Ken Deal1, Karim Keshavjee2, Sue Troyan3, Robert Kyba4, Anne Marie Holbrook5. 1. DeGroote School of Business, McMaster University, 1280 Main St. West, Hamilton, ON, Canada L8S 4M4. Electronic address: deal@mcmaster.ca. 2. CEO, InfoClin Inc, 567 College St., Suite 201, Toronto, ON, Canada M6G 3W9. Electronic address: karim@infoclin.ca. 3. Division of Clinical Pharmacology & Toxicology, McMaster University, c/o St. Joseph's Healthcare Hamilton, Charlton Ave East, Hamilton, ON, Canada L8N 4A6. Electronic address: troyan@mcmaster.ca. 4. Strategic Global Counsel, 52 Fairfield Road, Toronto, ON, Canada M4P 1T2. Electronic address: rkyba@stratgc.net. 5. Division of Clinical Pharmacology & Toxicology, McMaster University, c/o St. Joseph's Healthcare Hamilton, Charlton Ave East, Hamilton, ON, Canada L8N 4A6. Electronic address: holbrook@mcmaster.ca.
Abstract
OBJECTIVES: Cardiovascular disease (CVD) is an important target for electronic decision support. We examined the potential sustainability of an electronic CVD management program using a discrete choice experiment (DCE). Our objective was to estimate physician and patient willingness-to-pay (WTP) for the current and enhanced programs. METHODS: Focus groups, expert input and literature searches decided the attributes to be evaluated for the physician and patient DCEs, which were carried out using a Web-based program. Hierarchical Bayes analysis estimated preference coefficients for each respondent and latent class analysis segmented each sample. Simulations were used to estimate WTP for each of the attributes individually and for an enhanced vascular management system. RESULTS: 144 participants (70 physicians, 74 patients) completed the DCE. Overall, access speed to updated records and monthly payments for a nurse coordinator were the main determinants of physician choices. Two distinctly different segments of physicians were identified - one very sensitive to monthly subscription fee and speed of updating the tracker with new patient data and the other very sensitive to the monthly cost of the nurse coordinator and government billing incentives. Patient choices were most significantly influenced by the yearly subscription cost. The estimated physician WTP was slightly above the estimated threshold for sustainability while the patient WTP was below. CONCLUSION: Current willingness to pay for electronic cardiovascular disease management should encourage innovation to provide economies of scale in program development, delivery and maintenance to meet sustainability thresholds.
OBJECTIVES:Cardiovascular disease (CVD) is an important target for electronic decision support. We examined the potential sustainability of an electronic CVD management program using a discrete choice experiment (DCE). Our objective was to estimate physician and patient willingness-to-pay (WTP) for the current and enhanced programs. METHODS: Focus groups, expert input and literature searches decided the attributes to be evaluated for the physician and patient DCEs, which were carried out using a Web-based program. Hierarchical Bayes analysis estimated preference coefficients for each respondent and latent class analysis segmented each sample. Simulations were used to estimate WTP for each of the attributes individually and for an enhanced vascular management system. RESULTS: 144 participants (70 physicians, 74 patients) completed the DCE. Overall, access speed to updated records and monthly payments for a nurse coordinator were the main determinants of physician choices. Two distinctly different segments of physicians were identified - one very sensitive to monthly subscription fee and speed of updating the tracker with new patient data and the other very sensitive to the monthly cost of the nurse coordinator and government billing incentives. Patient choices were most significantly influenced by the yearly subscription cost. The estimated physician WTP was slightly above the estimated threshold for sustainability while the patient WTP was below. CONCLUSION: Current willingness to pay for electronic cardiovascular disease management should encourage innovation to provide economies of scale in program development, delivery and maintenance to meet sustainability thresholds.