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Economic evaluation, value of life, stated preference methodology and determinants of risks
Örebro University, Swedish Business School at Örebro University.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The first paper examines the value of a statistical life (VSL) for out-of-hospital cardiac arrest (OHCA) victims. We found VSL values to be higher for OHCA victims than for people who die in road traffic accidents and a lower-bound estimate of VSL for OHCA would be in the range of 20 to 30 million Swedish crowns (SEK).

The second paper concerns hypothetical bias in contingent valuation (CV) studies. We investigate the link between the determinants and empirical treatment of uncertainty through certainty calibration and find that the higher the confidence of the respondents the more we can trust that stated WTP is correlated to actual WTP.

The third paper investigates the performance of two communication aids (a flexible community analogy and an array of dots) in valuing mortality risk reductions for OHCA. The results do not support the prediction of expected utility theory, i.e. that WTP for a mortality risk reduction increases with the amount of risk reduction (weak scope sensitivity), for any of the communication aids.

The fourth paper presents a cost-benefit analysis to evaluate the effects of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm. The intervention had positive economic effects, yielding a benefit-cost ratio of 36, a cost per quality-adjusted life-year (QALY) of € 13 000 and the cost per saved life was € 60 000.

The fifth paper explores how different response times from OHCA to defibrillation affect patients’ survival rates by using geographic information systems (GIS). The model predicted a baseline survival rate of 3.9% and reducing the ambulance response time by 1 minute increased survival to 4.6%.

The sixth paper analyzes demographic determinants of incident experience and risk perception, and the relationship between the two, for eight different risk domains. Males and highly educated respondents perceive their risks lower than what is expected compared to actual incident experience.

Place, publisher, year, edition, pages
Örebro: Örebro university , 2010. , 46 p.
Series
Örebro Studies in Economics, ISSN 1651-8896 ; 21
Keyword [en]
Cost-benefit analysis, value of a statistical life, contingent valuation, cardiac arrest, defibrillation, calibration, sensitivity to scope, risk communication, response times, incident experience, risk perception.
National Category
Social Sciences Economics
Research subject
Economics
Identifiers
URN: urn:nbn:se:oru:diva-12557ISBN: 978-91-7668-775-8 (print)OAI: oai:DiVA.org:oru-12557DiVA: diva2:372086
Public defence
2011-01-14, Hörsal Musik, Örebro universitet, Fakultetsgatan 1, Örebro, 13:15
Opponent
Supervisors
Available from: 2010-11-24 Created: 2010-11-24 Last updated: 2011-04-21Bibliographically approved
List of papers
1. The value of a statistical life for out-of-hospital cardiac arrest victims
Open this publication in new window or tab >>The value of a statistical life for out-of-hospital cardiac arrest victims
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: Economic evaluation of policies regarding out-of-hospital cardiac  arrest (OHCA) is important. We therefore estimates the value of a statistical life (VSL) for OHCA victims.Method:Responses to a national Swedish mail survey in 2007, based on  the stated-preference technique (contingent valuation) to directly elicit individuals’ hypothetical willingness to pay for a reduced risk of dying from OHCA.Results: VSL values are found to be higher than for comparable VSL estimates from the transport sector. A lower-bound estimate of VSL for OHCA would be in range of SEK 20 to 30 million.Conclusions: The results in this paper indicate that it is not an overestimation to use the ‘baseline’ VSL value from the transport sector (SEK 22 million) in cost-benefit analysis of OHCA policy decisions. We do not support a declining VSL with age, i.e. a ‘senior death discount’, for this cause of death.

Keyword
Cost-benefit analysis, Willingness to pay, Contingent valuation, Value of a statistical life, Cardiac arrest
National Category
Economics Social Sciences
Research subject
Economics
Identifiers
urn:nbn:se:oru:diva-12604 (URN)
Available from: 2010-12-01 Created: 2010-11-29 Last updated: 2016-11-21Bibliographically approved
2. Does the within-difference between dichotomous choice and open-ended questions measure certainty?
Open this publication in new window or tab >>Does the within-difference between dichotomous choice and open-ended questions measure certainty?
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Hypothetical bias is a serious problem of stated preference techniques. The certainty approach calibrates answers by attaching different weights to remedy respondents’ valuations. However, very little research has been done to find a link between the determinants and empirical treatment of uncertainty through certainty calibration. We use a combination of dichotomous choice (DC) and an open-ended (OE) question to examine the relation between the degree of confidence and the distance between the DC bid and the OE answer. The results show that the OE-bid difference is significantly correlated to the certainty level in one of our two contingent valuation (CV) surveys. The probability of stating the highest confidence value increased by 5-19 percent per SEK 1000 (~$170/€06) that the answer to the OE question and the bid differed. The second CV survey shows a significant relation for no-responders.

Keyword
contingent valuation, hypothetical bias, calibration, certainty approach, traffic safety, cardiac arrest
National Category
Economics
Research subject
Economics
Identifiers
urn:nbn:se:oru:diva-12606 (URN)
Available from: 2010-12-01 Created: 2010-11-29 Last updated: 2016-11-21Bibliographically approved
3. Sensitivity to scope in contingent valuation: testing two aids to communicate mortality risk reductions
Open this publication in new window or tab >>Sensitivity to scope in contingent valuation: testing two aids to communicate mortality risk reductions
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Validity in contingent valuation (CV) is often tested through the sensitivity of estimated willingness to pay (WTP) to the size or quality of a good or service (‘more is better’ and near proportionality). We investigate the performance of two communication aids (a flexible community analogy and an array of dots) in valuing mortality risk reductions for out-ofhospital cardiac arrest. Our results do not support the prediction of expected utility theory, i.e. that WTP for a mortality risk reduction increases with the amount of risk reduction (weak scope sensitivity), for any of the communication aids. In fact, the array of dots even shows a decreasing WTP when the risk reduction is larger. We find some evidence that level of education influences how communication aids are perceived.

Keyword
contingent valuation, willingness to pay, validity, sensitivity to scope, risk communication, community analogy, cardiac arrest
National Category
Economics Social Sciences
Research subject
Economics
Identifiers
urn:nbn:se:oru:diva-12608 (URN)
Available from: 2010-12-01 Created: 2010-11-29 Last updated: 2016-11-21Bibliographically approved
4. Favourable cost-benefit in an early defibrillation programme using dual dispatch of ambulance and fire services in out-of-hospital cardiac arrest
Open this publication in new window or tab >>Favourable cost-benefit in an early defibrillation programme using dual dispatch of ambulance and fire services in out-of-hospital cardiac arrest
(English)Manuscript (preprint) (Other academic)
Abstract [en]

 

 

Aims: Out-of-hospital cardiac arrest (OHCA) is fatal without treatment,and time to defibrillation is an extremely important factor in relation to survival. We performed a cost-benefit analysis of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm, Sweden.

 

 

 

Methods and Results:

 

A cost-benefit analysis was performed to evaluatethe effects of dual dispatch defibrillation. The increased survival rates were estimated from a real-world implemented intervention, and the monetary value of a life (€ 2.2 million) was applied to this benefit by using results from a recent stated-preference study. The estimated costs include defibrillators (including expendables/maintenance), training, hospitalisation/health care, fire service call-outs, overhead resources and the dispatch centre. The estimated number of additional saved lives was 16 per year, yielding a benefit-cost ratio of 36. The cost per quality-adjusted life years (QALY) was estimated to be € 13 000 and the cost per saved life was € 60 000.

 

Conclusions:

The intervention of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm had positive economic effects. For the cost-benefit analysis the return on investment was high and the cost-effectiveness showed levels below the threshold value for economic efficiency used in Sweden. The cost-utility analysis categorises the cost per QALY as medium.

Keyword
cost-benefit analysis, cost-utility analysis, cost-effectiveness analysis, out-of-hospital cardiac arrest, dual dispatch, defibrillation
National Category
Economics Social Sciences
Research subject
Economics
Identifiers
urn:nbn:se:oru:diva-12611 (URN)
Available from: 2010-12-01 Created: 2010-11-29 Last updated: 2016-11-21Bibliographically approved
5. Effect of response times on survival from out-of-hospital cardiac arrest: using geographic information systems
Open this publication in new window or tab >>Effect of response times on survival from out-of-hospital cardiac arrest: using geographic information systems
(English)Manuscript (preprint) (Other academic)
Abstract [en]

We explored how different response times from out-of-hospital cardiac arrest (OHCA) to defibrillation in the County of Stockholm, Sweden, affect patients’ survival rates. This was done by combining a geographic information systems (GIS) simulation of driving times with register data on survival rates. The emergency resources comprised ambulance alone and ambulance plus fire services. The simulation model predicted a baseline survival rate of 3.9 percent, and reducing the ambulance response time by one minute increased survival to 4.6 percent. Adding the fire services as first responders (dual dispatch) increased survival to 6.2 percent from the baseline level. The model predictions were validated using empirical data.

Keyword
out-of-hospital cardiac arrest, defibrillation, response time, survival rate, geographic information systems, fire services
National Category
Economics Social Sciences
Research subject
Economics
Identifiers
urn:nbn:se:oru:diva-12609 (URN)
Available from: 2010-12-01 Created: 2010-11-29 Last updated: 2016-11-21Bibliographically approved
6. Demographic determinants of incident experience and risk perception: do high-risk groups accurately perceive themselves as high-risk?
Open this publication in new window or tab >>Demographic determinants of incident experience and risk perception: do high-risk groups accurately perceive themselves as high-risk?
(English)Manuscript (preprint) (Other academic)
Abstract [en]

This paper analyses demographic determinants of incident experience and perception of risks, as well as the relationship between the two, for eight different risk domains. Analyses are conducted by merging the results of a Swedish population-based survey, which includes approximately 15 000 individuals, with demographic and economic register data. Being male is associated with higher incident experience yet a lower risk perception for nearly all risk domains. Lower socioeconomic status is associated with high incident experience for violence and falling accidents, but lower incident experience for road traffic accidents. For risk perception, lower socioeconomic status is associated with higher risk perception for falling accidents. On aggregate, ranking the different domains, respondents’ risk perception is almost in perfect correspondence to the ranking of actual incident experience, with the exception that the risk violence is ranked higher than indicated by actual incident experience. On a demographic group level, males and highly educated respondents perceive their risks to be lower than what is expected considering their actual incident experience.

Keyword
incident experience, risk perception, injuries, beliefs
National Category
Economics Social Sciences
Research subject
Economics
Identifiers
urn:nbn:se:oru:diva-12610 (URN)
Available from: 2010-12-01 Created: 2010-11-29 Last updated: 2016-11-21Bibliographically approved

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