Preferences and willingness-to-pay for a blood pressure telemonitoring program using a discrete choice experiment

This study aimed to elicit the preferences and willingness-to-pay for blood pressure (BP) telemonitoring programs. This study also investigated the different factors or participant characteristics that could influence preferences and choice behaviors. Participants with hypertension were identified from an online survey panel demographically representative of Singapore’s general population. Participants completed a discrete choice experiment (DCE) with 12 choice sets, selecting their preferred BP monitoring program differing on five attributes: mode of consultation, BP machine type (with Bluetooth or not), BP machine price, monthly fee, and program duration. The base reference population (male, married, higher income, more formal education years, full-time worker, aged 55 to <65 years, and digital skills score of 36) preferred teleconsultation over in-person consultation, Bluetooth feature, lower machine price, lower monthly fee, and shorter program duration. A subgroup of participants can be considered teleconsultation-resistant, and three demographic factors were associated with lower preference for teleconsultation: female, fewer formal education years, and lower income. Considering the reference population and Bluetooth attribute, participants were willing to pay 66 SGD (~49 USD) additional for the machine to obtain the Bluetooth feature. Considering the reference population and teleconsultation attribute, participants were willing to pay 6.80 SGD (~5.10 USD) extra monthly fee for a program using teleconsultation. Here we report that amongst participants with hypertension, there is strong preference for the use of teleconsultation and a BP machine with Bluetooth feature in a BP monitoring program. However, a subgroup of participants are teleconsultation-resistant and would prefer in-person consultation.

For this second part of the survey, there will be 12 questions.For each question, you will be presented with 2 options and asked to choose the option that you prefer for the following scenario: You have hypertension and you have decided to take action to monitor your blood pressure regularly and to try to keep it low.Your doctor has recommended for you to sign up for a hypertension management programme.Imagine that you do not have a working home blood pressure (BP) machine and so need to buy a new one.There are two different types of BP machines, Non-Bluetooth or Bluetooth, and there are two different consultation modes, In-Person or Tele-consult.This creates four different combinations of how the hypertension management programme is run.
• In-Person with Non-Bluetooth BP Machine: This in-person programme consists of going to the clinic to meet with the care team once a month.Using your non-Bluetooth BP machine, you will take your blood pressure at least once a week, manually record the readings and bring them to your visit with the care team.The care team will review the blood pressure readings recorded and provide advice and personalised education on lifestyle changes when you meet in-person.
• In-Person with Bluetooth BP Machine: This in-person programme consists of going to the clinic to meet with the care team once a month.Using your Bluetooth-enabled BP machine, you will take your blood pressure at least once a week, and the machine will automatically record the readings in the vital signs monitoring app on your phone.The care team will review the blood pressure readings recorded and provide advice and personalised education on lifestyle changes when you meet in-person.
• Tele-consult with Non-Bluetooth BP Machine: This tele-consult programme consists of a video call with the care team once a month, without having to go to the clinic.Using your non-Bluetooth BP machine, you will take your blood pressure at least once a week, manually input the readings in the vital signs monitoring app on your phone and send them to the care team.The care team will review the blood pressure readings recorded and provide advice and personalised education on lifestyle changes over video call.In addition, there is a chatbot (in English or Chinese), which provides timely and interactive advice through automated SMS.It can prompt you if you missed taking your blood pressure and can guide you towards appropriate self-care and encouragement towards a healthier lifestyle.
• Tele-consult with Bluetooth BP Machine: This tele-consult programme consists of a video phone call with the care team once a month, without having to go to the clinic.Using your Bluetooth-enabled BP machine, you will take your blood pressure at least once a week, and the machine will automatically record the readings in the vital signs monitoring app on your phone and send them to the care team.The care team will review the blood pressure readings recorded and provide advice and personalised education on lifestyle changes over video call.In addition, there is a chatbot (in English or Chinese), which provides timely and interactive advice through automated SMS.It can prompt you if you missed taking your blood pressure and can guide you towards appropriate self-care and encouragement towards a healthier lifestyle.
These different programmes will all have different pricing for the BP machine, different monthly fee that you have to pay for the programme, and different minimum duration that you have to commit to the programme.
In the following questions, the exact same type of programme using the same approach and BP machine might charge differently for the BP machine and the monthly fee, and have a different minimum duration.Please assume that the quality of care remains the same for that type of programme in these different imaginary options.
An example of such a question is presented below: Between the two options of hypertension management programmes, which would you prefer to sign up for?

Table 1 .
The demographic profiles of the participants in this study and those in the Multi-Ethnic Cohort byLiew et al (2019).