Abstract
© 2020, The Author(s).Objective: 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. Methods: 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. Results: 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. Conclusions and Implications: 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.
| Original language | English |
|---|---|
| Pages (from-to) | 443-458 |
| Journal | PharmacoEconomics |
| Volume | 38 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 1 May 2020 |
| Externally published | Yes |
Funding
The authors thank Natalie Boytsov, Levison Chiwaula, and Jesús Martín Fernández for providing the datasets of their studies for this meta-analysis. Furthermore, the authors thank Arthur Attema and the participants of lolaHESG 2017 for their valuable feedback on an earlier version of this paper. This research (including open access publication) was funded by the strategic program RIVM (S/133005), a research fund from the National Institute of Public Health and the Environment, the Netherlands. The funders had no role in the design of the study, its administration, or the analysis of the results and were not involved in the manuscript preparation or submission.
| Funders | Funder number |
|---|---|
| Arthur Attema | |
| Levison Chiwaula | |
| Natalie Boytsov | |
| National Institute of Public Health and the Environment |