Willingness to pay for hemoglobin A1c testing for diabetes Mellitus in Ethiopia: A Valuation Study

Abstract Introduction Diabetes is a global public health concern, with a significant prevalence in low and middle-income countries. Early diagnosis and management are crucial for preventing complications, and the HbA1c test is a gold standard for diabetes monitoring. However, cost barriers limit its accessibility, particularly in resource-limited settings. This study aimed to determine the willingness to pay (WTP) for HbA1c testing among adults in rural Kebeles of Southern Ethiopia Methods A community-based cross-sectional study was employed between April 1 and July 31, 2024. A total of 2,875 adults aged 45 and above were included in the survey through the census. Data were collected face-to-face using a pretested, structured, and interviewer-administered questionnaire. WTP was elicited using a double-bounded contingent valuation method (DB-CVM) with initial bids of 300, 400, 500, and 600 Ethiopian Birr. Seemingly unrelated bivariate probit regression was used to identify determinants of WTP for HbA1C test. The analysis was done Stata version 17.0. Results Findings indicated that 78.3% (95% CI: 76.0, 80.4%) of participants were WTP for HbA1c testing under the single-bound scenario, and 69.9% (95% CI: 67.5%, 72.3%) under the double-bound scenario. Bid amount, travel time to health facilities, household size, estimated annual income, and community-based health insurance membership were key determinants of WTP. Conclusions Nearly four in five of the study participants were willing to pay for HbA1C testing. The present study can inform policymakers and healthcare providers in providing cost-effective and accessible diabetes monitoring. Key messages • The study found that a majority of adults in rural Ethiopia were willing to pay for hemoglobin A1c testing: 78.3% in the single-bound scenario and 69.9% in the double-bound scenario. • Bid amount, travel time to health facilities, household size, estimated annual income, and community-based health insurance membership were identified determinants of willingness to pay.