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Research Article

Eliciting willingness to pay in obstetrics: comparing a direct and an indirect valuation method for complex health outcomes

  1. Denise Bijlenga1,*,
  2. Gouke J. Bonsel2,
  3. Erwin Birnie3

Article first published online: 22 OCT 2010

DOI: 10.1002/hec.1678

Issue

Health Economics

Health Economics

Volume 20, Issue 11, pages 1392–1406, November 2011

Additional Information

How to Cite

Bijlenga, D., Bonsel, G. J. and Birnie, E. (2011), Eliciting willingness to pay in obstetrics: comparing a direct and an indirect valuation method for complex health outcomes. Health Econ., 20: 1392–1406. doi: 10.1002/hec.1678

Author Information

  1. 1

    Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

  2. 2

    Obstetrics and Gynecology, Division of Obstetrics and Prenatal Care, Erasmus Medical Center – Sofia, Rotterdam, The Netherlands

  3. 3

    Institute of Health Policy and Management, Erasmus Medical Center, Rotterdam, The Netherlands

*Department of Social Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands

Publication History

  1. Issue published online: 5 OCT 2011
  2. Article first published online: 22 OCT 2010
  3. Manuscript Accepted: 31 AUG 2010
  4. Manuscript Revised: 16 JUL 2010
  5. Manuscript Received: 26 DEC 2009

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Keywords:

  • willingness to pay (WTP);
  • contingent valuation method (CVM);
  • discrete choice experiment (DCE);
  • utility;
  • psychometrics;
  • pregnancy;
  • obstetrics

Abstract

Objective: To compare direct and indirect willingness to pay (WTP) elicitation methods in terms of feasibility, reliability, and comparability. The application is obstetrics, where always both a mother's and a child's health are at stake.

Methods: An open-ended contingent valuation method (CVM) as a direct WTP elicitation method, and the discrete choice experiment (DCE) as an indirect WTP elicitation method. Vignettes to be valued were based on clinical patient data. Participants were 88 laypersons who received their questionnaires by postal mail.

Results: The DCE task was completed faster (p = 0.006) and was regarded easier (p<0.001) than the CVM task. Test–retest for CVM was substantial (ICC = 0.76), and for DCE moderate (k = 0.49). Female sex (p<0.001), age ≥50 years (p = 0.013), higher income (p<0.001), and higher education (p<0.001) were associated with higher WTP. Correlation between CVM and DCE was 0.79 (Kendall's Tau-b; p<0.001). The implied WTP as derived with DCE was between 2.3 and 10.2 times higher than with CVM. The relationship between the WTPs was linear.

Conclusion: It is yet unclear what lies behind the numbers of DCE. DCE has no methodological benefits over the conventional CVM when eliciting WTP for complex health outcomes in obstetrics. Copyright © 2010 John Wiley & Sons, Ltd.

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