Cost–benefit analysis of orientation and mobility programs for adults with vision disability: a contingent valuation study

Abstract

Purpose

The purpose of this study is to conduct a cost–benefit analysis of orientation and mobility (O&M) programs from three perspectives: the general public, the experienced, and the potential users of O&M programs.

Methods

Willingness-to-pay (WTP) for O&M programs was collected via a contingent valuation survey using a double-bound dichotomous choice approach. WTP was estimated using interval regression analyses, accounting for study arm, sex, occupation, income, and self-rated health. The cost data were estimated from a service provider’s perspective. The net present value (NPV), variation if delivered by tele-O&M, was investigated.

Results

The adjusted mean NPV of O&M programs was $3857 (95% CI: $3760–$3954) per client, with highest NPV from the general public ($4289, 95% CI: $4185–$4392), followed by the experienced users ($3158, 95% CI: $2897–$3419) and the potential users ($2867, 95% CI: $2680–$3054). The NPV reached break-even for tele-O&M.

Conclusions

There was strong community support for investment into O&M programs considering benefits for clients over and above the cost of providing the services.

Implications for rehabilitation

• This study demonstrates the feasibility of using cost–benefit analysis with a contingent valuation approach to economically assess a rehabilitation intervention, where its multi-dimensional benefits cannot be fully captured by a conventional appraisal technique such as cost-effectiveness analysis.

• The high willingness-to-pay (WTP) values amongst the general public suggests that Australians perceive government’s investment in orientation and mobility (O&M) rehabilitation as value for money and that individuals would be prepared to contribute to its costs.

• The lower WTP for O&M partially delivered via tele-practice (tele-O&M) indicates a lower acceptance of this innovation in comparison with the traditional face-to-face O&M.

• The estimated net present values of O&M programs, positive for traditional O&M and break-even for tele-O&M, can be of assistance to service planning and investment decisions within the Australian context.

Keywords:

• Cost–benefit analysis
• contingent valuation
• willingness to pay
• orientation and mobility
• vision disability

Acknowledgements

We thank Ms Linzi Coyle/Guide Dogs NSW/ATC, Ms Kathleen Watt/UNSW Optometry Clinic and Mr Wilson Luu/Centre for Eye Health for their assistance with participant recruitment. The lead author’s PhD scholarship was supported by the Guide Dogs NSW/ACT.

Disclosure statement

None of the following authors have any proprietary interests or conflicts of interest related to this submission: Kuo-yi Jade Chang, Blake Angell, Kris Rogers, Stephen Jan, and Lisa Keay.

Additional information

Funding

The telephone survey conducted in this study was funded by Guide Dogs NSW/ACT, Australia.