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Willingness to Pay for Cataract Surgeries Among Patients Visiting Eye Care Facilities in Dhaka, Bangladesh

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Abstract

Background

Cataract is the leading cause of avoidable blindness globally. It is estimated that 89% of people with visual impairment live in low- and middle-income countries where the cost of cataract surgery represents a major barrier for accessing these services. Developing self-sustaining healthcare programs to cater the unmet demands warrants a better understanding of patients’ willingness to pay (WTP) for their services.

Objectives

Using a sample of patients visiting eye care facilities in Dhaka, Bangladesh, we estimate WTP for two different cataract extraction techniques, namely small incision cataract surgery (SICS) and phacoemulsification.

Methods

We used contingent valuation (CV) approach and elicited WTP through double-bounded dichotomous choice experiments. We interviewed 556 randomly selected patients (283 for SICS and 273 for phacoemulsification) from five different eye care hospitals of Dhaka. In this paper, we estimated the mean and marginal WTP using interval regression models. We also compared the estimated WTP and stated demand for cataract surgeries against the prevailing market prices of SICS and phacoemulsification.

Results

We found the mean WTP of BDT 7579 (US$93) for SICS and BDT 10,208 (US$126) for phacoemulsification are equivalent to 12 and 16 days of household income, respectively. Household income and assets appeared as the major determinants of WTP for cataract surgeries. However, we did not find any significant association with gender, occupation, and household size among other socioeconomic characteristics. Comparisons between market prices and average WTP suggest it is possible to have a viable market for SICS, but a subsidy-based model for phacoemulsification will be financially challenging because of low WTP and high costs.

Conclusion

Our findings suggest lower-cost SICS can potentially provide patients access to surgeries to treat cataract conditions. Moreover, price discrimination and cross-subsidization could be a viable strategy to increase the service-uptake as well as ensure financial sustainability.

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Fig. 1
Fig. 2
Fig. 3

Source: Authors’ calculations using double-bounded dichotomous choice contingent valuation experiments

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Data Availability Statement

The datasets are not currently available. However, it can be made available upon request.

References

  1. Bourne RR, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Resnikoff S, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(9):e888–97.

    Article  PubMed  Google Scholar 

  2. WHO. Global initiative for the elimination of avoidable blindness: action plan 2006–2011. Geneva: World Health Organization; 2007.

    Google Scholar 

  3. WHO. Global data on visual impairments 2010. Geneva: World Health Organization; 2012.

    Google Scholar 

  4. Dineen BP, Bourne RRA, Ali SM, Huq DMN, Johnson GJ. Prevalence and causes of blindness and visual impairment in Bangladeshi adults: results of the National Blindness and Low Vision Survey of Bangladesh. Br J Ophthalmol. 2003;87:820–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Porter RB. Global initiative: the economic case. Community Eye Health. 1998;11:44–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Gogate PM, Deshpande M, Kulkarni SR, Wormald RP, Deshpande R. Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India: a randomised controlled trial. Br J Opthalmol. 2003;87:667–72.

    Article  CAS  Google Scholar 

  7. Lewallen S, Mousa A, Bassett K, Courtright P. Cataract surgical coverage remains lower in women. Br J Ophthalmol. 2009;93(3):295–8.

    Article  CAS  PubMed  Google Scholar 

  8. Radhakrishnan M, Venkatesh R, Valaguru V, Kevin DF. Economic and social factors that influence households not willing to undergo cataract surgery. Indian J Ophthalmol. 2015;63:594–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Grimes CE, Bowman KG, Dodgion CM, Lavy CBD. Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg. 2011;35:941–50.

    Article  PubMed  Google Scholar 

  10. Aboobaker S, Courtright P. Barriers to cataract surgery in Africa: a systematic review. Middle East Afr J Ophthalmol. 2016;23(1):145.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Shrestha MK, Thakur J, Gurung CK, Joshi AB, Pokhrel S, Ruit S. Willingness to pay for cataract surgery in Kathmandu valley. Br J Ophthalmol. 2004;88:319–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Ko F, Frick KD, Tzu J, He M, Congdon N. Willingness to pay for potential enhancements to a low-cost cataract surgical package in rural southern China. Acta Ophthalmologica. 2012;90:54–60.

    Article  Google Scholar 

  13. Gessesse GW, Demissie BS. Willingness to pay for cataract surgery among outreach site in South West Ethopia: a cross-sectional study. Int J Opthalmol Eye Sci. 2014;2:65–9.

    Google Scholar 

  14. Lewallen S, Geneau R, Mahande M, Msangi J, Nyaupumbwe S, Kitumba R. Willingness to pay for cataract surgery in two regions of Tanzania. Br J Ophthalmol. 2006;90:578–580.

    Google Scholar 

  15. Vaidyanathan K, Limburg H, Foster A, Pandey RM. Changing trends in barriers to cataract surgery in India. Bull World Health Organ. 1999;77:104–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Athanasiov PA, Casson RJ, Newland HS, Shein WK, Muecke JS, Selva D, Aung T. Cataract surgical coverage and self-reported barriers to cataract surgery in a rural Myanmar population. Clin Exp Ophthalmol. 2008;36:521–5.

    Article  PubMed  Google Scholar 

  17. Dean WH, Sherwin JC, Kumwendaa S, Angeletti M, Wiehlera U. Willingness to pay for cataract surgery in post-operative cataract patients in rural Malawi. Ophthalmic Epidemiol. 2012;19:265–71.

    Article  PubMed  Google Scholar 

  18. Cawley J. Contingent valuation analysis of willingness to pay to reduce childhood obesity. Econ Hum Biol. 2008;6:281–92.

    Article  PubMed  Google Scholar 

  19. Palumbo A, Fuente PDL, Rodrıguez M, Sanchez F, Martınez-Salazar J, Munoz M, Marqueta HJJ, Espallardo O, Polanco C, Paz S, Lizan L. Willingness to pay and conjoint analysis to determine women’s preferences for ovarian stimulating hormones in the treatment of infertility in Spain. Hum Reprod. 2011;26:1790–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Settumba SN, Shanahan M, Botha W, Ramli MZ, Chambers GM. Reliability and validity of the contingent valuation method for estimating willingness to pay: a case of in vitro fertilisation. Appl Health Econ Health Policy. 2018;17:1–8.

    Google Scholar 

  21. Ternent L, McNamee P, Newlands D, Belemsaga D, Gbangou A, Cross S. “Willingness to pay for maternal health outcomes. Appl Health Econ Health Policy. 2010;8(2):99–109.

    Article  PubMed  Google Scholar 

  22. Parvin M. Projecting the population size of Dhaka city with migration using growth rate method. IOSR J Math. 2013;8(5):29–37.

    Article  Google Scholar 

  23. James P. Grant School of Public Health, BRAC University, “Do urban poor seek and afford eye care? Why and Why not? Accessibility of Eye Care Service in an Urban Setting in Bangladesh,” 02 06 2015. [Online]. https://www.iapb.org/wp-content/uploads/Bangladesh-Report_final-version_02-06-2015.pdf. Accessed 23 Dec 2016.

  24. Finkelstein A, Luttmer EF, Notowidigdo MJ. What good is wealth without health? The effect of health on the marginal utility of consumption. J Eur Econ Assoc. 2013;11:221–58.

    Article  Google Scholar 

  25. Boyd NF, Sutherland HJ, Heasman KZ, Tritchler DL, Cummings BJ. Whose utilities for decision analysis? Med Decis Mak. 2010;10:58–67.

    Article  Google Scholar 

  26. Christensen-Szalanski JJ. Discount functions and the measurement of patients’ values women’s decisions during childbirth. Med Decis Mak. 1984;4(1):47–58.

    Article  CAS  Google Scholar 

  27. Sackett DL, Torrance GW. The utility of different health states as perceived by the general public. J Chronic Dis. 1978;31(11):697–704.

    Article  CAS  PubMed  Google Scholar 

  28. Hanemann M, Loomis J, Kanninen B. Statistical efficiency of double-bounded dichotomous choice contingent valuation. Am J Agric Econ. 1991;73:1255–63.

    Article  Google Scholar 

  29. Alberini A. Efficiency vs bias of willingness-to-pay estimates: bivariate and interval-data models. J Environ Econ Manag. 1995;29:169–80.

    Article  Google Scholar 

  30. Riaz Y, de Silva SR, Evans JR. Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus phacoemulsification with posterior chamber intraocular lens for age-related cataract. Cochrane Database of Systematic Reviews. 2013;10:1465–858.

    Google Scholar 

  31. Zhang J, Feng Y, Cai J. Phacoemulsification versus manual small-incision cataract surgery for age-related cataract: meta-analysis of randomized controlled trials. Clin Exp Ophthalmol. 2013;41(4):379–86.

    Article  PubMed  Google Scholar 

  32. Gogate P, Optom JJB, Deshpande S, Naidoo K. Meta-analysis to compare the safety and efficacy of manual small incision cataract surgery and phacoemulsification. Middle East Afr J Ophthalmol. 2015;22(3):362.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Green D, Jacowitz KE, Kahneman D, McFadden D. Referendum contingent valuation, anchoring, and willingness to pay for public goods. Resour Energy Econ. 1998;20(2):85–116.

    Article  Google Scholar 

  34. Bangladesh Bureau of Statistics. “Household Income and Expenditure Survey 2010,” Statistics Division, Ministry of Planning; 2011.

  35. Flachaire E, Hollard G. Controlling starting-point bias in double-bounded contingent valuation surveys. Land Econ. 2006;82(1):103–11.

    Article  Google Scholar 

  36. Lou L, Wang J, Xu P, Ye X, Ye J. Socioeconomic disparity in global burden of cataract: an analysis for 2013 with time trends since 1990. Am J Ophthalmol. 2017;180:91–6.

    Article  PubMed  Google Scholar 

  37. Foreit JR, Foreit KGF. The reliability and validity of willingness to pay surveys for reproductive health pricing decisions in developing countries. Health Policy. 2003;63(1):37–47.

    Article  PubMed  Google Scholar 

  38. Rangan VK, Thulasiraj RD. Making sight affordable (innovations case narrative: the Aravind Eye Care System). Innov Technol Gov Glob. 2007;2(4):35–49.

    Google Scholar 

  39. Lin P-J, Cangelosi MJ, Lee DW, Neumann P. Willingness to pay for diagnostic technologies: a review of the contingent valuation literature. Value Health. 2013;16(5):797–805.

    Article  PubMed  Google Scholar 

  40. Herrigesm JA, Shogren JF. Starting point bias in dichotomous choice valuation with follow-up questioning. J Environ Econ Manag. 1996;30:112–31.

    Article  Google Scholar 

Download references

Acknowledgements

We convey our heartfelt gratitude to all the survey participants, hospital management teams, Sightsavers Bangladesh Country Office, Standard Chartered Bank, and special thanks to all the enumerators for their efforts and patience.

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Authors and Affiliations

  1. BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Avenue, Mohakhali, Dhaka, 1212, Bangladesh

    Muhammed Nazmul Islam, Shafayet Hossain, Malabika Sarker & Atonu Rabbani

  2. Sightsavers, 35 Perrymount Road, Haywards Health, West Sussex, RH16 3BW, England, UK

    Thomas Engels

  3. Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany

    Malabika Sarker

  4. Department of Economics, University of Dhaka, Dhaka, 1000, Bangladesh

    Atonu Rabbani

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  1. Muhammed Nazmul Islam
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Contributions

AR and MS designed the study. AR, MNI, and SH developed the study instruments. MNI and SH managed the data collection. MNI and AR analyzed the data and drafted the manuscript. AR, MS, TE, and MNI critically revised the manuscript. All authors approved the version submitted for publication.

Corresponding author

Correspondence to Muhammed Nazmul Islam.

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Funding

The study was financially supported by Sightsavers International (GB) (Will be informed upon request), and Standard Chartered Bank’s “Seeing is Believing” program. Authors are responsible for all the findings and conclusions. It does not necessarily represent the views of Sightsavers and Standard Chartered Bank.

Ethical approval

The ethical review committee of James P Grant School of Public Health (JPGSPH) at BRAC University, Bangladesh approved the study protocol. Administrative authorization to do the survey in selected hospital premises was obtained from hospital management before the start of data collection activities. Informed verbal consents were also obtained from the participants of this study. All procedures performed in this study involving human participants were in accordance with the ethical standards of JPGSPH, BRAC University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

Muhammed Nazmul Islam, Thomas Engels, Shafayet Hossain, Malabika Sarker, and Atonu Rabbani have no conflict of interest to declare.

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Islam, M.N., Engels, T., Hossain, S. et al. Willingness to Pay for Cataract Surgeries Among Patients Visiting Eye Care Facilities in Dhaka, Bangladesh. Appl Health Econ Health Policy 17, 545–554 (2019). https://doi.org/10.1007/s40258-019-00478-3

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