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\def\RunningAuthor{Suruchi Singh and Satish Kumar Sharma}
\firstPage{7603}
\articleType{Original Article}
\receivedDate{15 Nov 2020}
\acceptedDate{23 Nov 2020}
\revisedDate{20 Nov 2020}
\journalVolume{2020, 11}
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\journalDoi{ijrps.v11i4.4104}
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\def\journalTitle{International Journal of Research in Pharmaceutical Sciences}

\title{\textbf{A Review on Importance of Contingent Value in Pharma Sector}}
\author{Suruchi~Singh\textsuperscript{*}\textsuperscript{1}, 
            Satish~Kumar~Sharma\textsuperscript{2}~\\[5pt]{\textsuperscript{1}Department of Pharmacology, Glocal School of Pharmacy, Glocal University, Mirzapur Pole, Saharanpur-247121, Uttar Pradesh, India}~\\{\textsuperscript{2}Glocal School of Pharmacy, Glocal University, Mirzapur Pole, Saharanpur-247121, Uttar Pradesh, India}}

\begin{abstract}
In comparison to other health economists' methods for benefit calculation, Contingent valuation (CV) was argued to theoretical benefits. However, in practice, as applicable to healthcare concerns, it seems that methodology has not analyzed benefits, as its impact on national decision making in medical sector has still not been exercised. This is not due to continued thriving methodological lack study in this field. It is product, somewhat unorganized and non-systematic, of such operations. To encourage analysts to reach beyond assessment of cost-effectiveness of offering a given degree of environmental products, there needs to be few ways of estimating benefit of supplying various degree of services compared to their costs. While other measures are feasible, such units are expressed more naturally in money terms. The major goal of pharmaceuticals is to enhance the economic value of pharmacy services. The contingent valuation (CV) provides a way to value importance of pharma services. The Contingent Valuation method provides benefit in terms of individual monetary amount provided by both product and services. The present paper provides a brief review about CV method, importance in raising economic value of pharmacy along with its implications. The review also provides some guidelines i.e. National Oceanographic and Atmospheric Administration (NOAA) that should be followed in order to raise the economic value. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Contingent Valuation,\newline Economic Value,\newline NOAA,\newline Pharma Sector
\end{keywords}
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\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Suruchi~Singh~\\ Phone:\ ~\\  Email:\ suruchi481@ gmail.com
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\section{Introduction}
The economic value of pharmaceuticals should be quantified in pharmacy career. Pharmacy career used herein refers to services furnished by any pharmacist. The requirement to assess the cost-effectiveness of clinical drug facilities was recognized as soon as in 1971 \unskip~\citep{962246:21040032}. Various published reviews indicate that profession performs research to achieve the challenge. However, because of methodological weaknesses, such findings are also constrained in implementation. Some research, for example, concentrate on avoiding of costs leading to incompletion of economic analysis. Many techniques for performing economic assessments are accessible \unskip~\citep{962246:21040024}. Currently, most customary approach is cost-efficiency analysis (CEA) for conducting economic analyses in health sector. At CEA, costs are reflected in currency units, health implications in non-currency units like life-years acquired or quality-adjusted life-years (QALY) \unskip~\citep{962246:21040021}. Ever since early 1960s and in medical applications in middle of 1970s and 1973, CVs have been used by fitness economists until late 1980s and early 1990s. Ever since, amount of CV reports in healthcare covers a wide range of disease sectors and regions and claimed that it had risen rapidly \unskip~\citep{962246:21040028}. Figure~\ref{f-dfca80f91d4d}  represents valuable elements explaining the core elements, commonly used elements and novel elements important in healthcare sector. 

This rate remained small in comparison with number of benefits and cost-effectiveness according to studies performed during the same duration. Inherently more versatile than disclosed choice strategies, like hedonic pricing and approach to household manufacturing, is addressed as contingent evaluation (CV) \unskip~\citep{962246:21040035}. Since the use of CV to analyze environmental products in theory is possible and words and conditions that vary from those which have been documented in the history. In theory, CV scenario experiments can also be performed to prevent several problems with economic modelling similar to most legal judgments. The only way to involve what is normally feasible is by contingent valuation usually referred to passive utilization of financial benefits of environmental commodities. The difficulties of surveys and reticence of few analysts to rely over information collected are compensating for these strengths. However, this hesitation is not impartial with respect to its policymaking implications. Instead that two methods are seen as compatible, but differing in strengths and limitations, instead of necessarily contradictory strategies of exposed and proclaimed choice \unskip~\citep{962246:21040020}. In reality, combining the two methods is often feasible and beneficial.

Of course, great benefit of exposed approach to choice is that it is centered on individual behavior. The problem is that the relation between activity and good of community is always complicated and implied economic benefit is measured. The contrary set of features is contingent valuation. Relationship between underlying theoretical model and preferences given in survey is generally very similar. Naturally, there exist econometric theories, but these tends to be distinctive in nature and contribute to distribution and nature of collection of information on survey. CV surveys vary in variety of crucial ways from several different public policy assessments. Next, a significant part of survey is dedicated to public benefit summary (or goods) \unskip~\citep{962246:21040031}. Secondly, it is much detailed and complex than traditional opinion poll to produce expectations for positive. It also includes eliciting money benefit measures: maximum willingness to pay (WTP) in having a desirable good which currently is not in possession or minimum compensation (WTA). A notable weakness of cost effective analysis (CEA) is that its conceptual foundation is subtle \unskip~\citep{962246:21040034,962246:21040030}. Moreover, to recognize cost-effective scheme, decision takers must first initiate the maximum quantity they are willing to pay for achieving specific results. 

Without primary setting this maximum quantity, decision takers cannot decide whether a programme is worthwhile. Lastly, when QALYs are utilized as resultant measures, several restrictive assumptions must be used. An excellent alternative to economic performance analysis are actually much less utilized in healthcare field than in CEA. A recent analysis found that reported CEAs outnumber 5 to 1 documented Cost benefit analysis (CBAs). In 1996 an analysis of pharmaceutical service literature reported 105 studies to determine pharmaceutical services' economic value, wherein it was observed that only seven of those were CBAs \unskip~\citep{962246:21040023}.

The methods of health economic assessment since the theory of economic welfare has an existing theoretical foundation. It is also differentiated from other modes of economic assessment by the beneficial CBA steps in monetary units. With expression of all costs and benefits within monetary units, decision-makers are able to quantify the programme to be measured as a net benefit (benefit minus cost). This net profit is one step in the programme from the point of view of performance, promoting allocative decisions \unskip~\citep{962246:21040033,962246:21040026}. CBA has been utilized as the basis for decision-making in several fields of economics and social policies and is most commonly utilized form of economic assessment in everything, since it appeals to experts and calls on stakeholders because net interest of Programs can be composed and contrasted with return of investments in other fields.

In 1960s, first CBAs took place in health sector. The "human capital approach" was utilized in early implementations, where advantages are measured as improvements in potential production capability. The reasons behind that technique is that, avoided output losses should be calculated at certain salary rate so that benefit of decreased illness may be measured. Several people are affected by human capital approach to CBA in healthcare restrictions \unskip~\citep{962246:21040027}. The primary is that strategy only values changes in health of gross national products, while denying inherent value of standard of living and other hygiene standards which do not impact jobs. Furthermore, strategy to human capital disregard value of serving people that are not in labour intensive work. Finally, it was criticized for its incompatibility with theoretical foundations of CBA in area of welfare \unskip~\citep{962246:21040022}. The shortcomings of CBA perspective on human resources in health sector prompted economists to find new methods of performing economic health assessments. The creation of CEA * as well as the understanding of new CBA strategy, i.e. contingent valuation (CV), were two significant findings from this investigation. The present review focuses on CV methodology along with its importance in healthcare sector. The review also discusses about methodology validation and guidelines for the proposed methodology. 

\textbf{CV Methodology}

The CV approach was proposed in environmental sector as way of carrying out CBA and also was commonly utilized to put monetary amount on environmental alteration. In resume, participants were interrogated about how likely they were to pay for given product, services or healthcare transition hypothetically \unskip~\citep{962246:21040037}. The present approach is centered on the principle of utility-theory that a person's willingness to exchange dollars in respect of alteration in a good, facility or medical outcomes is a person's net evaluation of individual's perceived virtues.CV is also called payment preparation. The process is based on specific microeconomic model, which seeks to generate an alternative amalgamation of goods which maintains usefulness of commodities. Maximum dollar sum to be deducted from income of an individual without decreasing his or her income refers to willingness to pay for fitness service, cerement or enhancement in health. The CV approach is a valuable tool to recognize the importance of people valuing articles not traded usually in private trades, like improvements in climate, health and security \unskip~\citep{962246:21040037,962246:21040039}. Theoretical willingness-for paying questions are asked if traditional markets are closed. The phrase contingent assessment derives from fact that assessment is centered on market liability.

\textbf{Environmental economics assessment}

In environmental economics assessment, Economist has described CV as theoretically sound methodology for estimating benefits to be utilized in CBA.CV. In field of environmental studies, interest in utilizing this approach in field of healthcare has grown. Some healthcare providers have proposed, willingness to pay approaches could be best way to measure benefits of CBA. Analytical methods in healthcare sector are beginning to occur more often.CV utilizes survey methods to calculate the hypothesis of payment for Nice. The prepayment measure derived from issue of CV is defined as dollar sum that person should be prepared to spend after moving from one health state to another. CV may also be utilized to promote readiness to accept reimbursement, i.e., minimum dollar amount that person can willingly consent to decrease in products or services. 


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\makeatother 
\caption{\boldmath {Healthcare valuable elements; wherein quality adjusted life year achieved is core element, productivity and adherence improving factor are commonly utilized elements}}
\label{f-dfca80f91d4d}
\end{figure*}
\egroup

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\caption{\boldmath {Block diagram of non-market valuation method. The method comprises of two methods i) indirect method ii) direct method}}
\label{f-2a6a6b4c3953}
\end{figure*}
\egroup

\begin{table*}[!htbp]
\caption{\boldmath {CV analysis data in different countries} }
\label{tw-91aa0daa6277}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.16\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}p{\dimexpr.172\linewidth-2\tabcolsep}p{\dimexpr.148\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Year & US & UK & Canada & Sweden & total\\
\tblmidrule 
2014 &
  10 &
  13 &
  14 &
  14 &
  66\\
2015 &
  12 &
  12 &
  16 &
  16 &
  56\\
2016 &
  10 &
  15 &
  16 &
  18 &
  59\\
2017 &
  10 &
  15 &
  16 &
  18 &
  59\\
2018 &
  13 &
  15 &
  19 &
  19 &
  66\\
2019 &
  10 &
  19 &
  20 &
  23 &
  72\\
2020 &
  18 &
  19 &
  23 &
  25 &
  85\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Clinical Diagnosis over Certain Years} }
\label{tw-af447c938a48}
\def\arraystretch{1.1}
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\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.112\linewidth-2\tabcolsep}p{\dimexpr.208\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}p{\dimexpr.199\linewidth-2\tabcolsep}p{\dimexpr.161\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Year & Cardiovascular & Carcinoma & Sugar level & Bone disorders & neurology\\
\tblmidrule 
2014 &
  0 &
  0 &
  4 &
  6 &
  9\\
2015 &
  1 &
  3 &
  2 &
  2 &
  4\\
2016 &
  5 &
  2 &
  2 &
  3 &
  1\\
2017 &
  4 &
  5 &
  3 &
  2 &
  2\\
2018 &
  6 &
  5 &
  2 &
  3 &
  1\\
2019 &
  4 &
  3 &
  1 &
  6 &
  5\\
2020 &
  4 &
  3 &
  5 &
  4 &
  6\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Interventions taken to for certain diseases over certain years} }
\label{tw-9d9b492178cc}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1705\linewidth-2\tabcolsep}p{\dimexpr.14950000000000001\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Year & Medication & Surgery & diagnosis & others & total\\
\tblmidrule 
2014 &
  4 &
  3 &
  4 &
  4 &
  15\\
2015 &
  5 &
  5 &
  6 &
  6 &
  22\\
2016 &
  8 &
  4 &
  6 &
  8 &
  26\\
2017 &
  10 &
  5 &
  6 &
  8 &
  29\\
2018 &
  10 &
  5 &
  9 &
  11 &
  35\\
2019 &
  10 &
  9 &
  12 &
  13 &
  44\\
2020 &
  12 &
  10 &
  15 &
  13 &
  50\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
The empirical findings of CV analysis include wealth of knowledge about programme's importance for population of interest. Contingent valuation is ambivalent of required summary measure that decision-makers can take. Some of the above is in the form of summarized details like aggregate WTP utilized in neoclassical cost-benefit analysis, or summary metric like median WTP. Contingent preferential studies produce generally knowledge on broader WTP distribution and usually on how distribution differs with characteristics of respondent, for example, income, and geographical location and similar. Figure~\ref{f-2a6a6b4c3953}  represents the block diagram of contagion valuation method. 

\textbf{CV Studies for pharmacy system}

For more than twenty years, researchers utilized willingness to pay questions, for making pharmacy services monetarily worthwhile. Many of readiness to invest early assessments of pharmaceutical services have been conducted without any gain to requirements or guidance in health sector and have preceded interest in implementing CV approaches. Future research must be intensively performed using state-of-the-art methodologies and guidelines, and is thus worth evaluating prior studies utilizing an on-going issue of willingness to offer pharmacy services financial value. The research using the CV (willingness to pay) issue for a medication service between Jan. 1970 and Mar.1999 have been examined in the Medleine@, HealthSTAR and EConelit databases \unskip~\citep{962246:21040025}. The search strategy involved text strings searches for pharmacy facilities and pharmaceutical treatment for the "willed for paying," "contingent assessment," and "cost-benefit study," among others.

\textbf{Parameters for selection of CV studies}

The selection of analysis was centered on: (1) valuation components services were given by pharmacist, (2) investigators prompted urge for paying for pharmaceutical service's from real or prospective service customer; and (3) research was published in English. In international scientific papers, this technique was utilized to classify few studies using the CV approach in which pharmacy services have to be given financial importance. The first CV study was conducted in 1973 in field of pharmaceutical services, wherein 400 consumers were given a choice related to requiring pharmacists to give medication history of patients or they want to pay some amount more per prescription for such service \unskip~\citep{962246:21040038}. Of those polled, 97\% thought pharmacist could provide such service, and 92\% believed in paying for such service. The thesis is CV thesis that has not been completed since it's not feasible to measure mean desire for paying. The only data collected was that 92 percent were prepared to pay \$0.27 or more, and 7 percent were reluctant to pay \$O.29 \unskip~\citep{962246:21040037}. The price must either in various subgroups were variable to calculate mean capacity to invest, or every person should be asked about their maximum willingness to make a payment. Smith54 carried out a nationwide survey of the ability of the American Pharmaceutical Organization to charge for the health services of more than I200 customers. Three open questionnaires about maximum ability to pay of the respondents were involved in this telephonic survey. The primary question was whether customers would have been prepared to pay consultation with their private pharmacists to fill out prescription; 35\% of respondents ready for payment with 5 percent desire to pay approximately \$20 (mean readiness to pay) \unskip~\citep{962246:21040020}. 

The second concern was whether customers were prepared to pay for Pharmacists to keep account of patient drug review; 40\% of them were happy to pay for that service, 15\% were prepared to pay z\$2. Third question included home consultation with pharmacists, wherein it was observed that45\% were prepared and 7\% were willing to give r\$ 30. In healthcare sector, major CV producers are US and Great Britain (Table~\ref{tw-91aa0daa6277}). However, CV implications in countries except US, UK, Canada, and Sweden are the improvements that have been most evident in recent years. At minimum one healthcare CV analysis was carried out in 35 countries since 2000. CV therefore tends to inroads into a variety of various health cultures, particularly in certain developing nations where such studies are mostly utilized to estimate future rates of growth and co-performance and therefore consist of very specific policy emphasis. 

Table~\ref{tw-af447c938a48}  represents that many of early studies were centered on cardiovascular diseases-mainly by Johannesson in Sweden, however broader geographical utilization of CV coinciding with expansion of clinical region since mid-1990s. 

Table~\ref{tw-9d9b492178cc}  reveals that interventions are important, but minority, of pharmaceuticals have been tested. But there exist more research since 2000 concentrating on testing for multiple diseases, maybe because large part of screening is linked to data significance, typically not included in other assessment methods. 

To recognize if any improved methodology utilized in CV studies, a requirement for standard protocol is crucial. Without formal guidelines developed or validated in field of health economy, several studies say that they have pursued guidelines in field of environmental economics. As long as it is appropriate for moment, National Oceanographic and Atmospheric Administration (NOAA) guidelines \unskip~\citep{962246:21040029}  reflect changes over time. The NOAA Group suggested that dichotomous-choicing questions be preferred to open-ended questions because they are biased, erratically and inaccurate' in first place, using question-request model as an example \unskip~\citep{962246:21040029}  dichotomous option model was created to attempt to address three challenges, bid and payment card format: lower response rates; tactical bias; bidding level or reach (for payment card methodologies). Regarding this an argument was made that this format has three benefits over other strategies, more closely matches the customer option in real market situation; no participant can excessively influence overall value of WTP; it prevents bias of both point of departure (and range), as electors obtain only one offer. The NOAA guidelines to be followed for productive CV methodology is mentioned below \unskip~\citep{962246:21040036}.\textbf{\space }

\textbf{NOAA Guidelines}

\textbf{Development}

Pilot work and pre-assessment must be done and elaborated

\textbf{Design selection}


  
  \begin{enumerate}
  \item \relax Willingness to pay protocol must be utilized
  \item \relax Sampling's probability
  \item \relax Define mode of payment delivery
  \item \relax Scheduled interviews
  \item \relax Dichotomous-choice queries outline, wherein an explanation of respondents should be required for ``no'' answer option.
  \item \relax Sufficient data should be required.
  \item \relax Answers should be reminded to respondents specifically of other products due to reduction of their spending on certain private goods
  \item \relax Survey must be incorporated at various durations with samples for testing time trends.
  \item \relax The survey must involve certain questions such as: i) Income; ii) Prior arts; iii) Prior interest; iv) Attitude for health; v) Issues relevancy; vi) Task understanding
  \item \relax Interviewer test impacts must be incorporated
  \end{enumerate}
  \textbf{Reporting: the contents included in this section are}


  
  \begin{enumerate}
  \item \relax Population sampling 
  \item \relax Sampling outline utilized
  \item \relax Sample dimension
  \item \relax Clear design selection
  \item \relax Data extraction must be proper and should be provided to those interested
  \end{enumerate}
  \textbf{Quality assessment}


  
  \begin{enumerate}
  \item \relax Increased response rate
  \item \relax Task understanding by participants
  \item \relax Scenario belief
  \end{enumerate}
  Interested or not interested votes must be explained w.r.t money and/or values of products and services.
    
\section{DISCUSSION}
When society seeks to distribute scarce resources, there exists thorough analysis of economic worth of medical services. To thrive, the evidence of "money importance" is needed for naive and existing programmes. In 1971 Pharmacist's Task Force on Clinical Position recognized need for studies to assess pharmacy services. In field of pharmaceutical services, only handful of research were performed utilizing this approach. Curiosity in CV methodology in healthcare environment is growing. Since 1994, the Search Strategy has not found any CV issues which had been applied to pharma services as monetary values, however a CV question from 1999 was utilized to apportion an economic value to pharmaceutical good (syringes). The present review includes citations pertaining to desired for investing towards pharmaceutical services. Moreover, a comprehensive evaluation was made that was limited to studies cited within three databases which were preferable \unskip~\citep{962246:21040032}  (MEDLINE@, HealthSTAR, and ECONLIT). Till date, pharmacy appraisal studies have mainly assessed ability of people to pay for such services to decide whether clinics have advantage of delivering and charging those facilities. Future research in such field would probably need to go farther these early assessments by assessing values of services and to show management organizations the importance. A full CBA would be needed, instead of simply measuring willingness of customer to invest for the service. The previous discussion of possible inclinations in CV analysis shows that viability of CV analysis has many problems. In order to minimize the likelihood of bias, CV query that interviewee finds plausible and substantive must be identified. When a fresh service is tested, the service shall be identified to respondent attentively and absolutely. A pilot test could allow researchers to identify possible sources of biasing and could help in identifying the bidding vector for clarification requests (i.e. different price levels).

It has been conferred that, an increase in aggregate number, width of geographical area, clinical sector and interventions can be observed. This clearly indicates that CV is not subsiding but leading to expansion in future research conduct. At present, it can be concluded that, CV is just like sailing ships {\textendash} its application is very slow in economic assessment methods, wherein there can be no surety in terms of correct direction and also is not clear to achieve the destinations. It means that before full-fledge application of CV, complete understanding of dynamics and morphology of CV is required. Along with that its implications in right direction is also a point of concern. In order to evaluate the appropriateness of the CV methodology NOVAA guidelines were also provided.
    
\section{Conclusion}
The main problem with respect to fairness of CV protocol is degree to which there is a hypothetical ability to invest. In order to finally test this problem there exist a need for experimental studies that give 1 group of subject the possibility to purchase. In order to preferably assess the reliability of CV approach in healthcare field, medical products and services must be checked utilizing private goods as object to be evaluated. A detailed analysis of CV methodology in healthcare sector is required because of new opportunities like public health economics motive may renew validity of technique. Therefore this paper gives insights about hope towards stimulating responses of CV method in near future.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that they have no conflict of interest for this study.
    

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