Abstract
Childhood immunisation is one of the most cost-effective public health interventions, yet its population coverage in low- and middle-income countries is severely limited by the fiscal constraints that health services face. A recent proposal suggested that commitments to purchase vaccines and make them available to developing countries for modest co-payments could solve the problem. However, this is dependent on communities being willing and able to share the cost in this way, which is difficult to assess. One possible method to assess this demand is contingent valuation (CV). This article evaluates the usefulness of using CV in this way, by reviewing applications of CV in developing countries against current ’standards’ for CV of immunisation in the literature.
A structured review was adopted with reference to the standard frameworks for methodological evaluation. A set of five criteria were developed for evaluating an ‘acceptable’ CV study: (i) response rate; (ii) association between willingness to pay (WTP) and socioeconomic status (SES); (iii) sensitivity of WTP to benefit scale/scope; (iv) predictive validity; and (v) reliability in elicitation formats. Two strands of literature search were conducted using electronic databases (MEDLINE, EMBASE, HEALTHSTAR and Econlit) from 1966 to 2003, one for CV studies of immunisation and one for CV studies in developing countries.
Twelve CV studies of vaccination and 13 CV studies undertaken within developing countries were identified and reviewed. The quality of existing CV studies conducted in developing countries exceeded the benchmark standard set by studies of immunisation in the developed world in four of the five criteria. WTP estimates appeared both internally valid (i.e. associations with SES) and externally valid (i.e. predictive validity), reliability in developing countries was no less than that of the benchmark level in the existing literature, and the high response rates suggested that CV can be administered to a rural, and perhaps less literate, population. Only sensitivity to scale/scope was not well demonstrated.
Our assessment indicated that the CV technique offers a promising tool to estimate the demand for childhood immunisation in low- and middle-income countries. International agencies are therefore encouraged to devote resources to such an application when designing their support to the immunisation programmes.
Similar content being viewed by others
References
World Bank. Investing in health. The World Development Report 1993. Washington, DC: World Bank, 1993
Ehreth J. The global value of vaccination. Vaccine 2003; 21: 596–600
Kremer M. Creating markets for new vaccines: Part I. Rationale. Washington, DC: National Bureau of Economic Research, 2000. Working paper no.: 7716
Ainsworth M, Batson A, Rosenhouse S, editors. Accelerating an AIDS vaccine for developing countries: issues and options for the World Bank. Economics of AIDS. Washington, DC: World Bank, 1999
Kremer M. Creating markets for new vaccines: Part II. Design issues. Washington, DC: National Bureau of Economic Research, 2000. Working paper no.: 7717
Olsen JA, Smith RD. Theory versus practice: a review of ‘willingness-to-pay’ in health and health care. Health Econ 2001; 10: 39–52
Smith RD. The discrete-choice willingness-to-pay question format in health economics: should we adopt environmental guidelines? Med Decis Making 2000; 20: 194–206
Klose T. The contingent valuation method in health care. Health Policy 1999; 47: 97–123
Johannesson M. Theory and methods of economic evaluation of health care. Dordrecht: Kluwer Academic Publishers, 1996
Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ 2001; 323: 334–6
Liddle J, Williamson M, Irwig L. Method for evaluating research and guideline evidence (MERGE). Sydney (NSW): New South Wales Department of Health, 1996
Drummond MF, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ 1996; 313: 275–83
Mason J, Eccles M, Freemantle N, Drummond M. Nicely does it: economic analysis within evidence-based clinical practice guidelines. York: University of York, 1998. CHE discussion paper no.: 164
Smith RD. Construction of the contingent valuation market in health care: a critical assessment. Health Econ 2003; 12: 609–28
Whittington D. Administering contingent valuation surveys in developing countries. World Dev 1998; 26: 21–30
Lieu TA, Finkelstein JA, Adams MM. Pediatricians’ views on financial barriers and values for pneumococcal vaccine for children. Ambul Pediatr 2002; 2: 358–66
Sansom SL, Barker L, Corso PS. Rotavirus vaccine and intussusception: how much risk will parents in the United States accept to obtain vaccine benefits? Am J Epidemiol 2001; 154: 1077–85
Meyerhoff AS, Weniger BG, Jacobs RJ. Economic value to parents of reducing the pain and emotional distress of childhood vaccine injections. Pediatr Infect Dis J 2001; 20: S57–62
Kuppermann M, Nease Jr RF, Ackerson LM. Parents’ preferences for outcomes associated with childhood vaccinations. Pediatr Infect Dis J 2000; 19: 129–33
Lieu TA, Black SB, Ray GT. The hidden costs of infant vaccination. Vaccine 2000; 19: 33–41
Lee PY, Matchar DB, Clements DA. Economic analysis of influenza vaccination and antiviral treatment for healthy working adults. Ann Intern Med 2002; 137: 225–31
Hall J, Kenny P, King M. Using stated preference discrete choice modelling to evaluate the introduction of varicella vaccination. Health Econ 2002; 11: 457–65
Steiner M, Vermeulen LC, Mullahy J. Factors influencing decisions regarding influenza vaccination and treatment: a survey of healthcare workers. Infect Control Hosp Epidemiol 2002; 23: 625–7
Whittington D, Matsui-Santana O, Freiberger JJ. Private demand for a HIV/AIDS vaccine: evidence from Guadalajara, Mexico. Vaccine 2002; 20: 2585–91
Arana JE, Leon CJ. Willingness to pay for health risk reduction in the context of altruism. Health Econ 2002; 11: 623–35
Shiell A, Gold L. Contingent valuation in health care and the persistence of embedding effects without the warm glow. J Econ Psychol 2002; 23: 251–62
Pennie RA, O’Connor AM, Garvock MJ. Factors influencing the acceptance of hepatitis B vaccine by students in health disciplines in Ottawa. Can J Public Health 1991; 82: 12–5
Foreit JR, Foreit KG. The reliability and validity of willingness to pay surveys for reproductive health pricing decisions in developing countries. Health Policy 2003; 63: 37–47
Dong H, Kouyate B, Snow R. Gender’s effect on willingness-to-pay for community-based insurance in Burkina Faso. Health Policy 2003; 64: 153–62
Bhatia MR, Fox-Rushby JA. Willingness to pay for treated mosquito nets in Surat, India: the design and descriptive analysis of a household survey. Health Policy Plan 2002; 17: 402–11
Forsythe S, Authur G, Ngatia G. Assessing the cost and willingness to pay for voluntary HIV counseling and testing in Kenya. Health Policy Plan 2002; 17: 187–95
Onwujekwe O, Chima R, Shu E. Hypothetical and actual willingness to pay for insecticide-treated nets in five Nigerian communities. Trop Med Int Health 2001; 6: 545–53
Liu JT, Hammitt JK, Wang JD. Mother’s willingness to pay for her own and her child’s health: a contingent valuation study in Taiwan. Health Econ 2000; 9: 319–26
Mathiyazhagan K. Willingness to pay for rural health insurance through community participation in India. Int J Health Plann Manage 1998; 13: 47–67
Nahar S, Costello A. The hidden cost of ‘free’ maternity care in Dhaka, Bangladesh. Health Policy Plan 1998; 13: 417–22
Asenso-Okyere WK, Osei-Akoto I, Anum A. Willingness to pay for health insurance in a developing economy: a pilot study of the informal sector of Ghana using contingent valuation. Health Policy 1997; 42: 223–37
Alberini A, Cropper M, Fu TT. Valuing health effects of air pollution in developing countries: the case of Taiwan. J Environ Econ Manage 1997; 34: 107–26
Weaver M, Ndamobissi R, Kornfield R. Willingness to pay for child survival: results of a national survey in central African Republic. Soc Sci Med 1996; 43: 985–98
Walraven G. Willingness to pay for district hospital services in rural Tanzania. Health Policy Plan 1996; 11: 428–37
Acknowledgements
The authors thank Theresa Chan for comments and June Chau for research assistance. Financial support from Committee on Research and Conference is gratefully acknowledged. The authors have no conflict of interest and report no financial interest in this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yeung, R.Y.T., Smith, R.D. Can we use contingent valuation to assess the demand for childhood immunisation in developing countries?. Appl Health Econ Health Policy 4, 165–173 (2005). https://doi.org/10.2165/00148365-200504030-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00148365-200504030-00005