Consumer Preference and Willingness to Pay for Direct-to-Consumer Mobile Teledermoscopy Services in Australia

Objective: To investigate consumer preference and willingness to pay for mobile teledermoscopy services in Australia. Methods: Consumers who were taking part in a randomised controlled trial comparing mobile teledermoscopy and skin self-examination were asked to complete a survey which incorporated a discrete choice experiment (DCE) and a contingent valuation question. Responses were used to determine their willingness to pay for mobile teledermoscopy services in Australia and their overall service preferences. Results: The 199 consumers who responded were 71% female and had a mean age of 42 years (range, 18–73). The DCE results showed that consumers prefer a trained medical professional to be involved in their skin cancer screening. Consumers were willing to pay AUD 41 to change from a general practitioner reviewing their lesions in-person to having a dermatologist reviewing the teledermoscopy images. Additionally, they were willing to pay for services that had shorter waiting times, that reduced the time away from their usual activities, and that have higher accuracy and lower likelihood of unnecessary excision of a skin lesion. When asked directly about their willingness to pay for a teledermoscopy service using a contingent valuation question, the majority (73%) of consumers selected the lowest two value brackets of AUD 1–20 or AUD 21–40. Conclusion: Consumers are willing to pay out of pocket to access services with attributes such as a dermatologist review, improved accuracy, and fewer excisions.

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Feasibility of delivering and evaluating stratified care integrated with telehealth (‘Rapid Stratified Telehealth’) for patients with low back pain: protocol for a feasibility and pilot randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2021-056339 ◽

2022 ◽

Vol 12 (1) ◽

pp. e056339

Author(s):

Joshua R Zadro ◽

Christopher Needs ◽

Nadine E Foster ◽

David Martens ◽

Danielle M Coombs ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

Waiting Times ◽

Education Programme ◽

Low Back ◽

Pain Education ◽

Stratified Care ◽

Randomised Controlled

IntroductionLong waiting time is an important barrier to accessing recommended care for low back pain (LBP) in Australia’s public health system. This study describes the protocol for a randomised controlled trial (RCT) that aims to establish the feasibility of delivering and evaluating stratified care integrated with telehealth (‘Rapid Stratified Telehealth’), which aims to reduce waiting times for LBP.Methods and analysisWe will conduct a single-centre feasibility and pilot RCT with nested qualitative interviews. Sixty participants with LBP newly referred to a hospital outpatient clinic will be randomised to receive Rapid Stratified Telehealth or usual care. Rapid Stratified Telehealth involves matching the mode and type of care to participants’ risk of persistent disabling pain (using the Keele STarT MSK Tool) and presence of potential radiculopathy. ‘Low risk’ patients are matched to one session of advice over the telephone, ‘medium risk’ to telehealth physiotherapy plus App-based exercises, ‘high risk’ to telehealth physiotherapy, App-based exercises, and an online pain education programme, and ‘potential radiculopathy’ fast tracked to usual in-person care. Primary outcomes include the feasibility of delivering Rapid Stratified Telehealth (ie, acceptability assessed through interviews with clinicians and patients, intervention fidelity, appointment duration, App useability and online pain education programme usage) and evaluating Rapid Stratified Telehealth in a future trial (ie, recruitment rates, consent rates, lost to follow-up and missing data). Secondary outcomes include waiting times, number of appointments, intervention and healthcare costs, clinical outcomes (pain, function, quality of life, satisfaction), healthcare use and adverse events (AEs). Quantitative analyses will be descriptive and inform a future adequately-powered RCT. Interview data will be analysed using thematic analysis.Ethics and disseminationThis study has received approval from the Ethics Review Committee (RPAH Zone: X21-0221). Results will be published in peer-reviewed journals and presented at conferences.Trial registration numberACTRN12621001104842.

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Users are willing to pay for sanitation, but not as much as they say: empirical results and methodological comparisons of willingness to pay for peri-urban sanitation in Lusaka, Zambia using contingent valuation, discrete choice experiments, and hedonic pricing

Journal of Water Sanitation and Hygiene for Development ◽

10.2166/washdev.2020.072 ◽

2020 ◽

Vol 10 (4) ◽

pp. 756-767 ◽

Cited By ~ 1

Author(s):

James B. Tidwell

Keyword(s):

Willingness To Pay ◽

Contingent Valuation ◽

Discrete Choice ◽

Controlled Trial ◽

Choice Experiments ◽

Hedonic Pricing ◽

Discrete Choice Experiments ◽

Randomized Controlled ◽

Urban Sanitation ◽

Demand Assessment

Abstract Significant investment is needed to improve peri-urban sanitation. Consumer willingness to pay may bridge some of this gap. While contingent valuation has been frequently used to assess this demand, there are few comparative studies to validate this method for water and sanitation. We use contingent valuation to estimate demand for flushing toilets, solid doors, and inside and outside locks on doors and compare this with results from hedonic pricing and discrete choice experiments. We collected data for a randomized, controlled trial in peri-urban Lusaka, Zambia in 2017. Tenants were randomly allocated to discrete choice experiments (n = 432) or contingent valuation (n = 458). Estimates using contingent valuation were lower than discrete choice experiments for solid doors (US$2.6 vs. US$3.4), higher for flushing toilets ($3.4 vs. $2.2), and were of the opposite sign for inside and outside locks ($1.6 vs. $ − 1.1). Hedonic pricing aligned more closely to discrete choice experiments for flushing toilets ($1.7) and locks (−$0.9), suggesting significant and inconsistent bias in contingent valuation estimates. While these results provide strong evidence of consumer willingness to pay for sanitation, researchers and policymakers should carefully consider demand assessment methods due to the inconsistent, but often inflated bias of contingent valuation.

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A guided and unguided internet- and mobile-based intervention for chronic pain: health economic evaluation alongside a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2018-023390 ◽

2019 ◽

Vol 9 (4) ◽

pp. e023390 ◽

Cited By ~ 1

Author(s):

Sarah Paganini ◽

Jiaxi Lin ◽

Fanny Kählke ◽

Claudia Buntrock ◽

Delia Leiding ◽

...

Keyword(s):

Economic Evaluation ◽

Cost Effectiveness ◽

Willingness To Pay ◽

Treatment Response ◽

Controlled Trial ◽

Health Economic Evaluation ◽

Cost Effective ◽

Cost Utility ◽

Randomised Controlled ◽

The Cost

ObjectiveThis study aims at evaluating the cost-effectiveness and cost-utility of a guided and unguided internet-based intervention for chronic pain patients (ACTonPainguidedand ACTonPainunguided) compared with a waitlist control group (CG) as well as the comparative cost-effectiveness of the guided and the unguided version.DesignThis is a health economic evaluation alongside a three-arm randomised controlled trial from a societal perspective. Assessments were conducted at baseline, 9 weeks and 6 months after randomisation.SettingParticipants were recruited through online and offline strategies and in collaboration with a health insurance company.Participants302 adults (≥18 years, pain for at least 6 months) were randomly allocated to one of the three groups (ACTonPainguided, ACTonPainunguided, CG).InterventionsACTonPain consists of seven modules and is based on Acceptance and Commitment Therapy. ACTonPainguidedand ACTonPainunguidedonly differ in provision of human support.Primary and secondary outcome measuresMain outcomes of the cost-effectiveness and the cost-utility analyses were meaningful change in pain interference (treatment response) and quality-adjusted life years (QALYs), respectively. Economic evaluation estimates were the incremental cost-effectiveness and cost-utility ratio (ICER/ICUR).ResultsAt 6-month follow-up, treatment response and QALYs were highest in ACTonPainguided(44% and 0.280; mean costs = €6,945), followed by ACTonPainunguided(28% and 0.266; mean costs = €6,560) and the CG (16% and 0.244; mean costs = €6,908). ACTonPainguidedvs CG revealed an ICER of €45 and an ICUR of €604.ACTonPainunguideddominated CG. At a willingness-to-pay of €0 the probability of being cost-effective was 50% for ACTonPainguided(vs CG, for both treatment response and QALY gained) and 67% for ACTonPainunguided(vs CG, for both treatment response and QALY gained). These probabilities rose to 95% when society’s willingness-to-pay is €91,000 (ACTonPainguided) and €127,000 (ACTonPainunguided) per QALY gained. ACTonPainguidedvs ACTonPainunguidedrevealed an ICER of €2,374 and an ICUR of €45,993.ConclusionsDepending on society’s willingness-to-pay, ACTonPain is a potentially cost-effective adjunct to established pain treatment. ACTonPainunguided(vs CG) revealed lower costs at better health outcomes. However, uncertainty has to be considered. Direct comparison of the two interventions does not indicate a preference for ACTonPainguided.Trial registration numberDRKS00006183.

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What Drives Responses to Willingness-to-pay Questions? A Methodological Inquiry in the Context of Hypertension Self-management

Journal of Health Economics and Outcomes Research ◽

10.36469/9818 ◽

2016 ◽

Vol 4 (2) ◽

pp. 158-171

Author(s):

Billingsley Kaambwa ◽

Stirling Bryan ◽

Emma Frew ◽

Emma Bray ◽

Sheila Greenfield ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Contingent Valuation ◽

Multivariate Regression ◽

Statistical Tests ◽

Controlled Trial ◽

A Priori ◽

Descriptive Statistics ◽

Self Management ◽

Self Monitoring ◽

Randomised Controlled

Background: The use of economic evaluation to determine the cost-effectiveness of health interventions is recommended by decision-making bodies internationally. Understanding factors that explain variations in costs and benefits is important for policy makers. Objective: This work aimed to test a priori hypotheses defining the relationship between benefits of using self-management equipment (measured using the willingness-to-pay (WTP) approach) and a number of demographic and other patient factors. Methods: Data for this study were collected as part of the first major randomised controlled trial of self-monitoring combined with self-titration in hypertension (TASMINH2). A contingent valuation framework was used with patients asked to indicate how much they were willing to pay for equipment used for self-managing hypertension. Descriptive statistics, simple statistical tests of differences and multivariate regression were used to test six a priori hypotheses. Results: Data for this study were collected as part of the first major randomised controlled trial of self-monitoring combined with self-titration in hypertension (TASMINH2). A contingent valuation framework was used with patients asked to indicate how much they were willing to pay for equipment used for self-managing hypertension. Descriptive statistics, simple statistical tests of differences and multivariate regression were used to test six a priori hypotheses. Conclusion: The majority of hypertensive patients who had taken part in a self-management study were prepared to purchase the self-monitoring equipment using their own funds, more so for men, those with higher incomes and those with greater satisfaction. Further research based on bigger and more diverse populations is recommended.

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Consumer Preferences for Skin Cancer Screening Using Mobile Teledermoscopy: A Qualitative Study

Dermatology ◽

10.1159/000505620 ◽

2020 ◽

Vol 236 (2) ◽

pp. 97-104 ◽

Cited By ~ 1

Author(s):

Fleur Kong ◽

Caitlin Horsham ◽

Jenna Rayner ◽

Marko Simunovic ◽

Montana O’Hara ◽

...

Keyword(s):

Consumer Preferences ◽

Controlled Trial ◽

Structured Interview ◽

Patient Relationship ◽

Doctor Patient Relationship ◽

Skin Cancer Screening ◽

Skin Examination ◽

Direct To Consumer ◽

Skin Cancers ◽

Randomised Controlled

Background: Mobile teledermoscopy is a rapidly advancing technology that promotes early detection and management of skin cancers. Whilst the use of teledermoscopy has proven to be effective and has a role in the detection of skin cancers, patients’ attitudes towards the multiple ways in which this technology can be utilised has not been explored. Methods: Data were obtained from a large randomised controlled trial comparing mobile teledermoscopy-enhanced skin self-examinations (SSEs) with naked-eye SSE. A semi-structured interview guide was developed by the investigators with questions focusing on people’s previous skin screening behaviours and 2 of the major pathways which can be utilised in mobile teledermoscopy: (i) direct-to-consumer and (ii) doctor-to-doctor. All interviews were tape-recorded and transcribed verbatim. Thematic analysis was undertaken by 2 independent researchers. Results: Twenty-eight participants were interviewed. Eighty-six percent of participants (n = 24/28) had previously had a clinical skin examination. Only 18% of participants (n = 5/28) visited the same doctor for each clinical skin examination. Five main themes were identified in the interviews that affected how people felt about the integration of mobile teledermoscopy into skin screening pathways: history of clinical skin examinations, continuity of the doctor-patient relationship, convenience of the direct-to-consumer teledermoscopy, expedited review enhancing the doctor-to-doctor setting and mobile teledermoscopy as a partner-assisted task. Conclusions: Overall mobile teledermoscopy was viewed positively for both direct-to-consumer and doctor-to-doctor interaction. Continuity of care in the doctor-patient relationship was not found to be a priority for clinical skin examination with most participants visiting several doctors throughout their clinical skin examination history.

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Direct-to-consumer mobile teledermoscopy for skin cancer screening: Preliminary results demonstrating willingness-to-pay in Australia

Journal of Telemedicine and Telecare ◽

10.1177/1357633x18799582 ◽

2018 ◽

Vol 24 (10) ◽

pp. 683-689 ◽

Cited By ~ 5

Author(s):

Centaine L Snoswell ◽

Jennifer A Whitty ◽

Liam J Caffery ◽

Lois J Loescher ◽

Nicole Gillespie ◽

...

Keyword(s):

Cancer Screening ◽

Skin Cancer ◽

Willingness To Pay ◽

Consumer Preferences ◽

Screening Method ◽

Randomised Control Trial ◽

Skin Cancer Screening ◽

Direct To Consumer ◽

Screening Services ◽

Self Examination

Introduction Internationally, teledermoscopy has been found to have clinical and economic efficacy. This study aims to identify the attributes of a mobile teledermoscopy service that consumers prefer. This preliminary study was set within a broader randomised control trial (RCT) investigating the effectiveness of direct to consumer mobile teledermoscopy. Methods We undertook a discrete choice experiment (DCE). The DCE comprised 24 choice sets, divided into in two blocks of 12. For each choice set, respondents were asked to make discrete choices between two opt-out choices and two skin cancer screening service options described by seven attributes. A mixed logit model was used to estimate preferences for skin cancer screening services. Consumer preferences weights were used to calculate marginal willingness-to-pay (WTP) for skin cancer screening services. Results The DCE was completed by 113 consumer respondents. Consumers’ preference for dermatologist involvement in their diagnosis, increased accuracy, and reduced excisions were all statistically significant in driving choice between service models. Consumers preferred having a professional involved in their skin cancer screening, rather than performing a self-examination. Consumers were only WTP $1.18 to change from a GP visit to mobile teledermoscopy (diagnosis using a phone camera). However, they were WTP $43 to have their results reviewed by a dermatologist rather than a GP, and $117 to increase the chance of detecting a melanoma if it was present from 65-75% to 95%. Conclusion Skin cancer screening services which are delivered by health professionals, rather than skin self-examination, are preferred by consumers. Consumers were willing to pay for their preferred skin cancer screening method, especially if a dermatologist was involved.

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Effects of mobile text messaging on breast cancer and breast self-examination (BSE) knowledge, BSE self-efficacy, and BSE frequency: a randomised controlled trial

Scandinavian Journal of Caring Sciences ◽

10.1111/scs.12849 ◽

2020 ◽

Author(s):

Leodoro J. Labrague ◽

Jolo R. Galabay ◽

Angeline L. Anastacio ◽

Denise M. McEnroe-Petitte ◽

Konstantinos Tsaras

Keyword(s):

Breast Cancer ◽

Randomised Controlled Trial ◽

Self Efficacy ◽

Text Messaging ◽

Controlled Trial ◽

Breast Self Examination ◽

Randomised Controlled ◽

Self Examination

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Achieving Self-Directed Integrated Cancer Aftercare (ASICA) in melanoma: Protocol for a randomised patient-focused pilot trial of delivering the ASICA intervention as a means to earlier detection of recurrent and second primary melanoma

10.21203/rs.2.269/v1 ◽

2019 ◽

Author(s):

Peter Murchie ◽

J Masthoff ◽

FM Walter ◽

K Rahman ◽

JL Allan ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Clinical Data ◽

Cutaneous Melanoma ◽

Controlled Trial ◽

Primary Melanoma ◽

Trial Registration ◽

Randomised Controlled ◽

The Uk ◽

Self Examination

Abstract Background: Melanoma is common, 15,906 people in the UK were diagnosed with melanoma in 2015 and incidence has increased five-fold in 30 years. Melanoma affects old and young people with poor prognosis once metastatic. UK guidelines recommends people treated for cutaneous melanoma receive extended outpatient hospital follow-up to detect recurrence or new primaries. Such follow-up to the growing population of melanoma survivors is burdensome for both individuals and health services. Follow-up is important since approximately 20% of patients with early-stage melanoma experience a recurrence and 4-8% develop a new primary, the risk of both is highest in the first five years. ASICA (Achieving Self-directed Integrated Cancer Aftercare) is a digital intervention to increase Total-Skin-Self-Examination (TSSE) by people treated for melanoma, with usual follow-up. Methods: We aim to recruit 240 adults with a previous first stage 0-2C primary cutaneous melanoma from secondary care in North-East Scotland and the East of England. Participants will be randomised to receive the ASICA intervention (a tablet based digital intervention to prompt and support TSSE) or control group (treatment as usual). Patient-reported and clinical data will be collected at baseline, including the modified Melanoma Worry Scale (MWS), the Hospital Anxiety and Depression Scale (HADs), the EuroQoL EQ-5D-5L, and questions about TSSE practice, intentions, self-efficacy and planning. Participants will be followed up by postal questionnaire at 3, 6 and 12 months following randomisation along with a 12 month review of clinical data. 12 months following randomisation will be considered the primary timepoint for outcome analyses. Discussion: If the ASICA intervention improves total-skin-self-examination practice in those affected by melanoma, this may lead to improved psychological well-being and earlier detection of recurrent and new primary melanoma. This could impact both patients and NHS resources. This study will determine if a full scale randomised controlled trial can be undertaken in the UK NHS to provide the high-quality evidence needed determine the effectiveness ASICA is a pilot study evaluating the effectiveness of total skin self-examination practice in those affected by melanoma. Trial Registration: Clinical Trials.gov :Trial registration number NCT03328247. Registered 01 November 2017, https://clinicaltrials.gov/ct2/show/NCT03328247?term=ASICA&rank=1. First participant randomised on 25 January 2018. Keywords: Primary care, Melanoma, Cancer, Randomised Controlled Trial, Survivorship, Self-directed care, e-health, ASICA.

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