title: Physician and patient willingness to pay for electronic cardiovascular disease management.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: DeGroote School of Business, McMaster University, 1280 Main St. West, Hamilton, ON, Canada L8S 4M4. Electronic address: deal@mcmaster.ca.
authors.forename: Ken
authors.initials: K
authors.lastname: Deal
authors.affiliation: CEO, InfoClin Inc, 567 College St., Suite 201, Toronto, ON, Canada M6G 3W9. Electronic address: karim@infoclin.ca.
authors.forename: Karim
authors.initials: K
authors.lastname: Keshavjee
authors.affiliation: 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.
authors.forename: Sue
authors.initials: S
authors.lastname: Troyan
authors.affiliation: Strategic Global Counsel, 52 Fairfield Road, Toronto, ON, Canada M4P 1T2. Electronic address: rkyba@stratgc.net.
authors.forename: Robert
authors.initials: R
authors.lastname: Kyba
authors.affiliation: 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.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Holbrook
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D002755:Choice Behavior; D020000:Decision Support Systems, Clinical / Q000191:economics* / Q000706:statistics & numerical data; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D057240:Patient Preference / Q000191:economics*; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic
keywords: Chronic disease management; Discrete choice; Electronic decision support; Patient preferences; Physician preferences; Vascular disease; Willingness to pay