What Explains Willingness to Pay for Smoking-Cessation Treatments —Addiction Level, Quit-Rate Effectiveness or the Opening Bid?
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Background: Several countries have now passed laws that place limitations on where smokers may smoke. A range of smoking-cessation treatments have become available, many of which have documented increased quit rates. Population surveys show that most smokers wish to quit, and most nonsmokers would prefer to reduce the prevalence of smoking in society. The strengths of these preferences, however, as measured by their willingness to pay (WTP), have not yet been investigated.
Objective: This study aims to identify variables that explain variations in people’s answers to WTP questions on smoking-cessation treatments.
Methods: A representative sample of the Norwegian population was asked their WTP in terms of an earmarked contribution to a public smokingcessation programme. A sub-group of daily smokers was, in addition, asked about their WTP for a hypothetical treatment that would remove their urge to smoke. The impact of variation in the question format (different opening bids) on stated WTP was compared with that of factors suggested by economic theory, such as quit-rate effectiveness, degree of addiction as measured by the 12-item Cigarette Dependence Scale (CDS-12), and degree of peer group influence as measured by the proportion of one’s friends who smoke.
Results: In both programmes, the most important determinant for explaining variations in WTP was the size of the opening bid. Differences in quit-rate effectiveness did not matter for people’s WTP for the smoking-cessation programme. Addiction, and having a small proportion of friends who smoke, were positively associated with smokers’ WTP to quit smoking.
Conclusion: Variations in WTP were influenced more by how the question was framed in terms of differences in opening bids, than by variables reflecting the quality (effectiveness) and need (addiction level) for the good in question. While the WTP method is theoretically attractive, the findings that outcomes in terms of different quit rates did not affect WTP, and that WTP answers can be manipulated by the chosen opening bid, should raise further doubts on the ability of this method to provide valid and reliable answers that reflect true preferences for health and healthcare.
KeywordsDiscrete Choice Experiment Daily Smoker Addiction Level Cigarette Dependence Scale Hypothetical Good
We thank the Foundation for Health Service Research (HELTEF), University of Oslo, University of Tromsø and GlaxoSmithKline for financial support. The study received an unrestricted grant from GlaxoSmithKline for partial funding of this study. The funding agreement assured the authors’ independence in design, analysis, interpretation, writing and publishing of the study.
Authors’ contribution: JAO took the lead in writing the paper, and is the guarantor for the overall content. All three authors contributed jointly to design, statistical analysis and interpretation, and were actively involved in all stages of the work.
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