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A utility-theoretic approach to the aggregation of willingness to pay measured in decomposed scenarios: development and empirical test

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  • Thomas Hammerschmidt

    (Department of Health Economics, University of Ulm, Germany)

  • Hans-Peter Zeitler

    (Department of General Medicine, University of Ulm, Germany)

  • Reiner Leidl

    (Department of Health Economics, University of Ulm, Germany)

Abstract

For cost-benefit analysis, health technologies with multiple effects should be valued in a single scenario by a holistic willingness-to-pay (WTP) measure. Recent studies instead used decomposed scenarios in which respondents report their WTP for each individual effect. Evidence can be found that the sum of such decomposed WTPs overestimates the holistic WTP, i.e. the holistic WTP is sub-additive. This sum of decomposed WTPs can lead to wrong conclusions on the efficiency of health technologies. This is also relevant in decision making about new technologies that are valued separately in different surveys. To date, no utility-theoretical and empirically validated aggregation function for decomposed WTPs exists. Within an expected utility model, this paper identifies as a reason for sub-additivity - beside risk aversion with respect to wealth - a negative influence of better health on the marginal utility of wealth, i.e. marginal utility of wealth is smaller in better health states. Assuming mutual utility independence of health and wealth, a theoretically founded aggregation function covering these two impacts is derived. In a contingent valuation study, 92 patients with diabetes were asked to state their WTP for reductions of the risk of several diabetic complications in decomposed as well as in holistic scenarios. The patients had preferences with a significant negative influence of health on the marginal utility of wealth. Sub-additivity occurred and theoretically founded aggregation could considerably lower the degree of overestimation. These results suggest that the theoretically founded aggregation function might reduce problems of sub-additivity that can be economically relevant. Further empirical testing of the approach is indicated. Copyright © 2003 John Wiley & Sons, Ltd.

Suggested Citation

  • Thomas Hammerschmidt & Hans-Peter Zeitler & Reiner Leidl, 2004. "A utility-theoretic approach to the aggregation of willingness to pay measured in decomposed scenarios: development and empirical test," Health Economics, John Wiley & Sons, Ltd., vol. 13(4), pages 345-361.
  • Handle: RePEc:wly:hlthec:v:13:y:2004:i:4:p:345-361 DOI: 10.1002/hec.835
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    References listed on IDEAS

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    1. Johansson,Per-Olov, 1995. "Evaluating Health Risks," Cambridge Books, Cambridge University Press, number 9780521478786, March.
    2. Randall, Alan & Hoehn, John P., 1996. "Embedding in Market Demand Systems," Journal of Environmental Economics and Management, Elsevier, vol. 30(3), pages 369-380, May.
    3. Viscusi, W Kip & Evans, William N, 1990. "Utility Functions That Depend on Health Status: Estimates and Economic Implications," American Economic Review, American Economic Association, vol. 80(3), pages 353-374, June.
    4. Eckerlund, Ingemar & Johannesson, Magnus & Johansson, Per-Olov & Tambour, Magnus & Zethraeus, Niklas, 1995. "Value for money? A contingent valuation study of the optimal size of the Swedish health care budget," Health Policy, Elsevier, vol. 34(2), pages 135-143, November.
    5. Phillips, Kathryn A. & Homan, Rick K. & Luft, Harold S. & Hiatt, Patricia H. & Olson, Kent R. & Kearney, Thomas E. & Heard, Stuart E., 1997. "Willingness to pay for poison control centers," Journal of Health Economics, Elsevier, vol. 16(3), pages 343-357, June.
    6. Keeney,Ralph L. & Raiffa,Howard, 1993. "Decisions with Multiple Objectives," Cambridge Books, Cambridge University Press, number 9780521438834, March.
    7. repec:aph:ajpbhl:1984:74:8:808-812_0 is not listed on IDEAS
    8. John H. Beck, 1994. "An Experimental Test of Preferences for the Distribution of Income and Individual Risk Aversion," Eastern Economic Journal, Eastern Economic Association, vol. 20(2), pages 131-145, Spring.
    9. Johansson,Per-Olov, 1995. "Evaluating Health Risks," Cambridge Books, Cambridge University Press, number 9780521472852, March.
    10. Sloan, Frank A. & Kip Viscusi, W. & Chesson, Harrell W. & Conover, Christopher J. & Whetten-Goldstein, Kathryn, 1998. "Alternative approaches to valuing intangible health losses: the evidence for multiple sclerosis1," Journal of Health Economics, Elsevier, vol. 17(4), pages 475-497, August.
    11. Kahneman, Daniel & Knetsch, Jack L., 1992. "Valuing public goods: The purchase of moral satisfaction," Journal of Environmental Economics and Management, Elsevier, vol. 22(1), pages 57-70, January.
    12. Stéphane Luchini & Christel Protière & Jean-Paul Moatti, 2003. "Eliciting several willingness to pay in a single contingent valuation survey: application to health care," Health Economics, John Wiley & Sons, Ltd., vol. 12(1), pages 51-64.
    13. Evans, William N & Viscusi, W Kip, 1991. "Estimation of State-Dependent Utility Functions Using Survey Data," The Review of Economics and Statistics, MIT Press, vol. 73(1), pages 94-104, February.
    14. Thomas Klose, 2003. "A utility-theoretic model for QALYs and willingness to pay," Health Economics, John Wiley & Sons, Ltd., vol. 12(1), pages 17-31.
    15. Johannesson, Magnus, 1996. "A note on the relationship between ex ante and expected willingness to pay for health care," Social Science & Medicine, Elsevier, vol. 42(3), pages 305-311, February.
    16. Peter A. Diamond & Jerry A. Hausman, 1994. "Contingent Valuation: Is Some Number Better than No Number?," Journal of Economic Perspectives, American Economic Association, vol. 8(4), pages 45-64, Fall.
    17. Klose, Thomas, 1999. "The contingent valuation method in health care," Health Policy, Elsevier, vol. 47(2), pages 97-123, May.
    18. Blumenschein, Karen & Johannesson, Magnus & Yokoyama, Krista K. & Freeman, Patricia R., 2001. "Hypothetical versus real willingness to pay in the health care sector: results from a field experiment," Journal of Health Economics, Elsevier, vol. 20(3), pages 441-457, May.
    19. Dubourg, W R & Jones-Lee, M W & Loomes, Graham, 1994. "Imprecise Preferences and the WTP-WTA Disparity," Journal of Risk and Uncertainty, Springer, vol. 9(2), pages 115-133, October.
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    Cited by:

    1. Bernard van den Berg & Han Bleichrodt & Louis Eeckhoudt, 2005. "The economic value of informal care: a study of informal caregivers' and patients' willingness to pay and willingness to accept for informal care," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 363-376.
    2. Isabell Goldberg & Jutta Roosen, 2007. "Scope insensitivity in health risk reduction studies: A comparison of choice experiments and the contingent valuation method for valuing safer food," Journal of Risk and Uncertainty, Springer, vol. 34(2), pages 123-144, April.

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