Financing and Organizations in Your Profession
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Painter2018ConsumerReview.pdf
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Research in Social and Administrative Pharmacy
journal homepage: www.elsevier.com/locate/rsap
Consumer willingness to pay for pharmacy services: An updated review of the literature
Jacob T. Paintera,∗, Laura Gresslera, Niranjan Kathea, S. Lane Slabaughb, Karen Blumenscheinc
a Division of Pharmaceutical Evaluation & Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA b Competitive Health Analytics, Inc., Humana, Louisville, KY, USA c Department of Pharmacy Practice, University of Kentucky College of Pharmacy, Lexington, KY, USA
A B S T R A C T
Background: Quantifying the value of pharmacy services is imperative for the profession as it works to establish an expanded role within evolving health care systems. The literature documents the work that many have contributed toward meeting this goal. To date, however, the preponderance of evidence evaluates the value of pharmacist services to third-party payers; few published studies address the value that consumers place on these services. Objectives: In 1999, a review of studies that used the contingent valuation method to value pharmacy services was published. The objective of this manuscript is to provide an update of that review. Methods: Relevant studies published in the English language were identified searching MEDLINE, ECONLIT and International Pharmaceutical Abstracts databases from January 1999 to November 2017. Only studies that specifically elicited willingness to pay for a community pharmacist provided service from actual or potential consumers were included. Results: Thirty-one studies using the contingent valuation method to value pharmacy services were identified using the search strategy outlined. These studies included surveys in different demographic and geographic populations and valuing various pharmacy services. Conclusions: Improving the quality of studies using contingent valuation to value pharmacy services will aid the profession in marketing pharmacy services to consumers, and may assist practitioners who wish to implement various pharmacy services in their practice settings. A limited number of studies have been conducted, but the quality of contingent valuation studies valuing pharmacist services is improving. Understanding the pharmacy services that consumers value, and understanding the level of their monetary willingness to pay for those ser- vices will be crucial as the profession continues to work toward establishing a sustainable and economically viable role within the evolving health care systems.
1. Introduction
An important objective for the profession of pharmacy is quanti- fying the economic value of pharmacy services. The contingent valua- tion method offers one approach to valuing the benefits of pharmacy services. The potential advantage offered by this method is that it re- flects in a single monetary value the entire range of attributes (both positive and negative) offered by the good or service being valued. In 1999, a review of studies that used the contingent valuation method to value pharmacy services was published.1 In the context of this paper, “pharmacy services” refers to any non-dispensing service provided by a pharmacist. The objective of this manuscript is to provide an update of that review, including studies published from January 1999 to June
2016. Quantifying the value of pharmacy services is imperative for the
profession as it works to establish an expanded role within evolving health care systems. This goal is not new. As early as 1971 the need for evaluation of the cost-benefit or cost-effectiveness of pharmacy services was identified, predating the pharmaceutical care era by nearly two decades.2 The literature demonstrating the clinical, economic, and humanistic gains that pharmacy services can provide continues to grow and contribute toward meeting this goal. To date, the preponderance of these publications demonstrates the value of pharmacist services to third-party payers; however, few published studies address the value that consumers place on these services.
Contingent valuation is a survey method used to elicit the monetary
https://doi.org/10.1016/j.sapharm.2018.01.010 Received 24 August 2017; Received in revised form 21 November 2017; Accepted 17 January 2018
∗ Corresponding author. 4301 W Markham #522-4, Little Rock, AR 72205, USA. E-mail address: [email protected] (J.T. Painter).
Research in Social and Administrative Pharmacy 14 (2018) 1091–1105
1551-7411/ Published by Elsevier Inc.
T
valuation of non-market goods or services. Contingent valuation sur- veys ask respondents how much they are hypothetically prepared to pay for a defined good, service or health status change. This method is based on microeconomic theory; specifically, the utility theory premise that an individual's willingness to trade dollars (i.e. willingness to pay) for a good, service, or health-status change is the individual's net ap- praisal of the perceived attributes possessed by the good, service, or health-status change being valued.3,4
Contingent valuation is a useful tool for understanding how people value items not typically marketed or items that have underdeveloped markets. Contingent valuation has been suggested as a tool to measure the economic value of community pharmacist provided services, since the market for these services is currently underdeveloped.5 When ty- pical markets are not available, hypothetical willingness to pay (WTP) questions are asked. The valuation for the good or service is based on the contingency of the market existing, thus the name contingent va- luation. Economists have identified contingent valuation as a theore- tically sound method, and it is used extensively in environmental eco- nomic evaluations. During the 1990s, interest in applying this method to health care increased6–8 with several publications documenting empirical applications.6,8–10
2. Pharmacy service contingent valuation studies
Researchers have used WTP questions to value pharmacy services for over thirty years. A 1999 publication reviewed ten studies published from 1973 to 1994 that used the contingent valuation method to value various pharmacy services (no eligible studies were published between 1995 and 1999).1 The authors suggested that the results of those studies should be viewed with caution, as most contained methodological de- ficiencies that limit their generalizability. However, it is important to note that many early pharmacy service WTP evaluations were con- ducted without the benefit of standards or guidelines to follow. Given that guidelines for performing contingent valuation studies have existed since 1993, combined with the fact that an increasing number of re- searchers are interested in this technique and are applying it to value health services, it is reasonable to expect that the rigor with which WTP studies are conducted has increased and that the application of the findings from these studies has been enhanced.
3. Methods
The current paper is an update of the 1999 review of pharmacy service WTP studies by Blumenschein & Johannesson1 that identified ten studies published prior to the 1999 publication date.5,11–20 For this update relevant studies published in the English language were identified searching MEDLINE, ECONLIT and International Pharma- ceutical Abstracts databases from January 1999 through November 2017. Search strategies included text word string searches using “willingness to pay”, “contingent valuation”, “conjoint analysis” or “cost benefit analysis”, combined with “medication therapy manage- ment”, “cognitive service”, “pharmacy service” or “pharmaceutical care”. Only studies that specifically elicited WTP for a community pharmacist provided service from actual or potential consumers were included. Table 1 presents an overview of the ten articles included in the original review and 31 newly published studies identified by the search strategy since 1999.
For articles published after 1999, the services valued included pharmacist services including counseling and comprehensive pharma- ceutical care,5,12,15,21–29 asthma education and management,11,13,30
bone mineral density screening and education,14,31 hypertension health promotion,16 patient education on proper self-use of over-the-counter medicines,18 medication therapy management (MTM),19,32–35 dia- betes management,20,36–38 pharmacist-provided menopause and hor- mone replacement therapy consultations,17 herbal counseling,39 weight management,40 and pharmacogenomic testing.41 These studies are
briefly described in the following section. All currencies not originally reported in US dollars (USD) were converted to USD using the exchange rate for the year the study was published.
4. Results
4.1. Consumer WTP for pharmacy services: 1999–2017
In 1999, Barner, Mason, & Murray11 studied the WTP and the willingness to give time to an asthma self-management program. The study identified 116 asthma patients in the Midwest region of the US aged 18–34 years and described to them an 8-week asthma manage- ment program that would improve their health by 50%. Patients were primarily black (59.5%), female (87.1%), and between the age of 30 and 45 years old (40.5%). The majority of the patients had at least a high school education (69.8%), with more than half with an annual income of less than $20,000. In a face-to-face interview, patients were asked open-ended WTP and willingness to give time questions. This study employed regression analysis to examine the effect of various factors on WTP including socio-demographic characteristics, level of care, and health care utilization factors. The model used was significant and explained 35% of the variation in WTP scores. Of the factors in the regression five were significantly related to WTP. Patients who were willing to pay more for the service included those who had lower levels of positive symptoms during an attack, who had more access to health care resources, who received less education information from health care providers, who had previously participated in an asthma education program, or who said they would like to participate in an asthma education program. Regressions analyzing the relationship between sex and age were not significant. No regression analysis was performed analyzing the relationship between WTP and education levels. The mean WTP for the program was $29.50 (SD = $15.20).
In 2000, Larson assessed the WTP for “comprehensive pharmaceu- tical care services”.12 Comprehensive pharmaceutical care services were defined as a pharmacist providing detailed counseling, monitoring for outcomes of medication use, checking for appropriateness of med- ications, and consulting with physicians. Using a mail survey, 175 re- sponses were obtained from a random sample of 2500 US citizens. The questionnaire provided a description of “comprehensive pharmaceu- tical care” and contained open-ended questions asking respondents about the level of care they were currently receiving. Most respondents were female and the mean age was 48 years. Over half the respondents had a bachelor's degree or higher, and the average income was $56,600. The mean WTP for a “one-time comprehensive evaluation of medica- tion use to check for appropriateness, effectiveness, drug interactions and adverse drug reactions” was $12.91 (SD = $18.41); the mean WTP for the above plus “one year's worth of follow-up, where a pharmacist regularly (with each new medication and at each refill) re-evaluated total medication use” was $27.87(SD = $42.16).12 Over half (55%) of respondents had a positive WTP (i.e., greater than $0) for the single evaluation and 56% had a positive WTP for an evaluation plus one year of follow-up. Statistical analyses (ANOVA) demonstrate that those who were willing to pay for the services were more apt to believe that in- surance should cover the costs and they were more willing to make an appointment with the pharmacist to discuss their medications. No sig- nificant correlations were observed between WTP and age, sex, or education level.
In 2000, Suh measured respondents' WTP for risk reduction of medication-related problems via pharmacist counseling.5 The ques- tionnaire described the nature of medication related-problems and in- cluded a description of information pharmacists can provide to mini- mize these problems. Respondents received one of three levels of risk reduction (from 40% without the pharmacist service to 20% with the pharmacist service, from 20% to 10%, or from 10% to 5%). Patients were asked for their WTP for a pharmacist counseling service that would provide that level of risk reduction for medication related
J.T. Painter et al. Research in Social and Administrative Pharmacy 14 (2018) 1091–1105
1092
T ab
le 1
O ve
rv ie w
of p h ar m ac y se rv ic e co
n ti n ge
n t va
lu at io n st u d ie s.
Y ea r
A u th or (s )
C it at io n
Lo ca ti on
R es ea rc h Q u es ti on
Se rv ic e V al u ed
A p p ro p ri at e
P op
u la ti on
Su rv ey
ed ?
M et h od
of Su
rv ey
A d m in is tr at io n
V al u e
el ic it at io n
m et h od
N St at is ti ca l
A n al ys is
% W T P M or e
T h an
$ 0
A ve
ra ge
W il li n gn
es s
to P ay
M ea n (S D )
U SD
u n le ss
ot h er w is e in d ic at ed
In st ru m en
t m ad
e av
ai la bl e
1 9 7 3
H u ff m an
D J A m
P h ar m
A ss oc
1 9 7 3 ; 1 3 (1 2 ); 6 6 6
U S
T o d et er m in e n ee d
fo r ad
d it io n al
p ro te ct io n an
d as si st an
ce in
d ru g
th er ap
y an
d W T P
fo r se rv ic e
M ed
ic at io n re co
rd m an
ag em
en t
R an
d om
ly se le ct ed
co n su m er
In te rv ie w er -
ad m in is te re d
P ol yc h ot om
ou s
ch oi ce
5 0 0
N ot
ad d re ss ed
9 4
N ot
p ro vi d ed
N o
1 9 7 5
Sm it h G H ,
So rb y D L,
Sh ar p
LJ
A m
J H os p P h ar m
1 9 7 5 ; 3 2 :1 9 –2
5 W A
T o d et er m in e if
p h ys ic ia n s n ee d ed
a d ru g in fo rm
at io n
se rv ic e li n e,
if th ey
w ou
ld u se
th e
se rv ic e an
d ga
in in fo rm
at io n on
to p la n an
op ti m al ly
eff ec ti ve
se rv ic e
D ru g in fo rm
at io n
se rv ic e
P h ys ic an
s fr om
th e
u n ic er si ty
h os p it al
M ai l
D ic h ot om
ou s
ch oi ce
1 2 0 0
D es ci rp ti ve
St at is it cs
p ro vi d ed
3 3
N ot
p ro vi d ed
Y es
1 9 8 3
B ro w n G H ,
K ir ki n g D M ,
A sc io n e FJ
A m
P h ar m
1 9 8 3 ;
N S2
3 :6 9 –7
1 M I
T o gu
ag e at ti tu d es
of co
m m u n it y
p h ar m ac y p at ro n s
on W T P fo r
p h ar m ac y se rv ic es
M ed
ic at io n
re m in d er
sy st em
C om
m u n it y
p h ar m ac y p at ro n s in
lo ca l ar ea
w it h
ca rd io va
sc u la r il ln es s
M ai l
P ol yc h ot om
ou s
ch oi ce
1 0 2
B iv ar ia te
an d
u n iv ar ia te
an al ys is
4 0 % :
ev al u at io n ,
6 3 % :
ev al u at io n ,
m on
it or in g
N ot
p ro vi d ed
N o
1 9 8 3
Sc h on
d el m ey
er SW
, T ri n ca
C E
A m
P h ar m
1 9 8 3 ;
N S2
3 :6 5 –6
8 A Z
T o d et er m in e th e
eff ec t of
p ri ce
u p on
u se
of p h ar m ac is t
se rv ic es
A n ti bi ot ic
co u n se li n g se rv ic e
Su bj ec ts
w it h p ri va
te p ay
cu st om
er s w it h a
n ew
p re sc ri p ti on
fo r
an an
ti bi ot ic
In te rv ie w er -
ad m in is te re d
P ol yc h ot om
ou s
ch oi ce
2 1 8
D es cr ip ti ve
st at is ti cs
2 6
U S$
2 .1 6
N o
1 9 8 3
Sm it h D L
A m
P h ar m
1 9 8 3 ;
N S2
3 :5 8 –6
4 U S
T o ga
u ge
th e W T P
of co
n su m er s fo r
p h ar m ac is ts '
cl in ic al
se rv ic es
C li n ic al
se rv ic e
N on
in st it u ti on
al iz ed
ad u lt p op
u la ti on
of th e U n it ed
Sa te s
T el ep
h on
e P ol yc h ot om
ou s
ch oi ce
1 2 5 4
N ot
ad d re ss ed
3 1 % , se rv ic e;
3 9 % , re vi ew
; 4 5 % ,
co n su lt at io n
N ot
p ro vi d ed
N o
1 9 8 4
La ve
rt y R
D ru g T op
ic s 1 9 8 4 ;
1 2 8 :1 8 –1
9 U S
T o d et er m in e W T P
to p ay
fo r
p h ar m ac y se rv ic es
C li n ic al
se rv ic e
D em
og ra p h ic al ly
ba la n ce d gr ou
p of
m or e th an
1 4 0 0
fa m il ie s
M ai l
D ic h ot om
ou s
ch oi ce
1 4 0 0
N ot
ad d re ss ed
2 6 % , se rv ic e;
3 7 % , re vi ew
; 1 3 % ,
co n su lt at io n
N ot
p ro vi d ed
N o
1 9 8 8
C u lb er ts on
V L,
A rt h u r T G
et al .
D ru g In te ll C li n
P h ar m
1 9 8 8 ;
2 2 :3 9 0 –3
9 6
U S
T o d et er m in e th e
ex te n t of
m ed
ic at io n u se
an d
d ru g in fo rm
at io n
p re fe re n ce s an
d W T P
D ru g in fo rm
at io n
se rv ic e
R ep
re se n ta ti ve
p h ar am
ac y se tt in g
su rv ey
ed to
p ar ti ci p at e,
ad m in is te r se rv ic es
an d fi ll ou
t qu
es ti on
n ai re
Se lf -
ad m in is te re d
N ot
ad d re ss ed
3 1 7
C h i- sq u ar ed
te st s
3 5
N ot
p ro vi d ed
N o
1 9 8 8
E in ar so n T R ,
B oo
tm an
JL et
al .
D ru g In te ll C li n
P h ar m
1 9 8 8 ;
2 2 :4 5 –4
8
A Z
T o d et er m in e
at ti tu d e to w ar d s
se rv ic e,
in te n ti on
to u se , an
d W T P
C h ol es te ro l
m on
it or in g se rv ic e
C om
m u n it y
p h ar m ac y th at
off er s
ot h er
re la te d se rv ic es
In te rv ie w er -
ad m in is te re d
P ol yc h ot om
ou s
ch oi ce
2 7
D es cr ip ti ve
st at is ti cs ,
C h i- sq u ar ed
te st s
N ot
p ro vi d ed
P re : U S$
1 1 .6 0
P os t: U S$
1 4 .3 5
Y es
1 9 9 4
A n d er so n P O
A m
J H os p P h ar m
1 9 9 4 ; 1 9 :1 7 –2
5 C A
T o d es cr ib e th e
eff ec ts
of co
n ve
rt in g a fr ee
d ru g in fr om
at io n
se rv ic e at
a u n iv er si ty
m ed
ic al
ce n te r to
a 9 0 0
te le p h on
e n u m be
r
D ru g in fo rm
at io n
se rv ic e
Lo ca l h os p it al s an
d p h ar m ac is ts
se ek
in g
d ru g in fo rm
at io n
T el ep
h on
e P ol yc h ot om
ou s
ch oi ce
N A
D es cr ip ti ve
st at is ti cs
of ca ll vo
lu m e
"M an
y" p h ar m ac is ts ,
"M os t"
n u rs in g
m ot h er s
N ot
p ro vi d ed
N o
(c on
ti nu
ed on
ne xt
pa ge )
J.T. Painter et al. Research in Social and Administrative Pharmacy 14 (2018) 1091–1105
1093
T ab
le 1 (c on
ti nu
ed )
Y ea r
A u th or (s )
C it at io n
Lo ca ti on
R es ea rc h Q u es ti on
Se rv ic e V al u ed
A p p ro p ri at e
P op
u la ti on
Su rv ey
ed ?
M et h od
of Su
rv ey
A d m in is tr at io n
V al u e
el ic it at io n
m et h od
N St at is ti ca l
A n al ys is
% W T P M or e
T h an
$ 0
A ve
ra ge
W il li n gn
es s
to P ay
M ea n (S D )
U SD
u n le ss
ot h er w is e in d ic at ed
In st ru m en
t m ad
e av
ai la bl e
1 9 9 4
G or e P R ,
M ad
h av
an S
J C li n P h ar m
T h er
1 9 9 4 ; 1 9 :1 7 –2
5 W V , P A ,
O H , M D ,
V A , K Y
T o d et er m in e
p re fe re n ce
fo r
p h ar m ac is t
co u n se li n g fo r n on
- p re sc ri p ti on
m ed
ic in e
p u rc h as es , an
d W T P fo r se rv ic e
C ou
n se li n g
se rv ic es
R an
d om
ly se le ct ed
co n su m er s in
si x
st at es
M ai l
D ic h ot om
ou s
ch oi ce
4 5 8
St u d en
ts t-
te st s
1 3
N ot
p ro vi d ed
N o
1 9 9 9
B ar n er
JC ,
M as on
H L,
M u rr ay
M D
C li n T h er
1 9 9 9 ;
2 1 (5 ): 8 7 8 -9 4
IN T o id en
ti fy
fa ct or s
th at
in fl u en
ce as th m a p at ie n ts '
W T P fo r an
d W T G T
to an
as th m a se lf -
m an
ag em
en t
p ro gr am
A st h m a ed
u ca ti on
p ro gr am
A d u lt as th m a
p at ie n ts
se ek
in g
p h ar m ac y se rv ic es
in h os p it al s w er e
se le ct ed
.
In te rv ie w er -
ad m in is te re d
B id d in g ga
m e
1 1 6
U n iv ar ia te
an d
m u lt iv ar ia te
re gr es si on
, re li ab
il it y
te st in g
N ot
p ro vi d ed
U S$
2 9 .5 0
N o
2 0 0 0
La rs on
R A
J A m
P h ar m
A ss oc
4 0 (S ep
–O ct ): p 6 1 8 -
6 2 4 .2 0 0 0 .
U S
T o d et er m in e th e
le ve
l at
w h ic h
p at ie n ts
re ce iv e
p h ar m ac eu
ti ca l
ca re
an d d et er m in e
th e W T P fo r
co m p re h en
si ve
p h ar m ac y ca re
se rv ic e
P h ar m ac eu
ti ca l
ca re
G en
er al
p op
u la ti on
, n at io n al ly
re p re se n ta ti ve
M ai l
O p en
-e n d ed
1 7 5
U n iv ar ia te
an d bi va
ri at e
an al ys is
5 5 % :
ev al u at io n
5 6 % :
ev al u at io n ,
fo ll ow
-u p
U S$
2 7 .8 7 (S D
$ 4 2 .1 6 )f or
m ed
ic at io n
ev al u at io n an
d fo ll ow
-u p U S$
1 2 .9 1
(S D $ 1 8 .4 1 ) fo r
m ed
ic at io n
ev al u at io n
N o
2 0 0 0
Su h D C
J A m
P h ar m
A ss oc
2 0 0 0 ; 4 0 :8 1 8 –2
7 N J
T o m ea su re
W T P
fo r se rv ic es
to re d u ce
ri sk
of m ed
ic at io n -r el at ed
p ro bl em
s an
d d et er m in e fa ct or s
th at
h av
e a
si gn
ifi ca n t
in fl u en
ce on
W T P
M ed
ic at io n re la te d
p ro bl em
m an
ag em
en t
R es p on
d en
ts w er e
p at ie n ts
an d /o
r fa m il y m em
be rs
w h o
vi si te d on
e ou
tp at ie n t cl in ic
an d
tw o p h ys ic ia n offi
ce s
Se lf -
ad m in is te re d
P ol yc h ot om
ou s
ch oi ce
3 1 6
D es cr ip ti ve
st at is ti cs
6 0 % : ri sk
4 0 % –2
0 % ;
3 5 .7 % : ri sk
1 0 % –5
%
U S$
5 .5 7
N o
2 0 0 1
B lu m en
sc h ei n
K , Jo
h an
n es so n
M et
al .
J H ea lt h E co
n 2 0 0 1 ;
2 0 (3 ): 4 4 1 -5 7
K Y
T o co
m p ar e
h yp
ot h et ic al
an d
re al
p u rc h as e
d ec is io n s fo r a
p h ar m ac is t
p ro vi d ed
as th m a
m an
ag em
en t
p ro gr am
A st h m a
m an
ag em
en t
p ro gr am
P at ie n ts
on a
co m m on
li st
ab ov
e th e ag
e of
1 8 w it h
as th m a an
d w it h a
fi ll ed
as th m a
m ed
ic at io n in
th e
p re vi ou
s 6 m on
th s
an d cl ie n ts
at on
e of
1 0 p h ar m ac ie s in
K en
tu ck y
In te rv ie w er -
ad m in is te re d
D ic h ot om
ou s
ch oi ce
1 7 2
D es cr ip ti ve
st at is ti cs
an d
m u lt iv ar ia te
re gr es si on
1 2
U S$
8 .9 7
Y es
2 0 0 1
B ar n er
JC Jo
u rn al
of M an
ag ed
P h ar m ac eu
ti ca l C ar e
1 .1
(2 0 0 1 ): 8 5 -9 6
T X
T o d et er m in e W T P
fo r d ia be
te s d is ea se
m an
ag em
en t
se rv ic es
D ia be
te s d is ea se
m an
ag em
en t
P at ie n ts
w h o h av
e re ce n tl y vi si te d a
n at io n al
ch ai n of
co m m u n it y
p h ar am
ci es
w it h
d ia be
te s ov
er th e ag
e of
1 8
M ai l
D ic h ot om
ou s
ch oi ce
1 6 9
U n iv ar ia te
an d bi va
ri at e
an al ys is
6 7
U S$
2 8 .1 6 (3 1 .1 2 )
M ed
ia n =
U S$
3 0
N o
2 0 0 1
H ai le m es ke
l, B .
T h om
p so n , M .
A SH
P M id ye
ar C li n ic al
M ee ti n g.
D C
T o d et er m in e th e
im p ac t of
h er ba
l- H er ba
l co
u n se li n g
P at ie n ts
re ce iv in g
h er ba
l an
d N ot
ad d re ss ed
N ot
ad d re ss ed
4 0
N ot
ad d re ss ed
7 0 %
w er e
w il li n g to
at A t le as t U S$
3 0 , or
ab ov
e U S$
6 0
N o
(c on
ti nu
ed on
ne xt
pa ge )
J.T. Painter et al. Research in Social and Administrative Pharmacy 14 (2018) 1091–1105
1094
T ab
le 1 (c on
ti nu
ed )
Y ea r
A u th or (s )
C it at io n
Lo ca ti on
R es ea rc h Q u es ti on
Se rv ic e V al u ed
A p p ro p ri at e
P op
u la ti on
Su rv ey
ed ?
M et h od
of Su
rv ey
A d m in is tr at io n
V al u e
el ic it at io n
m et h od
N St at is ti ca l
A n al ys is
% W T P M or e
T h an
$ 0
A ve
ra ge
W il li n gn
es s
to P ay
M ea n (S D )
U SD
u n le ss
ot h er w is e in d ic at ed
In st ru m en
t m ad
e av
ai la bl e
B et to n , T . K im
, M . D il lo n , E .
3 6 (D
ec ): p P -2 1 4 E .
2 0 0 1 .
co u n se li n g ce n te r
in co
m m u n it y
p h ar m ac y
p re sc ri p ti on
d ru gs
in a co
m m u n it y
p h ar m ac y
le as t p ay
$ U S3
0 , 1 5 %
w er e w il li n g
to p ay
at le as t $ U S6
0 2 0 0 2
La ta
P , B in kl ey
N , E ll io tt
E M en
op au
se 2 0 0 2 ;
9 (6 ): 4 4 9 -5 5
W I
T o as se ss
in fo rm
at io n
so u rc es
u se d fo r
p h ar m ac y- ba
se d
bo n e d en
si ty
sc re en
in g an
d W T P
fo r se rv ic e
B on
e m in er al
d en
si ty
sc re en
in g
p ro gr am
W om
en ag
e gr ea te r
th an
5 0 n ot
ta ki n g
bi sp h os p h on
at es
Se lf -
ad m in is te re d
N ot
ad d re ss ed
1 9 7
C h i- sq u ar ed
te st
9 3
M ed
ia n :$ 5 0
N o
2 0 0 2
E n gl is h , R A .
B ar n er , JC
. B ro w n , C M .
A SH
P M id ye
ar C li n ic al
M ee ti n g.
2 0 0 2 ; 3 7 (1 2 ): 3 1 9 E .
T X
T o d et er m in e ou
t of
p oc
ke t W T P fo r
co m m u n it y
p h ar m ac is t
p ro vi d ed
d ia be
te s
ca re
an d w h et h er
W T P va
lu es
d iff er
fo r in p at ie n ts
ve rs u s ou
tp at ie n ts ,
th os e w h o h av
e re ce iv ed
ed u ca ti on
to th os e w h o h av
e n ot , an
d if it is
re la te d to
p at ie n ts '
p er ce p ti on
s of
p h ar m ac is ts '
d is ea se
m an
ag em
en t
ab il it ie s
D ia be
te s ca re
se rv ic es
P at ie n ts
fr om
an ou
tp at ie n t d ia be
te s
ed u ca ti on
d ep
ar tm
en t an
d in p at ie n t ge
n er al
m ed
ic in e d ep
ar tm
en t
of a 2 0 0 be
d h os p it al
Se lf -
ad m in is te re d
N ot
ad d re ss ed
1 1 7
D es cr ip ti ve
st at is ti cs
N ot
ad d re ss ed
U S$
4 3 .9 0
(S D =
$ 4 1 .2 0 ) (2 5 %
im p ro ve
m en
t) U S
$ 5 6 .6 0
(S D =
$ 4 7 .8 0 ) (5 0 %
im p ro ve
m en
t)
N o
2 0 0 3
C ôt é I, G ré go
ir e
J- P , M oi sa n J
et al .
P h ar m ac oe
co n om
ic s
2 0 0 3 ; 2 1 (6 ): 4 1 5 -4 2
Q C
T o w ei gh
th e co
st s
an d be
n efi
ts of
a p h ar m ac y- ba
se d
h ea lt h p ro m ot io n
p ro gr am
m e in
h yp
er te n si on
H ea lt h p ro m ot io n
p ro gr am
in h yp
er te n si on
P at ie n ts
w it h
h yp
er te n si on
In te rv ie w er -
ad m in is te re d
O p en
-e n d ed
4 1
N ot
ad d re ss ed
P re : 1 7 % ;
P os t: 5 %
P re : C A $ 3 .2 9 A
(S D =
9 .3 ) P os t:
C A $ 0 .5 4 (S D =
3 .1 )A
N o
2 0 0 3
D af ta ry
M N ,L
ee E , D u tt a A P
et al .
J P h ar m
P ra ct
an d
R es
2 0 0 3 ; 3 3 (4 ): 2 6 5 -
2 6 7
D C
T o as se ss
W T P fo r
co gn
it iv e
p h ar m ac y se rv ic es
an d th e cu
rr en
t le ve
l at
w h ic h
p at ie n ts
re ce iv e th e
ty p es
of se rv ic es
C og
n it iv e se rv ic es
A m bu
la to ry
p h ar m ac y p at ro n s
Se lf -
ad m in is te re d
P ol yc h ot om
ou s
ch oi ce
9 0
D es cr ip ti ve
st at is ti cs
an d
m u lt iv ar ia te
re gr es si on
4 0 % :
ev al u at io n ;
6 3 % :
ev al u at io n
an d
m on
it or in g
N ot
p ro vi d ed
N o
2 0 0 4
C er u ll i J,
Z oe
ll a
M .
J A m
P h ar m
A ss oc
2 0 0 4 ; 4 4 :1 6 1 –1
6 7
N Y
T o as se ss
th e
im p ac t of
a co
m m u n it y
p h ar m ac y- ba
se d
B M D
sc re en
in g an
d ed
u ca ti on
p ro gr am
an d d et er m in e th e
fe as ib il it y of
B M D sc re en
in g an
d ed
u ca ti on
p ro gr am
W om
en 1 8 ye
ar s or
ol d er
w h o fi ll ed
th ei r
p re sc ri p ti on
at on
e of
fo u r co
m m u n it y
p h ar m ac ie s - n o
co m p en
sa ti on
Se lf -
ad m in is te re d
P ol yc h ot om
ou s
ch oi ce
1 4 0
R an
k co
rr el at io n
4 1
N ot
p ro vi d ed
N o
(c on
ti nu
ed on
ne xt
pa ge )
J.T. Painter et al. Research in Social and Administrative Pharmacy 14 (2018) 1091–1105
1095
T ab
le 1 (c on
ti nu
ed )
Y ea r
A u th or (s )
C it at io n
Lo ca ti on
R es ea rc h Q u es ti on
Se rv ic e V al u ed
A p p ro p ri at e
P op
u la ti on
Su rv ey
ed ?
M et h od
of Su
rv ey
A d m in is tr at io n
V al u e
el ic it at io n
m et h od
N St at is ti ca l
A n al ys is
% W T P M or e
T h an
$ 0
A ve
ra ge
W il li n gn
es s
to P ay
M ea n (S D )
U SD
u n le ss
ot h er w is e in d ic at ed
In st ru m en
t m ad
e av
ai la bl e
p ro vi d in g su ch
a se rv ic e
2 0 0 5
B ar n er
JC ,
B ra n vo
ld A
R es
So ci al
A d m
P h ar m . 2 0 0 5 M ar ;
1 (1 ): 7 7 -1 0 0
U S
T o d et er m in e w h at
W T P p h ar m ac is t-
p ro vi d ed
m en
op au
se an
d h or m on
e re p la ce m en
t th er ap
y co
n su lt at io n s
an d re la ti on
sh ip
be tw
ee n W T P an
d p at ie n ts '
p er ce p ti on
s of
im p or ta n ce
of re so lv in g
m en
op au
sa l
sy m p to m s
H or m on
e re p la ce m en
t th er ap
y co
u n se li n g
H om
on e re p la ce m en
t u se
re qu
ir ed
fo r
be in g a p ar t of
th e
st u d y.
Se lf -
ad m in is te re d
P ol yc h ot om
ou s
ch oi ce
2 0 3
D es cr ip ti ve
st at is ti cs ,
re li ab
il it y
te st in g
8 5
U S$
4 2 .0 7 (3 0 .2 7 )
(5 0 %
im p ro ve
m en
t) U S$
6 5 .6 0 (4 2 .8 0 )
(1 0 0 %
im p ro ve
m en
t)
Y es
2 0 0 5
H on
g S,
Sp ad
ar o D ,
W es t D , T ak
S
J C li n P h ar m
T h er
2 0 0 5 ; 3 0 (3 ): 1 9 3 -9
A R
T o d et er m in e
w h et h er
W T P fo r
p h ar m ac is t se lf -
ca re
se rv ic es
on p ro p er
u se
of O T C
m ed
ic at io n s an
d ex am
in e w h et h er
W T P w as
as so ci at ed
w it h
se tt in g an
d so ci oe
co n om
ic fa ct or s.
O T C m ed
ic at io n
ed u ca ti on
C om
m u n it y
p h ar m ac y p at ro n s
Se lf -
ad m in is te re d
D ic h ot om
ou s
ch oi ce
2 6 2
D es cr ip ti ve
st at is ti cs
an d
m u lt iv ar ia te
re gr es si on
5 1
N ot
p ro vi d ed
N o
2 0 0 8
B lu m en
sc h ei n
K , B lo m qu
is t G
et al .
E co
n J 2 0 0 8 ;
1 1 8 :1 1 4 –1
3 7
K Y
T o co
m p ar e
h yp
ot h et ic al
an d
re al
p u rc h as e
d ec is io n s fo r a
p h ar m ac is t
p ro vi d ed
d ia be
te s
m an
ag em
en t
p ro gr am
D ia be
te s
m an
ag em
en t
p ro gr am
T yp
e- 2 d ia be
te s
p at ie n ts , 1 8 or
ol d er ,
w h o h av
e re ce iv ed
a p re sc ri p ti on
fo r a
ty p e- 2 d ia be
te s
m ed
ic at io n in
th e
p as t 6 m on
th s an
d ar e cl ie n ts
at on
e of
9 p h ar m ac ie s in
K en
tu ck y
In te rv ie w er -
ad m in is te re d
D ic h ot om
ou s
ch oi ce
2 6 7
D es cr ip ti ve
st at is ti cs
an d
m u lt iv ar ia te
re gr es si on
4 5 % (U
S$ 1 5 ),
2 3 % (U
S$ 4 0 ),
1 0 % (U
S$ 8 0 )
N ot
p ro vi d ed
Y es
2 0 0 8
La w
A V ,
O ka
m ot o,
M P ,
B ro ck , K
J A m
P h ar m
A ss oc
2 0 0 8 ; 4 8 :6 4 8 –5
3 C A
T o xp
lo re
th e
aw ar en
es s of
M ed
ic ar e P ar t D
en ro ll ee s re ga
rd in g
M T M
an d ex am
in e
th ei r ex p ec ti on
s an
d p er ce p ti on
s of
p h ar m ac is ts
in p ro vi d in g M T M
M ed
ic at io n
th er ap
y m an
ag em
en t
M ed
ic ar e P ar t D
en ro ll ee s li vi n g in
C al if or n ia
In te rn et -b as ed
qu es ti on
n ai re
D ic h ot om
ou s
ch oi ce
5 0 4
D es cr ip ti ve
st at is ti cs
7 M ea n :U S$
2 1 .3 7
M ed
ia n :U S$
1 0
Y es
2 0 0 8
Sc h u h M J,
D ro eg
e M .
C on
su lt P h ar m . 2 0 0 8
M ar ; 2 3 (3 ): 2 2 3 -3 0 .
FL T o d et er m in e W T P
ou t- of -p oc
ke t fo r
sp ec fi c M T M
or
C og
n it iv e se rv ic es
C h oo
se d iff er en
t lo ca ti on
to be
re p re se n ta ti ve
. D id
Se lf -
ad m in is te re d
D ic h ot om
ou s
ch oi ce
1 0 4
D es cr ip ti ve
st at is ti cs
7 0 %
(w it h
2 0 %
C op
ay )
N ot
p ro vi d ed
Y es
(c on
ti nu
ed on
ne xt
pa ge )
J.T. Painter et al. Research in Social and Administrative Pharmacy 14 (2018) 1091–1105
1096
T ab
le 1 (c on
ti nu
ed )
Y ea r
A u th or (s )
C it at io n
Lo ca ti on
R es ea rc h Q u es ti on
Se rv ic e V al u ed
A p p ro p ri at e
P op
u la ti on
Su rv ey
ed ?
M et h od
of Su
rv ey
A d m in is tr at io n
V al u e
el ic it at io n
m et h od
N St at is ti ca l
A n al ys is
% W T P M or e
T h an
$ 0
A ve
ra ge
W il li n gn
es s
to P ay
M ea n (S D )
U SD
u n le ss
ot h er w is e in d ic at ed
In st ru m en
t m ad
e av
ai la bl e
ed u ca ti on
al se rv ic es
n ot
re co
rd %
n on
- re sp on
d er s
2 0 0 9
H off
m an
JD A SH
P M id ye
ar C li n ic al
M ee ti n g.
2 0 0 9 ; A N : 4 6 -2 1 4 7 8
U T
T o ev
al u at e th e
p er ce p ti on
of co
m m u n it y cl in ic al
p h ar m ac is t le d
m ed
ic at io n
m an
ag em
en t
se rv ic e
M ed
ic at io n
th er ap
y m an
ag em
en t
P ri va
te in su ra n ce
re ci p ie n ts
at te n d in g
h ea lt h fa ir .
In te rv ie w er -
ad m in is te re d
O p en
-e n d ed
3 5
N ot
ad d re ss ed
N ot
p ro vi d ed
M ed
ia n =
U S$
1 0
N o
2 0 0 9
So m ey
a, T ak
u m a F,
Iz u m is aw
a F,
Sh ir ag
am i M
J P h ar m
So c Ja p an
. 2 0 0 9 .1 2 9 (9 ):
1 1 3 7 -
1 1 4 0 .
Ja p an
T o d et er m in e n ee d
fo r p h ar m ac is t
co n su lt at io n
se rv ic es ,
sa ti sf ac ti on
w it h
cu rr en
t p ra ct ic e,
an d fa ct or s
re sp on
si bl e fo r
p at ie n t's
fo rg oi n g
co n su lt at io n
P h ar m ac eu
ti ca l
ca re
A d eq
u at e
in fo rm
at io n
re ga
rd in g sa m p li n g
st ra te gy
n ot
p ro vi d ed
. Lo
w re sp on
se ra te
1 7 .8 %
In te rn et -b as ed
qu es ti on
n ai re
O p en
-e n d ed
1 8 0 0
D es cr ip ti ve
st at is ti cs
N ot
p ro vi d ed
¥ 3 3 8 =
U S$
3 .5 0 ;
¥ 3 8 6 =
U S$
4 .0 0 fo r
th os e w il li n g to
p ay
.
N o
2 0 1 0
Fr ie d ri ch
M ,
Z ga
rr ic k D ,
M as oo
d A ,
M on
tu or o J.
J A m
P h ar m
A ss oc
2 0 1 0 Ja n –F
eb ;
5 0 (1 ): 7 2 -7
IL T o d et er m in e W T P
fo r M T M
an d
fa ct or s in fl u en
ci n g
W T P
M ed
ic at io n
th er ap
y m an
ag em
en t
C om
m u n it y
p h ar m ac y p at ro n s
Se lf -
ad m in is te re d
O p en
-e n d ed
6 8 3
U n iv ar ia te
an d bi va
ri at e
an al ys is
6 0
U S$
1 7 .5 7
(m ed
ia n =
$ 1 5 )
Y es
2 0 1 1
H on
g S,
Li u J
et al .
J A m
P h ar m
A ss oc
2 0 1 1 M ay
–J u n ;
5 1 (3 ): 3 7 8 -8 7
T N
T o d et er m in e th e
at tr ib u te s of
M T M
th at
ar e im
p or ta n t
to p at ie n ts
& W T P
fo r th es e at tr ib u te s
M ed
ic at io n
th er ap
y m an
ag em
en t
Se n io r ce n te r vi si to rs
In te rv ie w er -
ad m in is te re d
D is cr et e ch
oi ce
ex p er im
en t
3 5 5
U n iv ar ia te
an d
m u lt iv ar ia te
re gr es si on
N ot
p ro vi d ed
U S$
1 3 .3 1
Y es
2 0 1 2
G ri go
ro v E E ,
N as ev
a E K ,
Le ba
n ov
a H V ,
G et ov
IN
A fr ic an
J of
P h ar m ac y an
d P h ar m ac ol og
y 2 0 1 2
6 (1 3 ) 1 0 0 5 -1 0 1 0 .
B u lg ar ia
T o as se ss
W T P fo r
bl oo
d p re ss u re
m ea su re m en
t
D ia be
te s d is ea se
m an
ag em
en t
V is it or s an
d p at ie n ts
of a co
m m u n it y
p h ar m ac y
In te rv ie w er -
ad m in is te re d
O p en
-e n d ed
1 0 0
U n iv ar ia te
an d bi va
ri at e
an al ys is
9 5
2 .3 4 B G N = U S$
1 .5 8
N o
2 0 1 2
N ai k- P an
ve lk ar
P , A rm
ou r C ,
R os e J,
Sa in i B
J A st h m a.
2 0 1 2 A p r;
4 9 (3 ): 3 1 0 -6
N ew
So u th
W al es
T o ev
al u at e p at ie n t
p re fe re n ce s as
w el l
as th ei r W T P fo r a
co m m u n it y
p h ar m ac y-
d el iv er ed
sp ec ia li ze d as th m a
se rv ic e
A st h m a
m an
ag em
en t
p ro gr am
P at ie n ts
w it h as th m a
in N ew
So u th
W al es
M ai l
D is cr et e ch
oi ce
ex p er im
en t
8 0
U n iv ar ia te
an d
m u lt iv ar ia te
re gr es si on
N ot
p ro vi d ed
A U D $ 9 4 .8 6 =
U S
$ 9 1 .2 6
Y es
2 0 1 4
W as zy k-
N ow
ac zy k M ,
N ow
ac zy k P ,
Si m on
M
Sa u d i P h ar m
J. 2 0 1 4
D ec ; 2 2 (6 ): 5 3 7 -4 4
P ol an
d T o as se ss
op in io n s
of p at ie n ts
an d
p h ys ic ia n s ab
ou t
th e
im p le m en
ta ti on
of p h ar m ac eu
ti ca l
ca re
P h ar m ac eu
ti ca l
ca re
R es p on
d en
ts w er e
p h ys ic ia n s an
d p at ie n ts ; n o m en
ti on
of co
m p en
sa ti on
Se lf -
ad m in is te re d
P ol yc h ot om
ou s
ch oi ce
2 0 2
C h i- sq u ar e
te st , Fi sh er -
Fr ee m an
- H al to n te st
w it h 0 .0 5
si gn
ifi ca n ce
le ve
l, m ea n
8 6
U S$
7 .0 0
N o
2 0 1 4
U m
IS , A rm
ou r
C , K ra ss
I, G il l
T , C h aa
r B B
H ea lt h E xp
ec ta ti on
s. 2 0 1 4 A u g;
1 7 (4 ): 5 7 9 -5 9 2 .
N ew
So u th
W al es
T o d et er m in e
op in io n s on
an d
W T P fo r w ei gh
t m an
ag em
en t
se rv ic es
W ei gh
t m an
ag em
en t
se rv ic es
R es p on
d en
ts w er e 1 8
ye ar s of
ag e li vi n g in
N ew
So u th
W al es
In te rn et -b as ed
qu es ti on
n ai re
P ol yc h ot om
ou s
ch oi ce
4 0 3
D es cr ip ti ve
st at is ti cs
an d
fa ct or
an al ys is
5 0
M ed
ia n A U D
$ 1 0 =
U S$
9 .6 2
N o
(c on
ti nu
ed on
ne xt
pa ge )
J.T. Painter et al. Research in Social and Administrative Pharmacy 14 (2018) 1091–1105
1097
T ab
le 1 (c on
ti nu
ed )
Y ea r
A u th or (s )
C it at io n
Lo ca ti on
R es ea rc h Q u es ti on
Se rv ic e V al u ed
A p p ro p ri at e
P op
u la ti on
Su rv ey
ed ?
M et h od
of Su
rv ey
A d m in is tr at io n
V al u e
el ic it at io n
m et h od
N St at is ti ca l
A n al ys is
% W T P M or e
T h an
$ 0
A ve
ra ge
W il li n gn
es s
to P ay
M ea n (S D )
U SD
u n le ss
ot h er w is e in d ic at ed
In st ru m en
t m ad
e av
ai la bl e
2 0 1 4
R ic kl es
N M ,
Sk el to n JB
, D av
is J,
H op
so n
J
In te rn at io n al
Jo u rn al
of C li n ic al
P h ar m ac y.
2 0 1 4 A p r; 3 6 (3 ): 3 6 0 -
3 6 7 .
N C
T o ev
al u at e th e
im p ac t of
p h ar m ac y- ba
se d
co gn
it iv e m em
or y
sc re en
in g an
d re fe rr al
p ro gr am
, m ea su re
p at ie n ts
sa ti sf ac ti on
, an
d as se ss
W T P
C og
n it iv e m em
or y
sc re en
in g an
d re fe rr al
se rv ic e
R es p on
d en
ts w er e
id en
ti fi ed
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J.T. Painter et al. Research in Social and Administrative Pharmacy 14 (2018) 1091–1105
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problems. Using polychotomous choice, patients were giving a WTP range for a pharmacist consultation service fee out of pocket of $0-$30. Patients with health insurance were also asked to select the maximum extra to their insurance premium per year that they were willing to pay for the services. The polychotomous answer choices ranged from $0 to $500. Subjects were recruited at an outpatient clinic and in two phy- sician offices in New Jersey. The self-administered questionnaire was completed by 316 respondents. Most respondents were female with a mean age, education level in years, and income of 47 years, 15.3 years, and over $50,000, respectively. Sixty percent had a positive WTP. In the questionnaire, respondents were asked how long they thought the pharmacist counseling session should last. The mean length of time was 6.5 min and the average WTP for a counseling session lasting that long was $5.57 ($0.87 per minute). No standard deviation was provided. The mean WTP through an increased premium ranged from $28.79 to $36.29 per year. Respondents were willing to pay more for greater risk reduction. Regression analysis demonstrated that though income was positively and age was negatively related to WTP, this did not achieve statistical significance. Sex and education level were not evaluated. Respondents' health state indices were also positively related to WTP, indicating that healthier respondents were willing to pay more to pre- vent medication-related problems.
In 2001, Blumenschein et al. conducted a field experiment com- paring hypothetical versus real WTP for a pharmacist provided asthma management program.13 In this experiment 172 subjects with asthma were recruited from 10 different independent pharmacies in the state of Kentucky. A description of a three-month pharmacist provided asthma management program was read to the subject; in addition, a written description was provided to them. Subjects were divided into two groups: “hypothetical” and “real”. The hypothetical group was given a dichotomous choice (i.e., yes/no) contingent valuation question about purchasing a pharmacist provided asthma management program, while the subjects in the real group were given the opportunity to purchase the service. Three different prices were used in the experiment: $15, $40, and $80. Both groups were predominantly females with a mean age of 50 (standard deviation (SD = 15.5) and an average of approxi- mately 11.5 (SD = 3.34) years of education. The mean WTP for the asthma management program was estimated to be $29.23 in the hy- pothetical group and $8.97 in the real group.13 No standard deviations were provided. Regression and Pearson chi-squared were used to de- termine if the difference seen in the hypothetical and real groups was significant. Within the hypothetical group 38% of the subjects said they would purchase the service while only 12% of the subjects in the real group actually purchased the service. The results indicated that WTP decreased with education. The authors found a positive correlation between the income variable and sex with WTP but the correlation did not achieve statistical significance.
Also in 2001, Barner surveyed patients at 10 randomly selected stores from the local area of Austin, Texas to determine their WTP for diabetes disease management services.36 Diabetes disease management services is an application of pharmaceutical care to a specific disease state. In total, 169 patients responded to the mailed self-administered questionnaire. Patients were provided with a payment card with a list of dollar values ranging from $0-$150 and were told to choose their maximum WTP for the service. Most the population was white (71%) with an average age of 58.4, an education level of some college, and an income greater than or equal to $40,000. Of the respondents, 67.2% provided a non-zero WTP averaging $28.16 (SD = 31.12). The median value was $30. The authors used Pearson's correlation coefficients and identified a positive correlation between the perceived need and per- ceived importance of the service and the WTP for the service. The au- thors concluded that pharmacists should assess a patient's need for the service and educate them on the importance of the service. The authors did not evaluate the relationship between age, sex, or education level and WTP.
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J.T. Painter et al. Research in Social and Administrative Pharmacy 14 (2018) 1091–1105
1099
herbal counseling on patient satisfaction in a community pharmacy setting.39 A total of 40 patients, recruited from a community pharmacy, received counseling regarding herb-drug and herb-disease interactions and had a pharmacist review their herbal and prescription drug history. The respondents were primarily male (57.5%). No other socio- demographic variables were reported. The authors found that a sig- nificant number of patients who had previously received herbal coun- seling were more likely to be willing to pay for the service. Seventy percent of participants were willing to pay up to $30 for the service and fifteen percent were willing to pay over $60 for the service. No re- gression analyses were performed assessing the relationship between age, sex, education level and WTP.
In 2002, Lata et al. investigated the acceptability of a pharmacy- based bone mineral density measurement program.14 This study did not directly involve the contingent valuation method per se, but it did in- clude a WTP question and therefore was included in this review. In this study, 197 women aged 50 and older were recruited from four rural independent community pharmacies in Wisconsin. The authors did not collect data pertaining to the patients' socioeconomic status. Each pa- tient included in the study underwent bone density measurement and completed a questionnaire. The type of question used in the survey to determine the patient's WTP was not described. The surveys were de- signed to elicit information pertaining to knowledge of osteoporosis and bone density testing, frequency of health care provider visits, and the monetary value that was assigned to bone density testing. Ninety-three percent of patients said they were willing to pay for this type of service and the median value placed on the service was $25. In addition, 31% of the patients surveyed said they were willing to pay at least $50.14
The authors did not collect data pertaining to the patients' socio- economic status and no statistical analyses were done regarding the WTP question; therefore, no association between income, education, or any other socioeconomic factor and WTP could be formulated.
In 2002, English et al. studied the out-of-pocket WTP for community pharmacist provided diabetes care services and whether prior experi- ence with the service played a role in the WTP value.37 The study used a convenience sample from an outpatient diabetes education program and an inpatient community hospital in Texas. No demographic in- formation was collected and the type of question used to determine the WTP was not specified. The final sample consisted of 117 self-ad- ministered questionnaires. The mean WTP was $43.90 (SD = $41.20) for a 1 h consultation resulting in 25% improvement and $56.60 (SD = $47.80) for consultations resulting in a 50% improvement. Pa- tients who had not received prior diabetes management education were more likely to pay more for the service as well as patients who per- ceived the pharmacists as having the ability to perform these services. No analyses were done investigating the association between age, sex, education level and WTP.
In 2003, Côté et al. evaluated the cost and benefits and assessed consumer WTP for a 9-month hypertension health promotion program offered in community pharmacies in Quebec City, Quebec.16 The pro- gram consisted of the pharmacist assessing adherence and taking blood pressure readings at each visit to the pharmacy; appropriate interven- tions were made where needed. A face-to-face interview using an open- ended question was used to obtain WTP for the service before and after the program was implemented. Forty-one subjects received the inter- vention of which the majority was above the age of 65, female, and of low income strata. Prior to receiving the intervention, 17.1% had a mean WTP of CAN$3.29 (US$2.53) (SD = 9.3); upon conclusion of the program, 2 of the 41 patients expressed a positive WTP, with the mean being CAN$0.54 (US$0.42) (SD = 3.1).16 Unfortunately, 29% of sub- jects stated, “I don't know” or “I refuse” when asked the WTP question after the 9-month intervention. No statistical tests were performed to ascertain significance. The authors suggest that this lack of WTP may have been a result of the fact that participants did not experience much change in the way their disease had been managed and/or they may not have perceived changes in their health-related quality of life. The
authors did not present any analysis evaluating the relationship be- tween background characteristics and WTP.
In 2003, Daftary et al. repeated the previously mentioned Larson (2000) study with minor adjustments.15 As in the Larson study, the surveys were self-administered. The sample of 90 respondents was drawn from two Washington DC ambulatory care pharmacies. Unlike the open-ended question used by Larson, the Daftary study structured the WTP question as a dichotomous (i.e., yes/no) question, where re- spondents were asked if they would pay $10 or more for the service. Most respondents were female and between the ages 26 and 45. Unlike the Larson study, a minority of the sample was Caucasian (6%); 58% were African American and 13% were Hispanic. Sixty-one percent had annual income under $31,000, and 60% had at least some college education. Forty percent of the respondents were willing to pay at least $10 for a single pharmaceutical care evaluation; 63% were willing to pay at least $10 for a pharmaceutical care evaluation with a year of monitoring by the pharmacist.15 In multivariate analysis, no ex- planatory variable predicted WTP.
Cerulli & Zeolla assessed WTP for a bone mineral density screening program in 2004 in Albany, NY.31 As with the Lata et al. (2002) article, this was not a contingent valuation study; however, since the authors used a WTP question, it was included in this review. After participating in a bone mineral density screening and educational program, a self- administered questionnaire asked subjects how much they would have been willing to pay had the service not been free was administered in two independent and four chain community pharmacies in Albany, New York. The polychotomous choices were presented in $5 incre- ments. No demographic variables other than age were collected. Of the 140 women who participated, 41% expressed a WTP of at least $20.31
The mean WTP was not provided. Using Spearman's rank correlation test, the authors did not find any correlations between WTP and age, osteoporotic risk, or patient-reported usefulness of the screening.31 The authors did not test the relationship between sex, education and WTP.
A 2005 study by Barner & Branvold examined WTP for pharmacist- provided consultations regarding menopause and hormone replacement therapy (HRT).17 A convenience sample of adult women participants was recruited by 50 volunteer pharmacists, mainly in independent community pharmacies throughout the United States. Two hundred three women completed the self-administered questionnaire. WTP was assessed using the payment card system in which respondents are given a range of dollar amounts and asked to choose their maximum WTP. The range was US$0 to US$160 in US$20 increments. The participants were primarily Caucasian, with a mean age of 53 years, at least some college, and an income level between $25,000 and $75,000. Other in- formation collected by the survey included menopausal symptoms be- fore and after HRT, importance of resolving symptoms, satisfaction with services, perceptions of pharmacists' abilities, and income. Re- spondents were asked to value initial consultations and follow-up consultations under the assumption that symptoms would be reduced by 50%, and then asked to value initial and follow-up consultations under the assumption that symptoms would be reduced by 100%. Subjects were willing to pay more for initial consultations than for follow-up consultations and were willing to pay more for 100% im- provement in symptoms than for 50% improvement. For an initial consultation, patients were willing to pay $42.07 (SD = $30.27) for 50% improvement and $65.60 (SD = $42.80) for 100% symptom im- provement. For a follow-up consultation, respondents were willing to pay $33.68 (SD = $26.60) for 50% improvement and $51.40 (SD = $36.61) for 100% symptom improvement. At least 85% of the respondents were willing to pay a minimum of $20 for a 30-min con- sultation. Using logistic regression, the authors found that WTP in- creased with increased perceptions of pharmacists' abilities to provide the service and with patient income. No regression analyses were done analyzing the relationship between age, sex, education level, and WTP. It was therefore concluded that if pharmacists can convey to the public their abilities and expertise in drug therapy management, there may be
J.T. Painter et al. Research in Social and Administrative Pharmacy 14 (2018) 1091–1105
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a new opportunity in providing consultations regarding menopause symptom management and HRT.
In 2005, Hong et al. assessed whether or not patients are willing to pay for pharmacist self-care services on the proper use of over-the- counter medications.18 This study had 262 participants who were re- cruited by pharmacy students at community pharmacies in Arkansas. The study population was primarily female (61%), with over 95% having at least a high school education. In addition, greater than 83% of the study population had some form of insurance. Each participant completed a self-administered questionnaire pertaining to the amount they were willing to pay for pharmacist-provided advice regarding the use of over-the-counter medications. Subjects selected one of seven price ranges from $0 to $20. The authors found that 51% of patients had a positive WTP for pharmacist self-care services related to non- prescription products.18 In addition, after controlling for covariates, the authors found a strong correlation between WTP and the type of community practice setting, with grocery/chain pharmacy patrons willing to pay the most and mass market chain drug store patrons willing to pay the least for pharmacist based self-care programs. On average the study found that pharmacy patrons were willing to pay approximately $5 for a 5-min consultation on the proper self-use of over-the-counter medications.18 Age, gender, income, and education level were not significantly correlated with the patients' WTP.
In 2008, Blumenschein et al. performed a field experiment to study diabetes patients' WTP for a pharmacist-provided diabetes management program in Kentucky.20 Similar to their work in 2001 related to asthma management, this study addressed the concern regarding the possible existence of hypothetical bias in contingent valuation studies. The au- thors approached this problem by using three separate treatment groups: real, hypothetical, and “cheap talk”. The real group was actu- ally given the opportunity to purchase the service at the pharmacy, the hypothetical group received a hypothetical dichotomous choice (i.e., yes/no) contingent valuation question with the price varying from $15, $40, and $80. The “cheap talk” group received the same hypothetical dichotomous choice question, but the question was preceded by a “cheap talk” script that explicitly explained the concept of hypothetical bias (i.e., the tendency to overstate values when asked hypothetical WTP questions compared to actually being offered the opportunity to purchase the good or service).42 Those in the hypothetical group with a non-zero WTP received a follow-up question to determine whether they were “probably sure” or “definitely sure” of their response. Two hun- dred sixty-seven responses were collected. The majority were women, white, with about 11 years of education, and a mean household income of approximately $31,000. Results indicated that the hypothetical group (mean WTP = $42.36; SD = 6.34) had WTP nearly twice that of the real group ($22.11; SD = 4.71). However, when only including the “definitely sure” responses from the hypothetical group, the mean WTP was $20, thereby removing the bias. The cheap talk script had no effect on removing hypothetical bias (mean WTP = $44; SD = 6.56). Logistic regression showed no significant correlation between age, sex, income, education level and WTP. The authors concluded that although the cheap talk approach to hypothetical bias is not effective, the addition of a simple follow-up question regarding the certainty of responses may provide accurate estimation.
In 2008, Law et al. studied the expectations and perceptions of patients toward pharmacists in their dispensing roles and as medication therapy management (MTM) providers.19 A total of 504 Medicare Part D (i.e. government-provided prescription drug coverage among US ci- tizens over age 65) enrollees from California completed the online questionnaire. The sample was primarily white, female, had a mean age of 72, and used an average of 4.3 prescriptions per day. Among other questions the questionnaire asked if patients would be willing to attend a clinic where pharmacists provide information, but not medications, and if so, how much they would be willing to pay for such a service. No statistical analysis was performed, but the study found that most pa- tients were unfamiliar with the term “MTM”. However, once provided a
definition, 70% responded that they did not require MTM. Of those who were willing to attend and willing to pay, approximately 7% of the sample, the mean WTP was $21.37 (Median: $10). No standard de- viation was provided. Law et al. conclude: “The profession needs to focus efforts to increase enrollee awareness, modify perceptions, and use patient trust as a springboard to positive image marketing.” No regressions were performed analyzing the correlation between the sex, age, income, education level and WTP.
In 2008, Schuh and Droege surveyed a sample of pharmacy custo- mers in the three Florida cities of Manasota, Clearwater, and Jacksonville.21 Their objective was to determine the customer's WTP out-of-pocket for cognitive services that included MTM and education services using a self-administered questionnaire. Participants were presented with three polychotomous choices of a 0% copay, 20% copay, and 100% copay. Out of 104 responders, 56% were female, 27% were above the age of 60, and 30% had an income greater than $100,000. No demographic data about education level was collected. Of the sample, 70% were willing to pay their usual 20% copay rate for cognitive ser- vices. No monetary value was provided. Although a disproportionate number of responders earned more than $100,000 per year, the authors found that WTP did not significantly vary with income. Both men and individuals over the age of 50 were found to be less willing to pay for these services. The authors also observed an inverse relationship be- tween WTP and out-of-pocket costs; patients were willing to pay more for pharmacy services as their out-of-pocket expenses decreased. Fe- male patients and patients with a higher income were willing to pay more for cognitive services. The relationship between education level and WTP was not assessed.
In 2009, Hoffman conducted a study to assess patient's perception of medication management services offered in community pharmacies.32
The survey was administered to health fair attendees; 35 of the 200 attendees completed the survey. Respondents indicated preferences for care settings such as short wait times and designated counseling areas, as well as the nature of service offered including medications review and advice on medications and health. Most respondents indicated a willingness to pay of $10 per visit. The authors noted patient appre- ciation for the services but a lack of awareness among respondents regarding impact on health. The relationship between socioeconomic factors and WTP was not examined.
Someya et al. conducted an online survey in Japan in 2009 to assess the patient's perceptions regarding pharmacist consultation services and to estimate their willingness to pay.22 Of the 1800 people surveyed, 49.9% were willing to use pharmacist consultation services if it was offered. The average WTP for consultation service was 338 ¥ (US$3.50) for patients willing to use the service and 386 ¥ (US$4.00) among those who reported a positive value. Common reasons cited by patients for forgoing consultation were pharmacy attributes such as waiting time and patient privacy. Based on the assessed patient need and their willingness to pay, the authors recommended introducing a system for patient consultation and improving the current state of practice. No analysis examining the relationship between demographic factors and WTP were reported.
In 2010, Friedrich et al. surveyed a convenience sample of grocery store pharmacy customers in Chicago, Illinois regarding their WTP for MTM services from pharmacists.33 Of the 683 patients that completed the self-administered open-ended question regarding WTP, 60% (105) provided unusable responses. The majority of the sampled population was female, white, and with a household income less than $100,000. Demographics on the level of education were not collected. The overall mean WTP, including those with $0 responses, was $17.57 (median = $15). Of the 60% of respondents whose answer was non- zero, the mean WTP was $23.58 (median = $20). No relationship was found between income, race, or gender and WTP; however, younger patients were willing to pay more for these services. The relationship between education level and WTP was not assessed. WTP was also dependent on presence of certain chronic diseases. An ANOVA analysis
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found that patients with dyslipidemia or hypertension were willing to pay less when compared to patients overall, while those with arthritis or chronic pain and those with heart failure were willing to pay more. Overall those not suffering from a chronic condition were willing to pay more, though having multiple chronic conditions was not significantly different than having only one. There was a significant and positive correlation between the perceived helpfulness of the pharmacist and WTP. Finally, patients with public insurance were willing to pay less for pharmacy services.
In 2011, Hong et al. performed a discrete choice experiment to identify attributes associated with positive marginal WTP for MTM services in Memphis, TN.23 This study interviewed 355 Medicare (ie. government-provided health insurance among US citizens over age 65) enrollees about various program characteristics. These characteristics, in order of importance to survey respondents, were cost of the service, service setting, provider experience in overall practice, provider ex- perience in geriatrics, provider type, number of drug therapy problems, and service duration. Participants were presented three choices of $30, $60, and $90 to pay for the service. The sample was primarily female, non-Hispanic white, with at least some college education. The marginal WTP for program characteristics was determined using a multivariate model. The most attractive scenario for patients was a 15-min (vs. 30) session provided at a community pharmacy (vs. clinic, home, tele- phone) by an experienced (vs. inexperienced) pharmacist (vs. nurse or nurse practitioner) for three (vs. one or two) drug therapy problems. Participants were willing to pay $31.76 for clinic based MTM vs. tele- phone MTM, and $13.31 more for a community pharmacy vs. clinic based MTM. Total marginal WTP for the more attractive scenario was $126.52 over the least preferential scenario. The authors did not eval- uate the relationship between age, sex, income, or education level and WTP.
Grigorov et al. carried out a study in 2012 to assess the amount of money patients in a community pharmacy were willing to pay for the measurement of their blood pressure.38 Participants were sampled from community pharmacies in Sofia, Bulgaria. Face-to-face interviews with open-ended questions were performed during a period of two months with 100 participants. Participants were primarily female (54%) and between the age of 50 and 59 years. Education levels were not col- lected. The results showed that 95% of the sampled population was willing to pay for measurement of their blood pressure. The mean value paid was 2.34 BGN (US$1.58). The median value was 2 BGN (US$1.35). Chi-square tests were performed to determine which factors may affect a respondent's WTP. Demographic variables such as sex, age, and in- come were not significantly related to a respondent's WTP. The asso- ciation between education status and WTP was not measured. Statis- tical tests did show that respondents who measured their blood pressure more frequently were also more likely to be willing to pay for the services.
In 2012, Naik-Panvelkar et al. investigated attributes of a specia- lized asthma service that were associated with positive marginal WTP in New South Wales, Australia.24 This study utilized a discrete choice experiment that was mailed to patients who had received the service in question. The questionnaire featured two different scenarios and the patients chose the one they preferred. The sample, consisting of 80 asthma patients, was primarily female, with a mean age of 55.6 and a high school diploma or less education. Using a multivariate regression, the authors analyzed the responses of 80 participants and found that access to a pharmacist (AUD$9.18 = US$8.83), availability of a private area for consultation (AUD$18.00 = US$17.32), provision of lung function testing (AUD$9.18 = US$8.83), comprehensive advice (AUD $22.80 = US$21.94) and cost of service had significant and positive marginal WTP. No standard deviations were reported. Other factors including frequency of visits, number of days with symptoms of asthma, and interaction with the pharmacy staff were not significant predictors of WTP. The marginal WTP for the total service was AUD$94.86 = US $91.26. The authors found a significantly positive correlation with age
and education level with WTP. No significant associations were found between gender and income level.
A study published in 2014 by Waszyk-Nowaczyk et al. aimed to assess the opinion of patients and physicians on the implementation of pharmaceutical care services in independent community pharmacies and their WTP for these services in Poland.26 A self-administered questionnaire with polychotomous answer choices was administered to 202 patients. The demographics of the patients were not reported. A majority (85.64%) of patients were in favor of implementing pharma- ceutical care in community pharmacies. The mean appointment cost was $7 though a majority of respondents indicated that an appropriate appointment cost would be $1. No standard deviations were provided. Most patients agreed that the service should take on average five to 15 min. One third of the patients surveyed indicated that the service should be reimbursed by the state. Authors in the 2014 study did not evaluate the association between WTP and the patient sex, age, or education level.
In 2014, Um et al. evaluated the perspectives of Australians on weight management services performed in a pharmacy setting, their past experiences and their WTP for these services.40 Four hundred and three consumers above the age of 18 from New South Wales, Australia completed online self-administered questionnaires consisting of open-, closed-ended questions, and polychotomous choices. WTP was assessed through polychotomous choices ranging from $0-$50 in $10 incre- ments. The participants were primarily women (51%) with a median age of 39 years. Education level was not reported. Only 13% of the participants had previously sought pharmacists' advice regarding weight management and approximately half of the participants were not willing to pay for the service. Those who were willing to pay for the service provided a median value of AUD$10 (US$9.62). Some we were willing to pay up to AUD$50 (US$48). No mean or standard deviations were reported. The association between demographic data of the re- spondents and their WTP was not analyzed. The main reasons stated for a lack of WTP were that pharmacists may not be suitably trained to give advice in the domain or may have a conflict of interest due to profiting from sales of recommended products.
In 2014, Rickles et al. evaluated the impact of a pharmacy-based cognitive memory screening and referral program and assessed patient WTP for the service in Oregon and North Carolina.25 Pharmacists spe- cifically trained to administer the cognitive screening test administered the test to 161 patients in 12 chain pharmacies. The patients were primarily female (74%), had a high school or college education (77%) with a mean age of 65 years. Pharmacists referred 54 of the patients who exhibited symptoms to physicians. Referred patients were then contacted via telephone and were administered a survey to determine their WTP and overall satisfaction. The survey consisted of poly- chotomous, dichotomous, and open-ended questions. Almost all pa- tients were satisfied with the program. Of the referred patients, 56.4% were willing to pay out-of-pocket for the service. Of these patients 77% were willing to pay between $5 and $10, 5% between $11 and $15, 14% between $16 and $20, and 5% between $21 and $25. Fifteen participants were referred to a physician and completed the telephone survey, which may introduce bias. The associations between age, sex, and education level with WTP was not tested.
In 2014, Woelfel et al. investigated Medicare beneficiaries' WTP for MTM services. The investigators identified 277 participants at nine outreach events in four cities in California.34 Pharmacists administered an open-ended questionnaire to the subjects and collected their socio- demographic data. The population was primarily female, white, had at least a bachelor's degree, and a mean age of 75 years. 56% of the subjects were willing to pay for the service. The mean WTP for the service was $33.15 (SD = $77.33). The investigators examined the subjects' characteristics and performed a bivariate analysis to determine the characteristics that influence that subject's WTP. They concluded that race, subsidy status, and the number of prescription medications are all factors that correlated with the subject's WTP for the service. Age
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and education level were not significantly associated with the WTP. The authors did not test the correlation of sex and WTP.
Sriram et al. published a study in 2015 investigating whether pharmacy customers in Western Australia, Australia were willing to pay for an advanced model of pharmacy consultation.27 Two video vign- ettes of the current and more advanced consultation model were pre- sented to 175 subjects. The participants were then asked to respond to an open-ended self-administered questionnaire on the perceived dif- ferences between the two models and their WTP. The population was primarily female (52%), had at least a year 12 education (41.1%) and between the age of 30 and 59 years of age. Of the 11% that were willing to pay for the standard service, the median payment was AUD$10 ($US8.23). Of the 28% of respondents that were willing to pay for the more advanced service, the median WTP was AUD$15 ($US12.35). Forty-one percent of the participants indicated no WTP more than $0 for either service. The authors found that education level was the only demographic variable that significantly influenced a participant's po- sitive attitude toward WTP for the more advanced consultation service. No significant associations were found between age, sex and WTP.
Tsao et al. published a study in 2015 examining the general public's opinions, preferences, and WTP with respect to MTM in British Columbia, Canada.35 A cross-sectional online survey with poly- chotomous choices was administered to 819 participants across British Columbia. WTP responses were divided into the following intervals: CAN$0-20, CAN$21-40, CAN$41-60, and > CAN$60. The participants had a mean age of 45 years, 37% were male, and 65% had at least post- secondary education. Of the respondents, 84% were willing to pay for the service. The average WTP for MTM was CAN$24.55 = US$21.26 (SD=CAN$21.44 = US$18.57). After examining the demographic in- formation of the participants, the authors found that age and income were significantly negatively correlated and income and previous ex- perience with MTM were significantly positively correlated with a participant's WTP.
In 2016, Porteous et al. used discrete choice experiment to de- termine the general public's preference for attributes of community practices in the United Kingdom.28 The authors used WTP to differ- entiate between the attribute levels. The face-to-face computer-assisted interviews were administered to 1049 participants. The participants had a mean age of 49 years and were primarily female (50.9%). Edu- cation levels were not recorded. Porteous et al. concluded that com- munity pharmacies with easy access to parking and with friendly and trained staff that help understand and manage symptoms are the main attributes that affect a patient's WTP for these services. The WTP for a service with the combined attributes above was estimated at 55.43 GBP = US$69.19. No analyses investigating the relationship between sex, age, education level and WTP were performed.
Gibson et al. conducted a study in 2017 to estimate the patient's attitude towards pharmacogenomic testing for therapies dispensed at pharmacies and estimated their willingness to pay.41 The anonymous survey was distributed online to the residents of a town in Tennessee. Of the 7019 emails sent out 734 were opened of which 27 recipients responded. The recipients had a mean age of 54.4, most were covered by private insurance and Caucasian. Patients were interested in using the service if covered by insurance. However, the willingness to pay out of pocket for the service varied considerably from $0 for 23% of the patients to $100 or more for 8% of patients. The authors concluded that further patient education on the value of pharmacogenomics in im- proving patient outcomes is needed, to increase its feasibility as a pharmacy service.
In 2017, a study by Kang et al. studied the willingness to pay for pharmaceutical care services in patients with chronic conditions.29 The researchers surveyed 220 patients from pharmacies across South Korea. The mean age of the sample was 61.3 (SD = 13.1), with only 30% patients having prior experience with pharmaceutical care services. The factors associated with the need for pharmaceutical care services in- cluded patient education level and region. Less than half of the patients
were willing to pay for pharmaceutical care services. The authors noted that although the need for pharmaceutical care exists, there are con- cerns regarding awareness and perceived value of those services.
5. Discussion
The economic value of health care services is being dissected as society attempts to allocate limited resources. To survive, new and existing services will have to demonstrate value to both health care payers and consumers. While there is a considerable volume of litera- ture assessing the economic value of pharmacy services, relatively few studies have addressed the consumer's perspective of value.
In a contingent valuation study, as in all survey research, the quality of the survey instrument is crucial. Mitchell and Carson have described a number of potential biases that must be considered when constructing the contingent valuation instrument.6 Careful phrasing of the scenario and contingent valuation question are extremely important to avoid scenario misspecification bias, which occurs when the respondent does not respond to the correct contingent scenario. This problem can be caused by incorrect and imprecise formulation of the contingent va- luation question or through the respondent misunderstanding the WTP question. For example, if the respondent perceives the WTP question to be symbolic, he/she may express an attitude or belief instead of a true valuation for the good or service being valued. The respondent may view the good or service worthwhile and use the WTP question as an opportunity to achieve a “warm glow” via the act of approval.5,43,44
Scenario misspecification can also be the result of valuing a dif- ferent quantity or quality of the good or service than what was intended by the researcher. Thus, unless the study authors explicitly state the description of the service that was provided to the respondent prior to answering the WTP question, it is difficult to assess the potential for scenario misspecification. It appears Suh (2000) did consider this po- tential bias in his survey design, as the survey included a description of medication related problems and identification of pharmacist services that can potentially reduce the risk for medication related problems.5
All of this information was provided prior to asking the contingent valuation question. Larson's (2000) survey asked respondents to con- sider various pharmacist provided services and comment on whether they had received them in the past.12 This may have helped clarify the concept of pharmaceutical care for the respondent. It is not clear if the study by Daftary et al. (2003) contained any description of pharma- ceutical care. Law et al. (2008) found 92.5% of survey takers were unfamiliar with the term MTM; in response to this finding, a definition was presented to participants, although this definition is not included in the published manuscript. The 2001 and 2008 studies by Blumenschein et al. had the respondent listen to and read a description of the asthma management program prior to responding to the contingent valuation question.13 It is unclear if the respondents in the Hong et al. (2005) study were given a detailed description of what the service on proper use of over-the-counter medications actually entailed.
Guidelines for conducting contingent valuation surveys were first published in 1993.45 Although these recommendations have been re- ported to enhance the quality of contingent valuation studies,10 studies using methodology outside the guidelines are still published. It is im- portant to keep in mind that the recommendations should not be viewed as binding or definitive, since the ideal design for a valid con- tingent valuation study is still an open research issue. However, given the fact that recommendations provide the state-of-the-science minimum standards for conducting WTP studies, it is reasonable to expect researchers to at least attempt to follow them.
The 1993 guidelines recommend the use of dichotomous choice (i.e., yes/no) questions rather than open-ended questions or payment card questions (i.e., questions that include a range of dollar values for the respondent to choose from). Three studies in the current review used dichotomous choice questions.13,15,20 Unfortunately, the Daftary et al. (2003) study did not vary the price in different sub-samples, so it
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is not possible to establish the mean WTP or to compute an aggregate demand curve. Both Blumenschein et al. studies (2001, 2008) did vary the price across the sub-samples and therefore were able to estimate the mean WTP. All other studies in this review used either range or open- ended questions to collect WTP amounts. The study by Law et al. (2008) describes mean payment, but the methodology used to arrive at this value is not specifically identified.
Interviews (ideally face-to-face) rather than self-administered questionnaires received via postal mail are also recommended when conducting contingent valuation surveys.45 The advantage of inter- views is that they lead to a higher response rate and make it possible to explain the question to the respondent, thus potentially averting sce- nario misspecification. Of the 31 studies evaluated since 1999, six used face-to-face interviews14,17,20,28,31,38 all others were self-administered questionnaires.
Another recommendation from the 1993 guidelines is to test whe- ther WTP increases with the magnitude of the good or service being valued, referred to as scope sensitivity. The study by Suh (2008) spe- cifically tested for the scope effect by randomizing respondents to one of three risk-reduction scenarios for the pharmacist counseling service,5
and found that the results were sensitive to scope, with consumers re- porting a higher WTP for scenarios in which a greater level of risk re- duction was achieved. Suh's study appears to be the first paper to specifically address the scope issue in contingent valuation studies va- luing pharmacy services. Barner and Branvold17 also examined the scope effect by asking respondents to value consultations that provided a 25% improvement and a 50% improvement in symptoms. No other studies in this review addressed the issue of scope.
A previous review of pharmacy services contingent valuation stu- dies suggested that more attention to statistical methodology is gen- erally needed in analyzing the results from WTP studies.1 It is important to utilize regression analysis to test whether WTP increases with vari- ables theoretically expected to affect WTP, e.g., income.8 Analyses of the relationship between WTP and socio-demographic variables should be a standard in any contingent valuation study. It is encouraging to note that twelve studies reviewed in the current paper did use more rigorous approaches to analysis.5,11,13,15,17,18,20,24,27–29,35
Logical antecedents of WTP have been described and identi- fied.8,46,47 Some are based on economic theory and others are simply sound reasoning. Age and education have been identified as possible demographic correlates of WTP,46–48 though the consistency of these relationships is lacking in published studies. Seven studies reviewed in the current paper found a definitive relationship between age or edu- cation and WTP.5,20,24,27,29,34,35 As in any other market, WTP should be constrained by the individual's ability to pay, thus a positive and sig- nificant relationship would be expected between income and WTP. In the Suh (2008) study, income was found to be positively related to WTP, but the relationship did not achieve statistical significance.5 Both Barner analyses (1999, 2001) found positive relationships between in- come and WTP that were statistically significant.11,17 Blumenschein et al. (2008) was the only study that examined the effect of income that found a significant relationship, but only when respondents noted that they were “definitely sure” of their responses.20
Individuals with increased disease severity, who are at increased risk and thus may garner greater rewards from pharmacist provided services, should logically be willing to pay more for a program that may enhance their health status. However, Suh (2000) found the opposite relationship in his study, i.e., healthier respondents were willing to pay more to prevent medication-related problems. Another unanticipated finding in this study was that respondents who had prior experience with medication-related problems were less willing to pay for phar- macist services than respondents with no history of medication-related problems. Suh explains this finding by stating that the prior experience with medication-related problems may have made those respondents more aware and/or more confident in terms of preventing and handling future medication-related problems.
The extent to which hypothetical WTP coincides with real WTP is a crucial issue concerning the validity of the contingent valuation method. Published guidelines for conducting contingent valuation surveys recommend that the mean WTP amount be deflated by 50% to account for the possibility of hypothetical bias.45,49 “Hypothetical bias” is the term used to describe the overestimation of WTP when hy- pothetical responses are used rather than real market behavior. Ex- perimental studies have been conducted to test this issue, with several investigations finding that hypothetical WTP exceeds actual WTP.13,20,50–53 Thus, it appears that the dollar amounts from con- tingent valuation studies will need to be adjusted downward unless the researcher has explicitly taken hypothetical bias into account.20,53–55 Two studies included in this review evaluated hypothetical bias.13,20
The authors concluded that the dichotomous choice contingent valua- tion method overestimates WTP, but that it may be possible to correct for this overestimation by sorting out “definitely sure” yes responses. This correction for the overestimation of WTP can be accomplished by asking a follow up question to assess the respondent's level of certainty in their hypothetical response. The follow-up question in these studies simply asks the respondents if they are “probably sure” or “definitely sure” they would purchase the service at the stated price.
It is somewhat surprising that so few studies have been conducted using the contingent valuation method within the pharmacy services field, although, unpublished studies were not included in this review. Finally, despite effort to be comprehensive, the evaluation is limited by the search strategy, which was confined to studies in the English lan- guage indexed by the selected databases (MEDLINE, ECONLIT, and International Pharmaceutical Abstracts).
6. Conclusion
A variety of issues can affect the validity of a contingent valuation study. Construction of a scenario that is perceived as plausible and meaningful to respondents is a crucial first step. If a new pharmacy service is being valued, careful and complete description of that service is crucial. Pilot testing can help the researcher identify potential sources of bias and can help establish a price vector for use in dichotomous choice questions. Use of regression, testing for scope effects, and ad- dressing the hypothetical bias issue will also strengthen future con- tingent valuation studies of pharmacy services and enhance their po- tential use.
Improving the quality of studies using contingent valuation to value pharmacy services is a worthwhile goal. Knowing the consumer's value for such services may aid the profession in marketing pharmacy services to consumers and may assist practitioners who wish to implement various pharmacy services in their practice settings. Unfortunately, the published literature to date provides little guidance on true valuation of pharmacy services. A limited number of studies have been conducted. It appears that the quality of contingent valuation studies valuing phar- macist services is improving; however, when vague, ill-defined services are valued it is difficult to translate the results into meaningful in- formation that can be used in practice-related decision making.
Considering the changing dynamics in health care, pharmacists find themselves in an ideal situation to bolster the case for nontraditional roles. The current fascination of policy makers with ideas such as comparative effectiveness should serve as impetus for the pharmacy profession to pursue further research in fields such as contingent va- luation to provide evidence for the feasibility and viability of various pharmacist-offered services. Contingent valuation and WTP studies, if properly performed, can provide answers to important questions in- volving hypothetical markets i.e. markets that do not currently include pharmacist services. Understanding which pharmacy services the con- sumer values, and understanding their WTP for those services, will be crucial as the profession continues to work toward establishing a sus- tainable and economically viable role within evolving health care sys- tems.
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Conflicts of interest
None.
Acknowledgements
This research was funded by a grant from the NCPA Foundation. The authors are grateful to Chris Malloy, Corey Thomas and Patricia Freeman for assistance in preparing this manuscript.
Appendix A. Supplementary data
Supplementary data related to this article can be found at http://dx. doi.org/10.1016/j.sapharm.2018.01.010.
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- Consumer willingness to pay for pharmacy services: An updated review of the literature
- Introduction
- Pharmacy service contingent valuation studies
- Methods
- Results
- Consumer WTP for pharmacy services: 1999–2017
- Discussion
- Conclusion
- Conflicts of interest
- Acknowledgements
- Supplementary data
- References
