OBJECTIVE: Despite increased use in the health care sector (HCS), the contingent valuation (CV) method remains controversial. The nucleus of the controversy is the extent to which hypothetical choices in the CV method mimic real economic choices. Correspondence between hypothetical and real willingness to pay (WTP) has been studied for private and environmental goods. These experiments demonstrate that dichotomous choice (DC) CV questions lead to hypothetical bias (overestimation of real WTP). Hypothetical bias has not been assessed in the HCS. We conducted an experiment directly comparing responses to a DC CV question with real purchase decisions using a pharmacist provided asthma management service as the item being valued. We examined whether DC CV questions lead to hypothetical bias for this good, and we tested whether “definitely sure” hypothetical yes responses, as identified in a follow‐up question, correspond to real yes responses. METHODS: 172 subjects with asthma were recruited from 10 Kentucky community pharmacies. Subjects received either a DC CV question or were given the opportunity to actually purchase the service. Three different prices were used: $15, $40, and $80. RESULTS: In the hypothetical group 38% of subjects stated they would purchase the good at the given price, but only 12% of subjects in the real group purchased the good (p = 0.000). We cannot, however, reject the null hypothesis that “definitely sure” hypothetical yes responses correspond to real yes responses. CONCLUSIONS: The DC CV method overestimates WTP in the HCS, but it may be possible to correct for this by sorting out “definitely sure” yes responses.
OBJECTIVES: Diabetes affects more than 15.7 million people in the United States, resulting in an estimated annual cost of $98 billion (1997). With numerous complications, including heart disease, retinopathy, nephropathy, and neuropathy, contributing to the direct and indirect costs of diabetes, control is vital. A cost‐effectiveness analysis was performed to compare health care resource utilization related to diabetes care incurred by health plan patients. METHODS: Subjects were enrolled in the Diabetes Care Clinic (DCC) for at least one year and were members of the health plan for one year prior to enrollment. Pharmacy and medical claims data from 1997–2000 were analyzed to identify diabetes‐related charges incurred one year pre‐ and post‐enrollment in the DCC. Charges were used to estimate costs and were adjusted to year 2000 dollars at a rate of inflation of 3%. Using the electronic medical record and clinic charts, hemoglobin A1c (HgbA1c), cholesterol profile, microalbuminuria, and blood pressure were evaluated. RESULTS: 23 diabetic patients met the inclusion criteria. These patients were mostly Type 2 diabetics (91%), female (65%), and Caucasian (70%). The mean age was 58 years. A preliminary analysis of the data indicated that the average HgbA1c decreased from 10.3 to 8.5, with 9 patients attaining glycemic control (defined as HgbA1c < 8.0) after one year of enrollment. Additionally, average blood pressure decreased from 152/80 to 136/73. The average annual cost per patient for diabetes‐related care was $3,090 pre‐enrollment and $4,760 post‐enrollment. A marginal cost‐effectiveness ratio, in terms of cost to number of patients attaining glycemic control, was calculated. The added cost for glycemic control of one patient was $186. CONCLUSIONS: An analysis of short‐term outcomes demonstrated the cost‐effectiveness of a diabetes care clinic. By maintaining tight glycemic and blood pressure control, diabetic complications can be reduced with significant savings to the health plan.
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