title: Impact of income and education on drug purchasing decisions in Hong Kong Chinese cancer patients: a pilot study.
abstract: BACKGROUND
  The affordability of diagnostic, preventive and therapeutic interventions is a global concern, particularly in the developing world. To clarify the educational and financial factors that influence purchasing decisions, we conducted a survey of Hong Kong cancer patients across a broad social spectrum.
  
  
  METHODS
  A questionnaire was designed to assess the effect of costs on purchasing decisions relating to six drug-related variables: efficacy, tolerability, convenience, safety, peer pressure, and uncertainty. Validation of the original 31-part survey resulted in a final set of 22 core questions that was administered to 51 consecutive oncology patients who were characterized in terms of varying household income and educational level.
  
  
  RESULTS
  Most respondents (87.6%) were Hong Kong-born or mainland Chinese. There was a strong correlation between household income and education. Demand for drug tolerability and safety was high and cost-inelastic across all educational and income groups. An unexpected finding was that patients from low-income/education households were keen to purchase costly medications (whether Western, or Chinese herbs) of reputed high efficacy, whereas patients from middle-income/-education backgrounds were more negatively influenced by considerations of cost. Only the most affluent and well-educated patients valued overall survival above disease-free survival when making drug purchasing decisions; this cohort was also the least influenced by peer pressure, and the most willing to pay extra for drugs offering more convenience alone.
  
  
  CONCLUSIONS
  Low-income/education Asian patients had paradoxically high expectations of costly drug interventions. Although larger studies addressing this issue are needed to confirm these conclusions, public education initiatives aimed at protecting low-income/education patients from exploitation or disappointment may be desirable.
authors.affiliation: Division of Haematology and Oncology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: W M
authors.initials: WM
authors.lastname: Chan
authors.forename: J
authors.initials: J
authors.lastname: Mak
authors.forename: R J
authors.initials: RJ
authors.lastname: Epstein
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics*; D044466:Asian People; D015331:Cohort Studies; D003657:Decision Making; D018572:Disease-Free Survival; D016527:Drug Costs; D004522:Educational Status; D006723:Hong Kong; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics*; D010865:Pilot Projects; D011203:Poverty; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents