Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Pharmacoeconomics. 2020 May;38(5):443-458. doi: 10.1007/s40273-020-00890-x.
The objective of this systematic review was to review the available evidence on the disparity between willingness to accept (WTA) and willingness to pay (WTP) for healthcare goods and services.
A tiered approach consisting of (1) a systematic review, (2) an aggregate data meta-analysis, and (3) an individual participant data meta-analysis was used. MEDLINE, EMBASE, Scopus, Scisearch, and Econlit were searched for articles reporting both WTA and WTP for healthcare goods and services. Individual participant data were requested from the authors of the included studies.
Thirteen papers, reporting WTA and WTP from 19 experiments/subgroups, were included in the review. The WTA/WTP ratios reported in these papers, varied from 0.60 to 4.01, with means of 1.73 (median 1.31) for 15 estimates of the mean and 1.58 (median 1.00) for nine estimates of the median. Individual data obtained from six papers, covering 71.2% of the subjects included in the review, yielded an unadjusted WTA/WTP ratio of 1.86 (95% confidence interval 1.52-2.28) and a WTA/WTP ratio adjusted for age, sex, and income of 1.70 (95% confidence interval 1.42-2.02). Income category and age had a statistically significant effect on the WTA/WTP ratio. The approach to handling zero WTA and WTP values has a considerable impact on the WTA/WTP ratio found.
The results of this study imply that losses in healthcare goods and services are valued differently from gains (ratio > 1), but that the degree of disparity found depends on the method used to obtain the WTA/WTP ratio, including the approach to zero responses. Irrespective of the method used, the ratios found in our meta-analysis are smaller than the ratios found in previous meta-analyses.
本系统评价的目的是回顾有关医疗保健商品和服务的支付意愿（WTP）和可接受意愿（WTA）之间差异的现有证据。
采用分层方法，包括（1）系统评价，（2）汇总数据荟萃分析，和（3）个体参与者数据荟萃分析。检索 MEDLINE、EMBASE、Scopus、Scisearch 和 Econlit 以获取报告医疗保健商品和服务的 WTA 和 WTP 的文章。向纳入研究的作者请求个体参与者数据。
共纳入了 13 篇报告了 19 个实验/亚组的 WTA 和 WTP 的文献。这些文献中报告的 WTA/WTP 比值从 0.60 到 4.01 不等，15 个平均值的估计值为 1.73（中位数 1.31），9 个中位数的估计值为 1.58（中位数 1.00）。从六篇涵盖了本综述中纳入的 71.2%的受试者的文献中获得的个体数据，得出未经调整的 WTA/WTP 比值为 1.86（95%置信区间 1.52-2.28），以及调整了年龄、性别和收入的 WTA/WTP 比值为 1.70（95%置信区间 1.42-2.02）。收入类别和年龄对 WTA/WTP 比值有统计学上的显著影响。处理 WTA 和 WTP 值为零的方法对发现的 WTA/WTP 比值有很大影响。
本研究的结果表明，医疗保健商品和服务的损失与收益的估值不同（比值＞1），但发现的差异程度取决于获得 WTA/WTP 比值的方法，包括对零响应的处理方法。无论使用哪种方法，我们的荟萃分析中发现的比值都小于之前荟萃分析中发现的比值。
