Jacobs R Jake, Moleski Ronald J, Meyerhoff Allen S
Capitol Outcomes Research, Inc, Alexandria,Virginia 22310, USA.
Pharmacoeconomics. 2002;20(11):739-47. doi: 10.2165/00019053-200220110-00003.
The cost effectiveness of hepatitis A prevention is typically assessed by comparing vaccination costs with the number of life-years saved. This endpoint does not consider the benefits of preventing nonfatal yet symptomatic infections. Nearly as many days of healthy life are lost to hepatitis A morbidity as mortality.
To investigate the value American adults place on preventing hepatitis A symptoms by using the willingness-to-pay and time trade-off metrics.
We provided a written description of hepatitis A symptoms to 181 American adults, who judged the amounts of money and lifespan they would forego to avoid them. The description made no reference to the possibility of fatality, and respondents were asked not to consider costs of medical care and work loss. We investigated relationships between demographic characteristics and each metric, the relationship between the two metrics, and the test/re-test reliability of the metrics.
Respondents would pay a median of dollars US 2000 (inter-quartile range, dollars US 500 to 5000; 2001 values) for risk-free prevention of hepatitis A symptoms. Alternatively, they would forego a median of 28 days survival (inter-quartile range, 6 to 40 days) for cost-free prevention. There was modest correlation between willingness-to-pay and time trade-off responses (r = 0.24, p < 0.01), suggesting these metrics measure independent aspects of preference. Strong correlations between measures obtained 30 days apart support the test/re-test reliability of willingness to pay (r = 0.70, p < 0.01) and time trade-off (r = 0.73, p < 0.01) metrics. In multivariate analyses, higher household income (p = 0.02) predicted greater willingness to pay in dollars. Male gender (p < 0.01) predicted greater willingness to forego life expectancy for better health.
In our study population of US adults, most were willing to pay or trade life expectancy for a hypothetical preventative drug for hepatitis A symptoms. The amount respondents were willing to pay appears dependent on their income level while males are willing to trade more life expectancy than female respondents. The values expressed should be considered in assessments of hepatitis A prevention.
甲型肝炎预防的成本效益通常通过比较疫苗接种成本与挽救的生命年数来评估。该终点未考虑预防非致命但有症状感染的益处。因甲型肝炎发病而损失的健康生活天数几乎与因死亡而损失的天数一样多。
通过使用支付意愿和时间权衡指标，调查美国成年人对预防甲型肝炎症状的重视程度。
我们向181名美国成年人提供了一份甲型肝炎症状的书面描述，让他们判断为避免这些症状愿意放弃的金钱数额和寿命。描述中未提及死亡的可能性，并且要求受访者不考虑医疗费用和工作损失成本。我们研究了人口统计学特征与每个指标之间的关系、两个指标之间的关系以及指标的重测信度。
受访者为无风险预防甲型肝炎症状愿意支付的中位数为2000美元（四分位间距为500美元至5000美元；2001年价值）。或者，他们为免费预防愿意放弃的生存中位数为28天（四分位间距为6天至40天）。支付意愿和时间权衡反应之间存在适度相关性（r = 0.24，p < 0.01），表明这些指标衡量了偏好的不同方面。相隔30天获得的测量值之间的强相关性支持了支付意愿（r = 0.70，p < 0.01）和时间权衡（r = 0.73，p < 0.01）指标的重测信度。在多变量分析中，较高的家庭收入（p = 0.02）预示着更高的支付意愿。男性（p < 0.01）预示着为了更好的健康更愿意放弃预期寿命。
在我们的美国成年人研究人群中，大多数人愿意为一种假设的预防甲型肝炎症状的药物支付费用或用预期寿命进行交换。受访者愿意支付的金额似乎取决于他们的收入水平，而男性比女性受访者更愿意用更多的预期寿命进行交换。在评估甲型肝炎预防时应考虑所表达的价值。
