Willingness to Pay for Cataract Surgeries Among Patients Visiting Eye Care Facilities in Dhaka, Bangladesh
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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.
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.
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.
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.
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.
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.
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.
Compliance with Ethical Standards
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.
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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