DOI: 10.1111/j.1741-6612.2008.00302.x Australasian Journal on Ageing, Vol 27 No 3 September 2008, 161–164 161 © 2008 The Authors Journal compilation © 2008 ACOTA Blackwell Publishing Asia Brief Report Public provision of four-wheeled walkers: Contingent valuation study of economic benefit Terry Haines The University of Queensland and Princess Alexandra Hospital, Brisbane, Australia Cassandra Brown Princess Alexandra Hospital, Woolloongabba, Queensland, Australia Jan Morrison Medical Aids Subsidy Scheme, Brisbane, Queensland, Australia Objective: To quantify the economic value of publicly provided four-wheeled walkers as judged by recipients in Queensland, Australia. Method: Contingent valuation study using willingness-to-pay approach. A sample of 49 Australian older adults who received a publicly funded four-wheeled walker in the past 3 months completed the survey via telephone. A discrete choice bidding response format with a randomly selected starting bid was employed to glean valuations. Results: This approach yielded only one non-response, and one zero dollar response. The mean (standard deviation) valuation provided was $A290 ($A167), which was $A84 in excess of the price paid by the public provider agency to purchase the equipment. Starting bid was significantly associated with values provided. Conclusion: The current public provision program of four-wheeled walkers is likely to generate net societal benefit. These findings coupled with arguments based on equity build a moderate case for the continuation of this program. Key words: assistive devices, contingent valuation, survey administration. Introduction Mobility impairment is common in older age and is associated with several negative health outcomes such as accidental falls, reduced independence and institutionalisation [1]. Mobility aids such as walking sticks and four-wheeled frames are often prescribed to reduce the impact of unsteady gait and mobility impairment. Prevalence estimates of mobility aid use rise as high as 80% in Australian residential aged care facilities [2]. Integration of walking aid prescription and provision into modern geriatric rehabilitation practice has proceeded with little convincing empirical evidence of effectiveness, particularly in the medium to long term. Mobility aids are commonly prescribed for the prevention of falls [3], yet beyond bio- mechanical analyses of the acute effect of their use on gait [4], no controlled trial has been conducted to determine their effectiveness in isolation. Acute use of a four-wheeled walker has been found to increase the distance walked in 6 minutes by people with chronic obstructive pulmonary disease, along with reduced dyspnoea and an enhanced perception of safety [5]. However, a subsequent randomised trial indicated that provision of a four-wheeled walker did not enhance the quality of life or exercise capacity amongst people with chronic obstructive pulmonary disease over an 8-week period [6]. A primary concern raised by these authors was that a high proportion of participants used the four-wheeled walkers only sparingly during the study period. Four-wheeled walkers can be purchased privately or can be provided at public expense in Australia. Public provision of four-wheeled walkers is questionable, however, given the limited evidence of clinical benefit from their use. Conducting a randomised trial to determine the clinical effects of this equipment on outcomes such as accidental falls and community participation among people currently accessing this program is needed. However, public provision of this equipment impedes the feasibility and challenges the ethical standards of such an investigation taking place in Australia as control group participants would have to forgo receipt of equipment to which they are currently entitled at public expense. Even if research evidence were available to demonstrate clinical benefits of this equipment, the potential for poor adherence with use of this equipment in ‘real life’ dictates that pragmatic program evaluation is still required. This is particularly the case as public provision creates incentive for more people to request or be provided with this equipment than the number who actually ‘need’ it. This study aims to quantify the benefit of four-wheeled walkers as judged by recipients of these publicly funded aids through the economic measurement approach of contingent valuation. This approach creates the possibility of measuring the ‘benefit’ that recipients perceive they have received from the four- wheeled walker from their own perspective and expressing this benefit in monetary terms. Doing so allows direct comparison of costs and benefits of program provision in the same metric permitting health policy makers to evaluate the net benefit of a program. Method Design The study used cross-sectional survey incorporating user-based contingent valuation question. Correspondence to: Dr Terry Haines, The University of Queensland and Princess Alexandra Hospital. Email: terrence_haines@health.qld.gov.au