women were willing to pay for the hepatitis B virus (HBV) vaccine and there was no difference in willingness to pay for HBV vaccination between income quintiles.The amount willing to pay for the vaccine was different between income levels for prices higher than US$4.50. Key Implications Because women from the lowest income quintile had the lowest awareness of the HBV vaccine, efforts on education and awareness of HBV and the vaccine should focus on low-income women.Given the high vertical transmission rates of HBV infection, policy makers should prioritize vaccinating women of reproductive age as well as newborns.In light of the finding that higher-income women were willing to pay more for the vaccine, adopting a sliding-scale payment system may mitigate challenges with funding and provide opportunities for equitable vaccine access., Background: Hepatitis B virus (HBV) infection is endemic in Vietnam and can be transmitted from mother to child. Vaccination of women of reproductive age (WRA) can reduce this transmission. Because adult HBV vaccination in Vietnam follows a fee-for-service model, research is needed to determine the effect of household income on willingness to pay (WTP) to ensure equitable access to the vaccine. Methods: A cross-sectional study was performed in Hanoi, Vietnam, in April 2018, among WRA. Questionnaires were administered to assess household income, HBV history, vaccination status, vaccine awareness, and WTP for the vaccine. Multivariable logistic and interval regression were performed to assess the impact of household income on WTP for HBV vaccine. Results: This study found that 62.3% of all participants were willing to pay for the HBV vaccine with no differences in WTP across income quintiles. There were significant differences among household income levels in awareness of HBV vaccination and WTP amount beyond US$4.50 with the lowest awareness and WTP amount among women from the lowest income quintiles. Conclusions: Our data suggest the need to subsidize HBV vaccination for low-income women to ensure more equitable access to HBV vaccination. We propose that a sliding-scale payment method may be an effective strategy in light of limited funding to support vaccination expansion. An education campaign focusing on lower-income households should also be implemented in conjunction with this program. Further research would be required to evaluate consumer acceptance of this payment scheme and to develop an appropriate sliding scale to maximize vaccine uptake.

South Korea is pushing for the waste-to-hydrogen (W2H) project to reduce greenhouse gases and utilize plastic and vinyl waste (PVW) while reducing environmental pollution from PVW. This research seeks to estimate additional willingness to pay (WTP) for electricity produced using W2H over that produced using traditional power sources, such as coal and nuclear. For the purpose of the estimation, a contingent valuation survey of 1000 people was performed employing the closed-ended one-and-one-half-bound question during November 2020. A spike model is utilized to reflect zero WTP values that a number of interviewees reported in the survey. Several factors affecting the additional WTP were also analyzed to derive implications. The average WTP was computed as KRW 27.7 (USD 0.025) per kWh with statistical significance, which reaches 26.4% of the electricity price. One more point to note is that 54.3% of the respondents stated a zero WTP as they thought that W2H is of no value to them or were worried that the W2H project could increase electricity bills.

Background The aim of this study was to assess the willingness of the general population in Germany to bear the economic costs of measures against the spread of SARS-CoV-2. Methods Repeated cross-sectional data were taken from three waves of a nationally representative survey of individuals aged 18 to 74 years (wave 8: 21–22 April 2020, N = 976; wave 16: 7–8 July 2020, N = 977; wave 38: 9–10 March 2021). The willingness to accept a reduction of annual household income in order to bear the economic costs of the measures against SARS-CoV-2 served as outcome measure. Two-part models were used including explanatory variables on sociodemographic and (subjectively assessed) potential health hazard caused by COVID-19. Results 65.5% (61.6%; 56.9%) of respondents in wave 8 (wave 16; wave 38) were willing to accept a reduction of income, with the likelihood for accepting a reduction of income being positively associated with higher affect (i.e. emotional reaction) and presumed severity regarding COVID-19 in all three waves. The mean maximum percentage of income participants were willing to give up was 3.3% (95% CI: 2.9 to 3.7%) in wave 8, 2.9% (95% CI: 2.5 to 3.3%) in wave 16 and 4.3% (95% CI: 3.6 to 5.0%) in wave 38, with presumed severity of COVID-19 being positively associated with this percentage in all three waves. Conclusions The majority of respondents indicated willingness to sacrifice income in order to bear the costs of measures against the spread of SARS-CoV-2, with the potential health hazard caused by COVID-19 being consistently associated with this willingness. However, the proportion of individuals who were willing to give up income slightly decreased throughout the pandemic.

Naoya Emoto,1– 3 Mikiko Okazaki-Hada,1 Yuji Yamaguchi,1 Fumitaka Okajima,1,2 Rei Goto,4 Hitoshi Sugihara1 1Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; 2Department of Diabetes, Endocrinology and Metabolism, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan; 3Diabetes & Thyroid Clinic, Sakura Chuo Hospital, Chiba, Japan; 4Graduate School of Business Administration, Keio University, Tokyo, JapanCorrespondence: Naoya EmotoDiabetes & Thyroid Clinic, Sakura Chuo Hospital, 20-4, Sakaecho, Sakura City, Chiba, 285-0014, JapanTel +81-43-486-1311Fax +81-43-486-1314Email emotonaoya1954@gmail.comPurpose: Patients with thyrotoxicosis show neuropsychological changes, and these may damage the quality of informed consent in clinical practice. Therefore, we examined patients’ real-life preferences to assess whether change in risk preferences was dependent on thyroid function state.Patients and Methods: The participants were 86 patients who were newly diagnosed with Graves’ thyrotoxicosis between 1 January and 31 December 2018 (group A), and an additional 33 euthyroid patients diagnosed before 2018 (group B). In a survey conducted via a questionnaire based on the concept of behavioral economics, we sought to determine risk preferences, rationality of choices, and other relevant factors. An identical second survey was completed 6– 12 months later by 36 patients in group A after their thyroid functions had been normalized by treatment, and by 11 euthyroid patients in group B. We performed paired analysis of the first and second surveys in 32 patients of group A and single regression analysis of a total of 140 surveys obtained from 119 patients by combining the first and second surveys of groups A and B with serum level of FT3 as an independent variable.Results: The paired analysis indicated that there was no significant difference in any survey item. The single regression analysis revealed that willingness-to-pay (WTP) for preventive medicine and monthly average out-of-pocket (OOP) expenditure on medical care were both significantly positively associated with serum level of FT3. Patients in the hyperthyroid state tend to have high WTP for preventive medicine, which may be accelerated by the anchoring effect of OOP expenditure.Conclusion: Almost all risk preferences of patients with Graves’ disease are constant, rational, and reproducible in the hyperthyroid and euthyroid states. However, medical professionals should be aware that the willingness of patients with thyrotoxicosis to pay for medical costs may change after the normalization of thyroid function.Keywords: informed consent, behavioral economics, out-of-pocket expenditure, anchoring effects

Introduction/Main Objectives: This study estimates how much economic value will be lost from contact activities within the coastal areas in the research location. Background Problems: The area of Semarang City has flood and tidal problems, the damage to the mangrove forests in Semarang City began with the boom in shrimp farming between 1980 and 1990. Hopefully, this valuation can provide an overview of the current health of the ecosystem and become the basis for a mangrove management strategy in the future. Novelty: The novelty of this study is that it uses a sharper satellite (Image Pleades Resolution 0.5 m) to calculate the mangrove area in the research location. Research Methods: This research uses a total economic valuation, an estimation of the mangrove’s carbon stock and heavy metals, the replacement cost to prevent tidal flooding, and the willingness to pay. Findings/Results: We find that the existing economic value in the study area is very large and should be preserved for conservation. Conclusion: The environment cannot produce something instantly, but it needs to be preserved as a balance to nature.

Appendicitis is the most common pediatric emergent surgical condition, with 77,000 American pediatric admissions costing $680 million US annually. Diagnosing appendicitis can be challenging. The prospective Quality Assurance and performance improvement project for suspected aPPEndicitis (QAPPE) study implemented a standardized appendicitis assessment pathway. This current study aims to assess the cost-effectiveness of the QAPPE pathway.QAPPE data (February 2018-January 2019) were compared to retrospective data from the year prior (January-December 2017). Patients aged18, presenting with suspicion of appendicitis were identified using the emergency department patient database. Patients were excluded if they were transferred from an outside center or if appendicitis was not suspected. Study arms were compared using Student's t-test and assessed with standard costing techniques. The Incremental Cost-Effectiveness Ratio (ICER) was determined. Deterministic and probabilistic sensitivity analyses of the model were performed. Effectiveness was assessed by percent of negative appendectomies where alternate diagnosis was made intraoperatively or histologically. Significance was set at p 0.05.QAPPE (n = 247) and traditional care (n = 234) patients were compared. Traditional care had higher admission frequency and lower pediatric appendicitis score. Demographics between all included patients and those admitted were similar overall. Patient costs were $3656.32 (95% CI $2407-$5250) Canadian (CAD) for QAPPE and $3823.56 (95% CI $2604-$5451) CAD for traditional care. QAPPE was the dominant strategy in the base model and probabilistic simulation found it favored in 64.7% of model iterations with a willingness to pay of $70,000 CAD.Using the QAPPE pathway to assess patients with suspected appendicitis reduced costs and improved effectiveness of patient care.2.

Due to the rising interest in healthy products, superfoods such as pomegranate have begun to spread widely on the international market in recent years. Identification of the consumer choice determinants is a key factor behind the success of innovative products. Nevertheless, to date, there has been no comprehensive analysis of consumers’ preferences for pomegranate. The aim of this study is to understand the characteristics of pomegranate and its derivatives that are most preferred by consumers and to identify the buyers’ profiles by performing a systematic review (SR). The results suggest that there is not equal interest in the literature in all areas of the review. Indeed, most efforts have been made in characterizing the products, whereas consumers’ profiles and their willingness to pay for the various products features have been scarcely investigated. The SR highlights that consumer preference is first correlated with taste and, in particular, with the sweetness (positively) and astringency (negatively) of the product. The red colour and uniform shape of the husk are attractive attributes for consumers, as is the juiciness of the arils. Some innovative methods of product storage, such as intermittent heating (for fruits) and the use of pectin methyl esterase (for arils), guarantee higher consumer acceptability due to the maintenance of product genuineness. Moreover, familiarity with the product seems to be the main driver influencing consumers’ purchase decisions; in addition, people who are more “future oriented” are more willing to pay for pomegranate because of the nutraceutical attributes stressed on the label.

Background The difference between the costs of the newer and older glucose-lowering drugs (GLMs) has been steadily increasing since 2010. In 2018, newer drugs cost 8-12 times more than older drugs (except for insulin). This study aimed to understand how the cost change influenced the cost-effectiveness of the newer GLMs. Methods Based on our previous literature review on US-based cost-effectiveness studies comparing newer (i.e., dipeptidyl peptidase-4 inhibitors (DPP4), glucagon-like peptide 1 receptor agonists (GLP1-RA), and sodium-glucose transport protein 2 inhibitors) with older GLMs, we identified 12 studies that reported the cost-effectiveness of newer drugs based on drug costs estimated before 2010. We updated the corresponding cost-effectiveness of each study by replacing the old cost estimates with 2018 estimates from the 2018 IBM® MarketScan® Commercial Claims Databases. The time window and willingness to pay threshold were consistent with the original studies. Results Only 8% of the original studies suggested that the older drugs were cost-effective. However, 58% of studies were in favor of the older drugs after the cost update. Among the four studies comparing newer drugs with thiazolidinediones, all the original results favored newer drugs. However, all studies suggested thiazolidinedione to be cost-effective in the updated analysis. For the four studies comparing newer drugs with sulfonylureas, two studies suggested the sulfonylureas to be cost-effective after the cost update. All four studies suggested newer drugs to be cost-effective when compared with insulin in the original study. Only 1 flipped its conclusion when 2018 costs were used. Our sensitivity analysis shows that our results are robust under a 30% rebate. Conclusion Significant changes in the cost of GLMs have impacted the economic value of different GLM classes substantially. More cost-effectiveness analyses are warranted to support the drug choice in T2DM management.