JMIR Publications

ABSTRACT

Background:

In Canada, 11.5-15.7% of couples suffer from infertility. Anovulation, or failed ovulation, is one of the main causes of infertility in women. In Quebec, the treatment for ovulation induction and other services related to assisted reproductive technology (ART) have been partially reimbursed by the government since 2010.

Objective:

To compare the willingness to pay (WTP) of women of childbearing age to receive drug treatment in the event of failed ovulation, according to 3 different contingent valuation methods (CVM).

Methods:

Three elicitation techniques were used: simple bid price dichotomous choice (DC), DC followed by an open-ended question (DC-OE), and a simplified multiple-bounded discrete choice (MBDC). Each participant was randomly assigned to one of the 3 elicitation techniques. Bid prices ranged from $200-$5000 Canadian dollars (CAD). Of the seven bid prices, one was randomly proposed to each participant in the DC and the DC-OE groups. For the DC-OE, if the answer to the DC bid price was “no”, respondents were asked what was the maximum amount they were willing to pay. For the MBDC, each respondent was offered an initial bid price of $1500 CAD, and the subsequent bid price offer increased or decreased according to the answer provided. “Do not know” responses were considered as a “no”, and each individual was questioned as to their certainty after each choice. WTP values were estimated using probit and bivariate models; the Welsh and Poe model was also performed for the MBDC group.

Results:

The survey was conducted in 2009-2010 with a total sample of 680 women. Analyses were performed on 610 respondents (199 DC, 230 DC-OE, 181 MBDC). Of the 70 respondents who were excluded: 6 did not meet the age criterion, 45 had an annual income less than $2500 CAD, and 19 didn’t respond to the WTP question. Mean WTP values were $4033.26, $1857.90, and $1630.63 for DC, DC-OE, and MBDC, respectively. The WTP for MBDC “Definitely Yes” and “Probably Yes” values were $1516.73 and $1871.22, respectively. The three elicitation techniques provided WTP value differences that were statistically significant (p<0.01). The MBDC was the most accurate method, with lower confidence interval ($557) and lower (CI/mean) ratio (0.34).

Conclusions:

A positive WTP for ovulation induction was found in Quebec. Adding a follow-up question resulted in more accurate WTP values. The MBDC technique provided a more accurate estimate of the WTP with a smaller, and therefore more efficient, confidence interval. To help decision-making and to improve the effectiveness of the fiscal policy related to the ART program, WTP value elicited with the MBDC technique should be used.