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Fiala MA. Financial Toxicity and Willingness-to-Pay for Cancer Treatment Among People With Multiple Myeloma. JCO Oncol Pract 2024; 20:1263-1271. [PMID: 38885465 DOI: 10.1200/op.24.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/08/2024] [Accepted: 05/07/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE This study used willingness-to-pay (WTP) exercises to explore the relationships between race, financial toxicity, and treatment decision making among people with cancer. METHODS A convenience sample of people with multiple myeloma who attended an academic medical center in 2022 was surveyed. Financial toxicity was assessed by the Comprehensive Score for financial Toxicity, with scores <26 indicating financial toxicity. WTP was assessed with (1) a discrete choice experiment (DCE), (2) fixed-choice tasks, and (3) a bidding game. RESULTS In total, 156 people were approached, and 130 completed the survey. The majority of the sample was White (n = 99), whereas 24% (n = 31) was African American or Black. Forty-six percent (n = 60) of the sample were experiencing financial toxicity. In the DCE, the relative importance of cost was twice as high for those with financial toxicity (30% compared with 14%; P < .001). In the fixed-choice tasks, they were twice as likely to accept a treatment with shorter progression-free survival but lower costs (adjusted odds ratio [aOR], 2.47; P = .049). In the bidding game, the median monthly WTP of those with financial toxicity was half that of those without ($100 in US dollars [USD] compared with $200 USD; P < .001). Only in the bidding game was race statistically associated with WTP; after controlling for financial toxicity, African American or Black participants were three times as likely (aOR, 3.06; P = .007) to report a lower WTP. CONCLUSION Across all three exercises, participants with financial toxicity reported lower WTP than those without. As financial toxicity disproportionally affects some segments of patients, it is possible that financial toxicity contributes to cancer disparities.
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Affiliation(s)
- Mark A Fiala
- Department of Medicine, Washington University School of Medicine, St Louis, MO
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Chyderiotis S, Sicsic J, Gagneux-Brunon A, Raude J, Barret AS, Bruel S, Gauchet A, Le Duc Banaszuk AS, Michel M, Giraudeau B, Thilly N, Mueller JE. Optimizing Communication on HPV Vaccination to Parents of 11- to 14-Year-Old Adolescents in France: A Discrete Choice Experiment. THE PATIENT 2024; 17:575-588. [PMID: 38693318 PMCID: PMC11343910 DOI: 10.1007/s40271-024-00687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND With the aim to optimize communication during HPV vaccination campaigns in France, we elicited parental preferences around HPV vaccination. METHODS We conducted a single-profile discrete choice experiment (DCE) among parents of 11- to 14-year-old middle-school pupils, who completed an anonymous, self-administered, internet-based questionnaire during 2020-2021. The DCE comprised five attributes (vaccine-preventable disease, justification of optimal age, information on safety, indirect protection and coverage) of vaccination against an unnamed disease that were presented to respondents in ten choice tasks, or scenarios. We use fixed effect logit models to estimate attribute weights on theoretical vaccine acceptance, and random effect linear regression to estimate attribute coefficients on vaccine eagerness (decision and decision certainty). We estimated marginal effects of attributes on expected vaccine acceptance. RESULTS Vaccination scenarios were accepted by 55.6-89.2% of the 1291 participants. The largest marginal effects on expected vaccine acceptance in the full sample arose from prevention of cancer versus genital warts (+ 11.3 percentage points); from a "severe side effect suspicion that was not scientifically confirmed" versus a statement about "more benefits than risks" (+ 8.9 percentage points), and information on 80% vaccine coverage in neighbouring countries versus on "insufficient coverage" (+ 4.2 percentage points). Explaining the early age of vaccination by sexual debut had a strong negative impact among French monolingual parents with lower education level (vs age-independent, OR 0.48, 95% CI 0.27-0.86), but not other socio-economic groups. After removing low-quality responses (unvaried certainty and short questionnaire completion), among serial non-demanders with children not vaccinated against HPV, only disease elimination impacted vaccine eagerness positively (coefficient 0.54, 0.06-1.02). DISCUSSION Using DCEs to elicit parents' preferences around communication messages, notably on cancer prevention, vaccine coverage and information about vaccine safety, could help to optimize HPV vaccination promotion efforts.
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Affiliation(s)
- Sandra Chyderiotis
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015, Paris, France
| | | | - Amandine Gagneux-Brunon
- CHU de Saint-Etienne-Service d'Infectiologie, Saint-Etienne, France
- Centre International de Recherche en Infectiologie, Team GIMAP, Université de Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, Lyon, France
- CIC-Inserm, 1408, CHU de Saint-Etienne, Saint-Etienne, France
| | - Jocelyn Raude
- Univ. Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS (Recherche sur les Services et Management en Santé)-U1309, 35000, Rennes, France
| | | | - Sébastien Bruel
- Department of General Practice, Jacques Lisfranc Faculty of Medicine, Saint-Etienne-Lyon University, Saint-Etienne, France
- Health, Systemic, Process. UR 4129 Research Unit, University Claude Bernard, University of Lyon, Lyon, France
| | - Aurélie Gauchet
- Université Savoie Mont Blanc, Univ. Grenoble Alpes, LIP/PC2S, 73000, Chambéry, France
| | - Anne-Sophie Le Duc Banaszuk
- Centre Régional de Coordination des Dépistages des cancers-Pays de la Loire, 5 Rue des Basses Fouassières, 49000, Angers, France
| | - Morgane Michel
- Université Paris Cité, ECEVE, UMR 1123, Inserm, 75010, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, 75019, Paris, France
| | - Bruno Giraudeau
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, INSERM CIC 1415, CHRU de Tours, Tours, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, 54500, Nancy, France
- Département Méthodologie, Promotion, Investigation, Université de Lorraine, CHRU-Nancy, 54500, Nancy, France
| | - Judith E Mueller
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015, Paris, France.
- Univ. Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS (Recherche sur les Services et Management en Santé)-U1309, 35000, Rennes, France.
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Vass C, Boeri M, Shields G, Seo J. Making Use of Technology to Improve Stated Preference Studies. THE PATIENT 2024; 17:483-491. [PMID: 38632181 DOI: 10.1007/s40271-024-00693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/19/2024]
Abstract
The interest in quantifying stated preferences for health and healthcare continues to grow, as does the technology available to support and improve health preference studies. Technological advancements in the last two decades have implications and opportunities for preference researchers designing, administering, analysing, interpreting and applying the results of stated preference surveys. In this paper, we summarise selected technologies and how these can benefit a preference study. We discuss empirical evaluations of the technology in preference research, with examples from health where possible. The technologies reviewed include serious games, virtual reality, eye tracking, innovative formats and decision aids with values clarification components. We conclude with a critical reflection on the benefits and limitations of implementing (often costly) technology alongside stated preference studies.
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Affiliation(s)
| | - Marco Boeri
- Open Health, Belfast, UK
- Queen's University of Belfast, Belfast, UK
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Gisbert JP, Schreiber S, Siegel CA, Magro F, Jus A, Whichello C, Michaels-Igbokwe C, Heidenreich S, Oortwijn A, Vermeire S. Benefit-Risk Trade-offs and Patient Preferences for Therapy Selection in Ulcerative Colitis: a Multicountry Preference Study. Inflamm Bowel Dis 2024:izae162. [PMID: 39126434 DOI: 10.1093/ibd/izae162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND To help navigate the complex treatment landscape of ulcerative colitis (UC), we quantified the benefit-risk trade-offs that patients were willing to make when choosing treatment. METHODS Patients completed an online discrete choice experiment. Eligible patients had a UC diagnosis for ≥6 months, were aged ≥18 years, and resided in France, Germany, Italy, Spain, or the UK. Patients chose between 2 hypothetical treatments set up to ensure trade-offs were made. Clinical trial data, literature review, and patient interviews identified treatment attributes. Relative attribute importance (RAI) scores and maximum acceptable risks were generated. A patient-centric benefit-risk assessment of 200 mg of filgotinib was conducted as an example to show how measured trade-offs can be used. RESULTS Overall, 631 patients participated; patients had a mean age of 42.2 years and were predominantly male (75.3%). Achieving and maintaining clinical remission was the most important factor for patients (RAI 32.4%); to achieve this, patients were willing to accept slightly higher risks of blood clots, serious infections, and malignancies compared with lower risk treatment profiles. Patients also valued the convenience of oral treatments, avoiding steroids, and the ability to attend school/work. The patient-centric benefit-risk assessment suggested patients are significantly more likely to prefer Janus kinase 1 preferential inhibitor filgotinib over placebo. CONCLUSIONS Achieving clinical remission was the highest treatment priority for patients. To attain this, patients were willing to accept some slightly higher risk treatment profiles. Patient choices in the benefit-risk assessment suggested patients were significantly more likely to prefer filgotinib over placebo.
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Affiliation(s)
- Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III Health Institute, Madrid, Spain
| | - Stefan Schreiber
- Department of Internal Medicine I, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Corey A Siegel
- Inflammatory Bowel Disease Center, Section of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Fernando Magro
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Anna Jus
- Galapagos NV, Leiden, Netherlands
| | | | | | | | | | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
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Genie MG, Poudel N, Paolucci F, Ngorsuraches S. Choice Consistency in Discrete Choice Experiments: Does Numeracy Skill Matter? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02782-7. [PMID: 39094694 DOI: 10.1016/j.jval.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES This study investigated the relationship between numeracy skills (NS) and choice consistency in discrete choice experiments (DCEs). METHODS A DCE was conducted to explore patients' preferences for kidney transplantation in Italy. Patients completed the DCE and answered 3-item numeracy questions. A heteroskedastic multinomial logit model was used to investigate the effect of numeracy on choice consistency. RESULTS Higher NS were associated with greater choice consistency, increasing the scale to 1.63 (P < .001), 1.39 (P < .001), and 1.18 (P < .001) for patients answering 3 of 3, 2 of 3, and 1 of 3 questions correctly, respectively, compared with those with no correct answers. This corresponded to 63%, 39%, and 18% more consistent choices, respectively. Accounting for choice consistency resulted in varying willingness-to-wait (WTW) estimates for kidney transplant attributes. Patients with the lowest numeracy (0/3) were willing to wait approximately 42 months [95% CI: 29.37, 54.68] for standard infectious risk, compared with 33 months [95% CI: 28.48, 38.09] for 1 of 3, 28 months [95% CI: 25.13, 30.32] for 2 of 3, and 24 months [95% CI: 20.51, 27.25] for 3 of 3 correct answers. However, WTW differences for an additional year of graft survival and neoplastic risk were not statistically significant across numeracy levels. Supplementary analyses of 2 additional DCEs on COVID-19 vaccinations and rheumatoid arthritis, conducted online, supported these findings: higher NS were associated with more consistent choices across different disease contexts and survey formats. CONCLUSIONS The findings suggested that combining patients with varying NS could bias WTW estimates, highlighting the need to consider numeracy in DCE data analysis and interpretation.
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Affiliation(s)
- Mesfin G Genie
- Newcastle Business School, College of Human and Social Futures, The University of Newcastle, Australia; Department of Population Health Sciences, Duke University, Durham, NC, USA; Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK.
| | - Nabin Poudel
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL, USA; Department of Practice, Sciences, and Health Outcomes Research, University of Maryland, School of Pharmacy, Baltimore, MD, USA
| | - Francesco Paolucci
- Newcastle Business School, College of Human and Social Futures, The University of Newcastle, Australia
| | - Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL, USA
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Loría-Rebolledo LE, van Woerden HC, Bryers H, Erdem S, Watson V. Preferences of Recent Mums in Remote and Rural Areas for Type of Intrapartum Care: A Discrete Choice Experiment. THE PATIENT 2024:10.1007/s40271-024-00704-8. [PMID: 39012449 DOI: 10.1007/s40271-024-00704-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND AND OBJECTIVES Pregnant women living in rural areas considering their preferred place of birth may have to 'trade-off' travel time/distance and other attributes of care (e.g. the full choice of birthplace options is rarely available locally). This study assesses the preferences and trade-offs of recent mothers who live in remote and rural areas of Great Britain. METHODS An online survey, informed by qualitative research, was administered to women living in rural areas who had given birth in the preceding 3 years. The survey included a discrete choice experiment (DCE) to elicit women's preferences and trade-offs for place of birth. The DCE presented women with a series of eight choice tasks in which place of birth was defined by four attributes: (1) type of facility, (2) familiarity with staff, (3) understanding options and feel relaxed and reassured and (4) the travel time to the place of intrapartum care. DCE data were analysed using an error components logit model to identify preferences. RESULTS Across 251 survey responses, holding everything else equal, respondents preferred: intrapartum care in locations with more specialist staff and equipment, locations where they understood their options and felt reassured and where travel time was minimal. Women were willing to travel (92-183 min) to a well-staffed and equipped facility if they understood their options and felt relaxed and reassured. Willingness to travel was reduced if the care received at the specialist facility was such that they did not understand their options and felt tense and powerless (41-132 min). CONCLUSION These insights into the preferences of recent mums from remote and rural areas could inform future planning of rural intrapartum care.
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Affiliation(s)
| | - Hugo C van Woerden
- Division of Rural Health and Wellbeing, Centre for Health Science, University of the Highlands and Islands, Inverness, IV2 3JH, UK.
- Institute of Nursing and Health Research, Ulster University, Coleraine, BT52 1SA, UK.
| | - Helen Bryers
- Centre for Rural Health, University of Aberdeen, Inverness, IV2 3JH, UK
| | - Seda Erdem
- Stirling Management School, University of Stirling, Stirling, FK9 4LA, UK
| | - Verity Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
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Loría-Rebolledo LE, Abbott M, Antunes M, Norwood P, Ryan M, Watson V, Wu H. Public preferences and willingness to pay for a net zero NHS: a protocol for a discrete choice experiment in England and Scotland. BMJ Open 2024; 14:e082863. [PMID: 38908844 PMCID: PMC11328650 DOI: 10.1136/bmjopen-2023-082863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION Climate change poses a major threat to our health, livelihoods and the planet. In 2020, the UK National Health Service (NHS) committed to reducing its Scope 1, 2 and 3 emissions to reach net zero by 2045. Although a net zero NHS would help to limit the consequences of climate change, little is known about the UK general public's values and preferences for the proposed service changes needed to reach net zero. METHODS This study will elicit the public's preferences for actions to help achieve net zero NHS in England and Scotland using a discrete choice experiment (DCE). The DCE attributes and levels describe actions that can be taken by the NHS across key areas: buildings and estates, outdoor space, travel and transport, provision of care, goods and services and food and catering. The survey was designed using online think-aloud interviews with 17 members of the public. Two versions of the survey will be administered to a sample of up to 2200 respondents. One will include a payment vehicle as income tax increases. We will estimate the relative importance of each attribute and, for the former survey, the monetary trade-offs which individuals are willing to make between attributes. Where possible, we will match both samples to gauge preference robustness with the inclusion of the monetary payment. We will test whether respondents' preferences differ based on their socioeconomic circumstances and attitudes toward the NHS and climate change. ETHICS AND DISSEMINATION The University of Aberdeen's School of Medicine, Medical Sciences and Nutrition Ethics Research Board has approved the study (reference: SERB/690090). All participants will provide informed consent. Results will be submitted to peer-reviewed publications and presented at relevant conferences and seminars. A lay summary of the research will be published on the Health Economics Research Unit website.
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Affiliation(s)
| | - Michael Abbott
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mélanie Antunes
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Patricia Norwood
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Verity Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hangjian Wu
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Mott DJ, Hitch J, Nier S, Pemberton-Whiteley Z, Skedgel C. Patient Preferences for Treatment in Relapsed/Refractory Acute Leukemia in the United Kingdom: A Discrete Choice Experiment. Patient Prefer Adherence 2024; 18:1243-1255. [PMID: 38911590 PMCID: PMC11192962 DOI: 10.2147/ppa.s442530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/02/2024] [Indexed: 06/25/2024] Open
Abstract
Background Acute leukemia is a cancer of the white blood cells which progresses rapidly and aggressively. There are two types: acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). The latter has a rare subtype: acute promyelocytic leukemia (APL). For some patients, following first-line treatment, remission is not achieved ("refractory disease"), and for others the leukemia returns after achieving remission ("relapse"). For these individuals, outcomes are typically poor. It is, therefore, important to understand patients' treatment priorities in this context. Methods Building upon formative qualitative research, an online survey containing a discrete choice experiment (DCE) was designed to explore patients' treatment preferences in the relapsed/refractory setting. The DCE attributes were mode of administration; quality of life during treatment; chance of response; duration of response; and quality of life during response. Each respondent completed twelve scenarios containing two hypothetical treatments. Participants were eligible if they lived in the United Kingdom and had a diagnosis of acute leukemia. The data were analysed using a latent class model. Results A total of 95 patients completed the survey. The latent class analysis identified two classes. For both, chance of response was the most important attribute. For class 1, every attribute was important, whereas for class 2, the only important attributes were quality of life (during treatment and response) and chance of response. A greater proportion of respondents would fall into class 1 overall, and those with ALL or APL and those more recently diagnosed were more likely to be in class 2. Conclusion Our results indicate that patients are strongly concerned about the chance of response, as well as quality of life (to a lesser extent), when faced with different treatment options in the relapsed/refractory setting. However, there is significant preference heterogeneity within the patient population, and other treatment characteristics also matter to many.
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Affiliation(s)
| | - Jake Hitch
- Office of Health Economics, London, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Brandt SK, Essig S, Balthasar A. Professional beliefs of physicians and allied health professionals and their willingness to promote health in primary care: a cross-sectional survey. BMC PRIMARY CARE 2024; 25:188. [PMID: 38802787 PMCID: PMC11129482 DOI: 10.1186/s12875-024-02412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Primary care professionals could play a key role in health promotion implementation. A fundamental aspect that might affect the willingness of primary care professionals to strengthen health promotion, and about which we do not yet know much, are professional beliefs. Therefore, we conducted a quantitative survey to (1) compare professional beliefs and the willingness to work more in health promotion between five major primary care professions, and (2) investigate associations between professional beliefs and the willingness to work more in health promotion. METHODS A large-scale cross-sectional study based on a nation-wide web-based survey of primary care professionals in Switzerland was conducted from January to July 2022. The survey was addressed to pharmacists, physicians, medical practice assistants, nurses, and physiotherapists working in primary care in Switzerland. Differences between groups were tested using T-tests and Chi-square tests. Multivariable logistic regression analyses were used to evaluate the association between variables related to professional beliefs and the willingness to work more in health promotion. RESULTS The responses of 4'063 primary care professionals were used for analysis. Most primary care professionals revealed a salutogenetic attitude towards their primary care tasks. Members of all professions showed high awareness of their tasks in tackling increased risks of disease (80.2% of all participants). Especially allied health professionals wished to see a greater role of prevention in primary care (pharmacists: 72.4%, medical practice assistants: 63.9%, nurses: 75.6%, physiotherapists: 73.9% versus physicians: 46.9%). All professional groups showed a high willingness to work more in health promotion (88% of all participants). Salutogenetic beliefs of primary care professionals and their willingness to work more in health promotion are strongly associated. Participants agreeing that health promotion should play a greater role or that preventive consultations should be offered in primary care, are more willing to work more in health promotion compared to participants who disagree with these ideas. CONCLUSIONS Both affiliation to allied primary care professions and salutogenetic professional beliefs are associated with higher willingness to work more in health promotion. The high willingness provides evidence of a large, yet untapped potential. Promoting salutogenetic beliefs might further increase the willingness to engage in health promotion.
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Affiliation(s)
| | - Stefan Essig
- Center for Primary and Community Care, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Interface Policy Studies Research Consulting, Lucerne, Switzerland
| | - Andreas Balthasar
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Thai T, Lancsar E, Spinks J, Freeman C, Chen G. Understanding Australian pharmacy degree holders' job preferences through the lens of motivation-hygiene theory. Soc Sci Med 2024; 348:116832. [PMID: 38569288 DOI: 10.1016/j.socscimed.2024.116832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/27/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
Increasing the contribution of pharmacists to primary care has been long discussed, particularly in the context of health workforce shortages and the push to better integrate all providers across primary care. This study examines the employment preferences of Australian pharmacy degree holders (PDHs) elicited through a discrete choice experiment (DCE), to better understand the drivers of current labour force choices. A labelled DCE was developed incorporating the six employment sectors: hospital pharmacy, community pharmacy, primary healthcare settings, pharmaceutical industry, government/academia, and non-pharmacy-related sector. Each alternative was described by five attributes using Herzberg's Two Factor Theory as a conceptual framework. They include motivators - role and career opportunities, and hygiene factors-flexible work schedule, geographic location, and salary. Unforced choice data were analysed using conditional logit and mixed logit models. Based on a sample of 678 PDHs in Australia, our findings indicated pharmaceutical industry is the least preferred sector, followed by non-pharmacy-related sector. Motivators in the form of role and career opportunities are the most important attributes in hospital pharmacy while hygiene factors - geographic location and salary significantly drive the choice of community pharmacy and primary care settings. We provided evidence of a willingness to adopt expanded roles in community pharmacy. This unique interpretation of the key drivers of employment preference in light of motivators and hygiene factors provides policy makers with important information when designing policies to attract and retain PDHs across employment sectors.
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Affiliation(s)
- Thao Thai
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Emily Lancsar
- Department of Health Services Research & Policy, Research School of Population Health, College of Health & Medicine, The Australian National University, 63A Eggleston Road, Acton ACT, 2601, Australia
| | - Jean Spinks
- Centre for the Business and Economics of Health, Lev 5, Bld 14, The University of Queensland, St Lucia Campus, Brisbane, QLD, 4072, Australia
| | - Christopher Freeman
- The University of Queensland, School of Pharmacy, Brisbane, QLD, Australia; The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia; Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Level 5, Building H, Caulfield Campus, 900 Dandenong Road, Caulfield East, VIC, 3145, Australia
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Seo J, Saurkar S, Fernandez GS, Das A, Goutman SA, Heidenreich S. Preferences of Patients with Amyotrophic Lateral Sclerosis for Intrathecal Drug Delivery: Choosing between an Implanted Drug-Delivery Device and Therapeutic Lumbar Puncture. THE PATIENT 2024; 17:161-177. [PMID: 38097873 DOI: 10.1007/s40271-023-00665-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Novel intrathecal treatments for amyotrophic lateral sclerosis (ALS) may require delivery using lumbar puncture (LP). Implanted drug-delivery devices (IDDDs) could be an alternative but little is known about patients' preferences for intrathecal drug-delivery methods. OBJECTIVE We aimed to elicit preferences of patients with ALS for routine LP and IDDD use. METHODS A discrete choice experiment (DCE) and a threshold technique (TT) exercise were conducted online among patients with ALS in the US and Europe. In the DCE, patients made trade-offs between administration attributes. Attributes were identified from qualitative interviews. The TT elicited maximum acceptable risks (MARs) of complications from device implantation surgery. DCE data were analyzed using mixed logit to quantify relative attribute importance (RAI) as the maximum contribution of each attribute to a preference, and to estimate MARs of device failure. TT data were analyzed using interval regression. Four scenarios of LP and IDDD were compared. RESULTS Participants (N = 295) had a mean age of 57.7 years; most (74.2%) were diagnosed < 3 years ago. Preferences were affected by device failure risk (RAI 28.6%), administration frequency (26.4%), administration risk (19.7%), overall duration (17.8%), and appointment location (7.5%). Patients accepted a 5.6% device failure risk to reduce overall duration from 2 h to 30 min and a 3.6% risk for administration in a local clinic instead of a hospital. The average MAR of complications from implantation surgery was 29%. Patients preferred IDDD over LP in three of four scenarios. CONCLUSION Patients considered an IDDD as a valuable alternative to LP in multiple clinical settings.
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Affiliation(s)
- Jaein Seo
- Patient-Centered Research, Evidera, Bethesda, MD, USA
| | | | | | - Anup Das
- Patient-Centered Research, Evidera Ltd, 201 Talgarth Rd Hammersmith, London, W6 8BJ, UK
| | | | - Sebastian Heidenreich
- Patient-Centered Research, Evidera Ltd, 201 Talgarth Rd Hammersmith, London, W6 8BJ, UK.
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Alten R, Nieto-Gonzalez JC, Jacques P, Montecucco C, Moots R, Radner H, Vonkeman HE, Heidenreich S, Whichello C, Krucien N, Van Beneden K. What benefit-risk trade-offs are acceptable to rheumatoid arthritis patients during treatment selection? Evidence from a multicountry choice experiment. RMD Open 2024; 10:e003311. [PMID: 38199605 PMCID: PMC10806488 DOI: 10.1136/rmdopen-2023-003311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/14/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE Understanding preferences of patients with rheumatoid arthritis (RA) can facilitate tailored patient-centric care. This study elicited trade-offs that patients with RA were willing to make during treatment selection. METHODS Patients with RA completed an online discrete choice experiment, consisting of a series of choices between hypothetical treatments. Treatment attributes were selected based on literature review and qualitative patient interviews. Eligible patients were ≥18 years old, diagnosed with RA, receiving systemic disease-modifying antirheumatic drug therapy, and residents of Europe or USA. Male patients were oversampled for subgroup analyses. Data were analysed using a correlated mixed logit model. RESULTS Of 2090 participants, 42% were female; mean age was 45.2 years (range 18-83). Estimated effects were significant for all attributes (p<0.001) but varied between patients. Average relative attribute importance scores revealed different priorities (p<0.001) between males and females. While reducing pain and negative effect on semen parameters was most important to males, females were most concerned by risk of blood clots and serious infections. No single attribute explained treatment preferences by more than 30%. Preferences were also affected by patients' age: patients aged 18-44 years placed less importance on frequency and mode of treatment administration (p<0.05) than older age groups. Patients were willing to accept higher risk of serious infections and blood clots in exchange for improvements in pain, daily activities or administration convenience. However, acceptable trade-offs varied between patients (p<0.05). CONCLUSION Treatment preferences of patients with RA were individual-specific, but driven by benefits and risks, with no single attribute dominating the decision-making.
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Affiliation(s)
- Rieke Alten
- Schlosspark Klinik, University Medicine Berlin, Berlin, Germany
| | | | - Peggy Jacques
- Department of Rheumatology and VIB Inflammation Research Center, University Hospital Ghent, Ghent, Belgium
| | - Carlomaurizio Montecucco
- Division of Rheumatology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Robert Moots
- Department of Rheumatology, Aintree University Hospital, Liverpool, UK
- Faculty of Health, Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Helga Radner
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
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13
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Bae EY, Lim MK, Lee B, Bae G, Hong J. Public preferences in healthcare resource allocation: A discrete choice experiment in South Korea. Health Policy 2023; 138:104932. [PMID: 37924559 DOI: 10.1016/j.healthpol.2023.104932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/13/2023] [Accepted: 10/15/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES This study aimed to explore the public view on priority-setting criteria for healthcare resource allocation. Specifically, it investigates how the value of a quality-adjusted life year (QALY) varies depending on patient characteristics. METHODS A discrete choice experiment was conducted using an online sample of the general South Korean population. Respondents were presented with two competing treatment scenarios. The attributes of the scenarios were age at disease onset, life expectancy without treatment, life-years gain with treatment, health-related quality of life (HRQoL) without treatment, and HRQoL gains with treatment. Two hundred choice sets were generated and randomly allocated into 20 blocks. A conditional logit model was used to estimate the factors affecting the respondents' choices. RESULTS A total of 3,482 respondents completed the survey. The larger the QALY gain, the more likely it was that the scenario would be chosen but with a diminishing marginal value. Respondents prioritized 40-year-old patients over 5-year-olds and 5-year-olds over 70-year-olds and prioritized baseline HRQoL of 40% and 60% over 20%. Patients at the end of life were not preferred to those with a longer life expectancy. CONCLUSION Overall, respondents preferred health-maximizing options without explicit consideration for end-of-life patients or those with poor health. In addition, they revealed a kinked preference for patient age, prioritizing middle-aged patients over children and older people.
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Affiliation(s)
- Eun-Young Bae
- College of Pharmacy, Gyeongsang National University, Jinju, Republic of Korea; Institute of Pharmacy, Gyeongsang National University, Jinju, Republic of Korea.
| | - Min Kyoung Lim
- Health Insurance Research Institute, National Health Insurance Service, Wonju, Republic of Korea
| | - Boram Lee
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Green Bae
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Jihyung Hong
- Department of Healthcare Management, College of Social Science, Gachon University, Seongnam-si, Gyeonggi-do, Republic of Korea
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Mitchell BD, Rentz AM, Kummer S, Yan Y, Heidenreich S, Krucien N, Artime E, Osumili B, Rubio M, Gelhorn HL. People With Diabetes and Caregivers Prefer Rescue Glucagon Treatment With a Wider Storage Temperature Range and a Nasal Administration, When Efficacy is Similar: A Discrete Choice Experiment in Spain. J Diabetes Sci Technol 2023; 17:1623-1633. [PMID: 35533142 PMCID: PMC10658678 DOI: 10.1177/19322968221095882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Conventional injectable glucagon (IG) and nasal glucagon (NG), both having similar efficacy, are two options for the emergency treatment of severe hypoglycemia in Spain. This study elicited the effect of changes in key attributes on preferences for NG and IG medication profiles of people with diabetes and caregivers in Spain. METHODS The relative attribute importance (RAI) that participants placed on glucagon preparation, preparation and administration time, delivery method, recovery time, device size, storage temperature, and headache risk was estimated from an online discrete choice experiment. In addition, patients and caregivers were presented with NG and IG profiles that included rates of successful administration; the proportion of participants choosing each profile was summarized. RESULTS The analysis included 276 adults with diabetes (65% type 1) and 270 caregivers (49% type 1). Overall mean age was 40 years; 51% were female. The most important attributes were storage temperature (RAI [95% confidence interval] = 27.3% [22.9-32.2]) and delivery method (17.4% [13.1-21.9]). Headache risk (16.2% [11.8-20.7]), time to prepare and administer (14.5% [10.1-18.8]), glucagon preparation (11.4% [6.8-15.8]), recovery time (8.9% [4.3-13.3]), and device size (4.3% [0.3-8.8]) were also relevant. When comparing medication profiles, significantly more participants (78%) preferred NG over IG profiles (P < .001). CONCLUSION Adults with diabetes and caregivers prefer a glucagon treatment with a higher rate of successful administration, wider storage temperature, and nasal delivery method, when efficacy is similar. Participants favored NG over conventional IG as a rescue medication for severe hypoglycemia. This information may help decision-making by payers and treatment discussions between health care professionals and patients.
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Affiliation(s)
| | | | | | - Yu Yan
- Eli Lilly and Company, Indianapolis, IN, USA
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15
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Thompson A, Youn JH, Guthrie B, Hainsworth R, Donnan P, Rogers G, Morales D, Payne K. Quantifying the impact of taking medicines for primary prevention: a time-trade off study to elicit direct treatment disutility in the UK. BMJ Open 2023; 13:e063800. [PMID: 37734893 PMCID: PMC10514632 DOI: 10.1136/bmjopen-2022-063800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/03/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Direct treatment disutility (DTD) represents an individual's disutility associated with the inconvenience of taking medicine over a long period of time. OBJECTIVES The main aim of this study was to elicit DTD values for taking a statin or a bisphosphonate for primary prevention. A secondary aim was to understand factors which influence DTD values. METHODS Design: We used a cross-sectional study consisting of time-trade off exercises embedded within online surveys. Respondents were asked to compare a one-off pill ('Medicine A') assumed to have no inconvenience and a daily pill ('Medicine B') over 10 years (statins) or 5 years (bisphosphonates).Setting: Individuals from National Health Service (NHS) primary care and the general population were surveyed using an online panel company.Participants: Two types of participants were recruited. First, a purposive sample of patients with experience of taking a statin (n=260) or bisphosphonate (n=100) were recruited from an NHS sampling frame. Patients needed to be aged over 30, have experience of taking the medicine of interest and have no diagnosis of dementia or of using dementia drugs. Second, a demographically balanced sample of members of the public were recruited for statins (n=376) and bisphosphonates (n=359).Primary and secondary outcome measures: Primary outcome was mean DTD. Regression analysis explored factors which could influence DTD values. RESULTS A total of 879 respondents were included for analysis (514 for statins and 365 for bisphosphonates). The majority of respondents reported a disutility associated with medicine use. Mean DTD for statins was 0.034 and for bisphosphonates 0.067, respectively. Respondent characteristics including age and sex did not influence DTD. Experience of bisphosphonate-use reduced reported disutilities. CONCLUSIONS Statins and bisphosphonates have a quantifiable DTD. The size of estimated disutilities suggest they are likely to be important for cost-effectiveness, particularly in individuals at low-risk when treated for primary prevention.
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Affiliation(s)
- Alexander Thompson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Ji-Hee Youn
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, University of Edinburgh, Edinburgh, UK
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Robert Hainsworth
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Peter Donnan
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Dundee, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Daniel Morales
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Yu A, Luo Y, Bahrampour M, Norman R, Street D, Viney R, Devlin N, Mulhern BJ. Understanding the valuation of paediatric health-related quality of life: a qualitative study protocol. BMJ Open 2023; 13:e073039. [PMID: 37532476 PMCID: PMC10401228 DOI: 10.1136/bmjopen-2023-073039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION There is evidence from previous studies that adults value paediatric health-related quality of life (HRQoL) and adult HRQoL differently. Less is known about how adolescents value paediatric HRQoL and whether their valuation and decision-making processes differ from those of adults. Discrete choice experiments (DCEs) are widely used to develop value sets for measures of HRQoL, but there is still much to understand about whether and how the methods choices in the implementation of DCE valuation tasks, such as format, presentation and perspective, affect the decision-making process of participants. This paper describes the protocol for a qualitative study that aims to explore the decision-making process of adults and adolescents when completing DCE valuation tasks. The study will also explore the impact of methodological choices in the design of DCE studies (including decisions about format and presentation) on participants' thinking process. METHODS AND ANALYSIS An interview protocol has been developed using DCE valuation tasks. Interviews will be conducted online via Zoom with both an adolescent and adult sample. In the interview, the participant will be asked to go through some DCE valuation tasks while 'thinking aloud'. After completion of the survey, participants will then be asked some predetermined questions in relation to various aspects of the DCE tasks. Interviews will be recorded and transcribed and analysed using a thematic analysis approach. ETHICS AND DISSEMINATION Ethics approval for this study has been received for the adult sample (UTS ETH20-9632) as well as the youth sample (UTS ETH22-6970) from the University of Technology Sydney Human Research Ethics Committee. Results from this study will inform the methods to be used in development of value sets for use in the health technology assessment of paediatric interventions and treatments. Findings from this study will also be disseminated through national/international conferences and peer-reviewed journals.
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Affiliation(s)
- Alice Yu
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Yiting Luo
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Mina Bahrampour
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
| | | | - Deborah Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Nancy Devlin
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brendan James Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
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Choi SH, Templin T, Marrocco A. Development of an online discrete choice experiment to elicit preferences for tobacco treatment among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 37437187 DOI: 10.1080/07448481.2023.2227715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/24/2023] [Accepted: 06/11/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To develop an online discrete choice experiment (DCE) to elicit preferences for the format and content of tobacco treatment and determine the feasibility of the survey in face-to-face online interviews among college students. PARTICIPANTS A convenience sample of 28 college students. METHODS A pilot online DCE survey with sixteen choice sets was developed. The feasibility was assessed by: 1) ease of reading the survey descriptions, 2) ease of completing the DCE survey, and 3) appropriateness of the number of choice sets. Think-aloud data were analyzed to understand decision-making processes. RESULTS All participants completed the DCE survey and reported that it was very easy to read and complete and that the number of sixteen choice sets was appropriate. Such results support the feasibility of our online DCE survey. Five decision-making strategies were identified. CONCLUSIONS An online DCE survey administered during online interviews may replace in-person interviews for college students.
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Affiliation(s)
- Seung Hee Choi
- College of Nursing, Wayne State University, Detroit, Michigan, USA
| | - Thomas Templin
- College of Nursing, Wayne State University, Detroit, Michigan, USA
| | - Anna Marrocco
- College of Nursing, Wayne State University, Detroit, Michigan, USA
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18
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Isa YS, Sicsic J, Njuguna H, Ward J, Chakroun M, El-Kassas M, Ramanampamonjy R, Chalal S, Vincent JP, Andersson M, Desalegn H, Fall F, Johannessen A, Matthews PC, Ndow G, Okeke E, Riches N, Seydi M, Sinkala E, Spearman CW, Stockdale A, Vinikoor MJ, Wandeler G, Sombié R, Lemoine M, Mueller JE, Shimakawa Y. Informing a target product profile for rapid tests to identify HBV-infected pregnant women with high viral loads: a discrete choice experiment with African healthcare workers. BMC Med 2023; 21:243. [PMID: 37403107 DOI: 10.1186/s12916-023-02939-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/13/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Elimination of mother-to-child transmission of hepatitis B virus (HBV) requires infant immunoprophylaxis and antiviral prophylaxis for pregnant women with high viral loads. Since real-time polymerase chain reaction (RT-PCR), a gold standard for assessing antiviral eligibility, is neither accessible nor affordable for women living in low-income and middle-income countries (LMICs), rapid diagnostic tests (RDTs) detecting alternative HBV markers may be needed. To inform future development of the target product profile (TPP) for RDTs to identify highly viremic women, we used a discrete choice experiment (DCE) and elicited preference and trade-off of healthcare workers (HCW) in Africa between the following four attributes of fictional RDTs: price, time-to-result, diagnostic sensitivity, and specificity. METHODS Through an online questionnaire survey, we asked participants to indicate their preferred test from a set of two RDTs in seven choice tasks with varying levels of the four attributes. We used mixed multinomial logit models to quantify the utility gain or loss generated by each attribute. We attempted to define minimal and optimal criteria for test attributes that can satisfy ≥ 70% and ≥ 90% of HCWs, respectively, as an alternative to RT-PCR. RESULTS A total of 555 HCWs from 41 African countries participated. Increases in sensitivity and specificity generated significant utility and increases in cost and time-to-result generated significant disutility. The size of the coefficients for the highest attribute levels relative to the reference levels were in the following order: sensitivity (β = 3.749), cost (β = -2.550), specificity (β = 1.134), and time-to-result (β = -0.284). Doctors cared most about test sensitivity, while public health practitioners cared about cost and midwives about time-to-result. For an RDT with 95% specificity, costing 1 US$, and yielding results in 20 min, the minimally acceptable test sensitivity would be 82.5% and the optimally acceptable sensitivity would be 87.5%. CONCLUSIONS African HCWs would prefer an RDT with the following order of priority: higher sensitivity, lower cost, higher specificity, and shorter time-to-result. The development and optimization of RDTs that can meet the criteria are urgently needed to scale up the prevention of HBV mother-to-child transmission in LMICs.
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Affiliation(s)
- Yasir Shitu Isa
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France
- EHESP French School of Public Health, Rennes, France
| | | | - Henry Njuguna
- Coalition for Global Hepatitis Elimination, Decatur, GA, USA
| | - John Ward
- Coalition for Global Hepatitis Elimination, Decatur, GA, USA
| | - Mohamed Chakroun
- Infectious Disease Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Rado Ramanampamonjy
- Unité de Gastro-Entérologie, Hôpital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Salim Chalal
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France
- Plateforme de Data Management, Institut Pasteur, Paris, France
| | - Jeanne Perpétue Vincent
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France
| | - Monique Andersson
- Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Hailemichael Desalegn
- Medical Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Fatou Fall
- Department of Hepatology and Gastroenterology, Hopital Principal de Dakar, Dakar, Senegal
| | - Asgeir Johannessen
- Department of Infectious Diseases, Vestfold Hospital, Tønsberg, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Philippa C Matthews
- The Francis Crick Institute, London, UK
- Division of Infection and Immunity, University College London, London, UK
- Department of Infectious Diseases, University College London Hospital, London, UK
| | - Gibril Ndow
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
| | - Edith Okeke
- Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Nicholas Riches
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Moussa Seydi
- Service de Maladies Infectieuses Et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Edford Sinkala
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alexander Stockdale
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Michael J Vinikoor
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roger Sombié
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Maud Lemoine
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
| | - Judith E Mueller
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France
- EHESP French School of Public Health, Rennes, France
| | - Yusuke Shimakawa
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France.
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Föhn Z, Nicolet A, Marti J, Kaufmann C, Balthasar A. Stakeholder Engagement in Designing Attributes for a Discrete Choice Experiment With Policy Implications: An Example of 2 Swiss Studies on Healthcare Delivery. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:925-933. [PMID: 36646277 DOI: 10.1016/j.jval.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/13/2022] [Accepted: 01/05/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The use of discrete choice experiments (DCEs) has become increasingly popular in health policy development by involving and analyzing the preferences of target groups for different aspects of the policy intervention. In this article, we aim to contribute to the standardization of the process of attribute and attribute level development for DCEs with policy relevance. To do so, we propose and empirically illustrate a framework tool for the development and reporting of attributes and attribute levels, with the systematic engagement of relevant stakeholders. METHODS The framework tool was kept general to allow its use as a standard reporting approach on the development process of a DCE, involving relevant stakeholders at each stage. The proposed 3-stage process consists of (1) collection, (2) selection, and (3) refinement of the DCE attributes and attribute levels. The application of the framework tool is illustrated by 2 projects, Health2040 and COCONUTS-both concerning the preferences of the Swiss population for the future organization of healthcare. RESULTS By engaging stakeholders, we identified and included attributes and attribute levels that would not have been identified solely through the existing literature. In addition, including multiple stakeholders from different professional backgrounds ensured that the selected attributes and attribute levels were policy relevant, were applicable in practice, and reflected the opinions of multiple actors in healthcare. CONCLUSION The proposed framework helps to strengthen the standardization of the reporting on attribute and attribute level development with stakeholder engagement and to guide future research teams designing a DCE with policy implications.
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Affiliation(s)
- Zora Föhn
- Faculty of Humanities and Social Sciences, University of Lucerne, Lucerne, Switzerland; Interface Politikstudien Forschung Beratung, Lucerne, Switzerland.
| | - Anna Nicolet
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Joachim Marti
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Cornel Kaufmann
- Faculty of Humanities and Social Sciences, University of Lucerne, Lucerne, Switzerland; Interface Politikstudien Forschung Beratung, Lucerne, Switzerland
| | - Andreas Balthasar
- Faculty of Humanities and Social Sciences, University of Lucerne, Lucerne, Switzerland
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Mott DJ, Ternent L, Vale L. Do preferences differ based on respondent experience of a health issue and its treatment? A case study using a public health intervention. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:413-423. [PMID: 35716317 DOI: 10.1007/s10198-022-01482-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Preference information is increasingly being elicited to support decision-making. Although discrete choice experiments (DCEs) are commonly used, little is known about how respondents' relative experience of a health issue, and its treatment, might impact the results of preference studies. The aim of this study was to explore how preferences differ between groups of individuals with varying levels of experience of a health issue and its treatment, using a weight loss maintenance (WLM) programme as a case study. METHODS An online DCE survey was provided to four groups, each differing in their level of experience with weight loss and WLM programmes. One group was recruited from a randomised controlled trial of a WLM programme (ISRCTN14657176) and the other three from an online panel. Choice data were analysed using mixed logit models. Relative attribute importance scores and willingness-to-pay (WTP) estimates were estimated to enable comparisons between groups. RESULTS Preferences differed between the groups across different attributes. The largest differences related to the outcome (weight re-gain) and cost attributes, resulting in WTP estimates that were statistically significantly different. The most experienced group was willing to pay £0.35 (95% CI: £0.28, £0.42) to avoid a percentage point increase in weight re-gain, compared with £0.12 (95% CI: £0.08, £0.16) for the least experienced group. CONCLUSION This study provides evidence in a public health setting to suggest that preferences differ based on respondent experience of the health issue and its treatment. Health preference researchers should therefore carefully consider the appropriate composition of their study samples.
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Affiliation(s)
- David J Mott
- Office of Health Economics, Southside 7th Floor, 105 Victoria Street, London, UK.
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Laura Ternent
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Nicolet A, Perraudin C, Krucien N, Wagner J, Peytremann-Bridevaux I, Marti J. Preferences of older adults for healthcare models designed to improve care coordination: evidence from Western Switzerland. Health Policy 2023; 132:104819. [PMID: 37060718 DOI: 10.1016/j.healthpol.2023.104819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/02/2022] [Accepted: 04/04/2023] [Indexed: 04/08/2023]
Abstract
Implementing innovations in care delivery in Switzerland is challenging due to the fragmented nature of the system and the specificities of the political process (i.e., direct democracy, decentralized decision-making). In this context, it is particularly important to account for population preferences when designing policies. We designed a discrete choice experiment to study population preferences for coordination-improving care models. Specifically, we assessed the relative importance of model characteristics (i.e., insurance premium, presence of care coordinator, access to specialists, use of EMR, cost-sharing for chronic patients, incentives for informal care), and predicted uptake under different policy scenarios. We accounted for heterogeneity in preferences for the status quo option using an error component logit model. Respondents attached the highest importance to the price attribute (i.e. insurance premium) (0.31, CI: 0.27- 0.36) and to the presence of a care coordinator (0.27, CI: 0.23 - 0.31). Policy scenarios showed for instance that gatekeeping would be preferred to free access to specialists if the model includes a GP or an interprofessional team as a care coordinator. Although attachment to the status quo is high in the studied population, there are potential ways to improve acceptance of alternative care models by implementation of positively valued innovations.
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Louis E, Siegel CA, James B, Heidenreich S, Krucien N, Ghosh S. Patients with Inflammatory Bowel Disease Have Heterogeneous Treatment Preferences That Are Largely Determined by the Avoidance of Abdominal Pain and Side Effects [P-POWER IBD Study]. J Crohns Colitis 2023; 17:231-239. [PMID: 36130188 PMCID: PMC10024545 DOI: 10.1093/ecco-jcc/jjac130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Patient-centric management of inflammatory bowel disease [IBD] is important, with consensus considering patient-reported outcomes alongside clinical and endoscopic assessment by healthcare providers. However, evidence regarding patients' treatment priorities is still limited. This study aimed to elicit benefit-risk trade-offs that patients with IBD are willing to make, to help inform discussions about patient-centric treatment targets. METHODS This was a cross-sectional online survey of adults with self-confirmed Crohn's disease [CD] or ulcerative colitis [UC] receiving IBD treatment. The impact of efficacy, administration and safety on treatment preferences was elicited using a discrete choice experiment. Relative attribute importance [RAI] and maximum acceptable risk of mild-to-moderate side effects [SEs] were estimated from a mixed logit model. RESULTS In total, 400 patients [CD: 54%; UC: 46%; female: 38.0%; age range: 18-78 years] were recruited. Efficacy, administration and safety affected treatment preferences to varying degrees, with abdominal pain being most important [RAI 33%] followed by risks of mild-to-moderate SEs [RAI 27%] and serious infections [RAI 16%]. To reduce abdominal pain from severe to moderate/mild, patients accepted an additional 18.8% or 30.6% risk of mild-to-moderate SEs, respectively. While average preferences between patients with CD and UC were similar, patients with CD placed greater importance on abdominal pain [p < 0.05], and patients with UC on bowel urgency [p < 0.05]. However, preferences varied notably. CONCLUSIONS While avoiding abdominal pain, SEs and serious infections had on average the highest treatment priority, preferences varied between patients. Treatment strategies should consider the trade-offs individuals are willing to make.
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Affiliation(s)
| | | | | | - Sebastian Heidenreich
- Corresponding author: Sebastian Heidenreich, Evidera Ltd, London, UK. Tel: +44 20 8576 5000;
| | | | - Subrata Ghosh
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland
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Seo J, Heidenreich S, Aldalooj E, Poon JL, Spaepen E, Eby EL, Newson RS. Patients' Preferences for Connected Insulin Pens: A Discrete Choice Experiment Among Patients with Type 1 and Type 2 Diabetes. THE PATIENT 2023; 16:127-138. [PMID: 36437389 PMCID: PMC9911509 DOI: 10.1007/s40271-022-00610-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study quantified how people with diabetes value the unique features of connected insulin pens and related mobile apps, and the underlying reasons for preferring connected versus non-connected insulin pens. METHODS A discrete choice experiment (DCE) was conducted in the USA and UK to elicit preferences of adults (≥ 18 years) with type 1 or 2 diabetes for attributes of insulin pens. Attributes included device type, dosing support, glucose monitoring, additional app features, and data sharing. Relative attribute importance (RAI) scores were calculated to capture the relative importance of an attribute. Predicted choice probabilities were obtained to compare different profiles for connected and non-connected insulin pens. RESULTS The DCE was completed by 540 participants (58.9% male; 90.7% Caucasian; mean age, 58.3 years; 69.4% type 2 diabetes). Participants most valued the possibility of using a connected insulin pen with dosing support and automated dose logging (RAI = 39.9%), followed by automatic transfer of glucose levels (RAI = 29.0%), additional features of tracking diet and physical activity (RAI = 14.6%), data sharing (RAI = 13.6%), and device type (RAI = 2.9%). All profiles of connected insulin pens were preferred over a non-connected pen (p < 0.001), and pen profiles with advanced features were preferred over those without (p < 0.001). Preferences differed by age but not diabetes type, country of residence, or insulin regimen. CONCLUSION People with diabetes in the USA and UK prefer connected over non-connected insulin pens due largely to the availability of automated logging of dose and glucose levels.
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Affiliation(s)
- Jaein Seo
- Patient-Centered Research, Evidera, Bethesda, MD, USA
| | | | | | - Jiat Ling Poon
- Value, Evidence, and Outcomes, Eli Lilly and Co, Indianapolis, IN, USA
| | | | - Elizabeth L Eby
- Value, Evidence, and Outcomes, Eli Lilly and Co, Indianapolis, IN, USA
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Discrete Choice Experiment to Understand Japanese Patients' and Physicians' Preferences for Preventive Treatments for Migraine. Neurol Ther 2023; 12:651-668. [PMID: 36848008 PMCID: PMC10043145 DOI: 10.1007/s40120-023-00453-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION Self-injectable calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) auto-injectors and non-CGRP oral medications are currently available for migraine prevention in Japan. This study elicited the preferences for self-injectable CGRP mAbs and non-CGRP oral medications and determined differences in the relative importance of auto-injector attributes for patients and physicians in Japan. METHODS Japanese adults with episodic (EM) or chronic (CM) migraine and physicians who treat migraine completed an online discrete choice experiment (DCE), asking participants to choose a hypothetical treatment they preferred between two self-injectable CGRP mAb auto-injectors and a non-CGRP oral medication. The treatments were described by seven treatment attributes, with attribute levels varying between questions. DCE data were analyzed using a random-constant logit model to estimate relative attribution importance (RAI) scores and predicted choice probabilities (PCP) of CGRP mAb profiles. RESULTS A total of 601 patients (79.2% with EM, 60.1% female, mean age: 40.3 years) and 219 physicians (mean length of practice: 18.3 years) completed the DCE. About half (50.5%) of patients favored CGRP mAb auto-injectors, while others were skeptical of (20.2%) or averse (29.3%) to them. Patients most valued needle removal (RAI = 33.8%), shorter injection duration (RAI = 32.1%), and auto-injector base shape and need for skin pinching (RAI = 23.2%). Most physicians (87.8%) favored auto-injectors over non-CGRP oral medications. Physicians most valued less-frequent dosing RAI = 32.7%), shorter injection duration (30.4%), and longer storage outside the fridge (RAI = 20.3%). A profile comparable to galcanezumab showed a higher likelihood of being chosen by patients (PCP = 42.8%) than profiles comparable to erenumab (PCP = 28.4%) and fremanezumab (PCP = 28.8%). The PCPs of the three profiles were similar among physicians. CONCLUSION Many patients and physicians preferred CGRP mAb auto-injectors over non-CGRP oral medications and preferred a treatment profile similar to galcanezumab. Our results may encourage physicians in Japan to consider patient preferences when recommending migraine preventive treatments.
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Sicsic J, Blondel S, Chyderiotis S, Langot F, Mueller JE. Preferences for COVID-19 epidemic control measures among French adults: a discrete choice experiment. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:81-98. [PMID: 35305178 PMCID: PMC8934018 DOI: 10.1007/s10198-022-01454-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/21/2022] [Indexed: 06/04/2023]
Abstract
In this stated preferences study, we describe for the first time French citizens' preferences for various epidemic control measures, to inform longer-term strategies and future epidemics. We used a discrete choice experiment in a representative sample of 908 adults in November 2020 (before vaccination was available) to quantify the trade-off they were willing to make between restrictions on the social, cultural, and economic life, school closing, targeted lockdown of high-incidence areas, constraints to directly protect vulnerable persons (e.g., self-isolation), and measures to overcome the risk of hospital overload. The estimation of mixed logit models with correlated random effects shows that some trade-offs exist to avoid overload of hospitals and intensive care units, at the expense of stricter control measures with the potential to reduce individuals' welfare. The willingness to accept restrictions was shared to a large extent across subgroups according to age, gender, education, vulnerability to the COVID-19 epidemic, and other socio-demographic or economic variables. However, individuals who felt at greater risk from COVID-19, and individuals expressing high confidence in the governmental management of the health and economic crisis, more easily accepted all these restrictions. Finally, we compared the welfare impact of alternative strategies combining different epidemic control measures. Our results suggest that policies close to a targeted lockdown or with medically prescribed self-isolation were those satisfying the largest share of the population and achieving high gain in average welfare, while average welfare was maximized by the combination of all highly restrictive measures. This illustrates the difficulty in making preference-based decisions on restrictions.
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Affiliation(s)
- Jonathan Sicsic
- Université Paris Cité, LIRAES F-75006, 45 rue des Saints-Pères, 75006 Paris, France
| | - Serge Blondel
- Université Paris Cité, LIRAES F-75006, 45 rue des Saints-Pères, 75006 Paris, France
- Université d’Angers, GRANEM, SFR Confluences, F-49000 Angers, France
| | | | - François Langot
- Le Mans Université (GAINS-TEPP and IRA), IUF, PSE, Cepremap, Le Mans, France
- IZA, Bonn, Germany
| | - Judith E. Mueller
- EHESP French School of Public Health, Rennes and Institut Pasteur, Paris, France
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Brinkmann M, Diedrich L, Hemmerling M, Krauth C, Robra BP, Stahmeyer JT, Dreier M. Heterogeneous Preferences for Colorectal Cancer Screening in Germany: Results of a Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:104-114. [PMID: 36031478 DOI: 10.1016/j.jval.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Colorectal cancer (CRC) screening tests differ in benefits, harms, and processes, making individual informed decisions preference based. The objective was to analyze the preferences of insurees in Germany for characteristics of CRC screening modalities. METHODS A generic discrete choice experiment with 2-alternative choice sets and 6 attributes (CRC mortality, CRC incidence, complications, preparation, need for transportation, and follow-up; 3 levels each) depicting characteristics of fecal testing, sigmoidoscopy, and colonoscopy was generated. Participants completed 8 choice tasks. Internal validity was tested using a within-set dominated pair. Between June and October 2020, written questionnaires were sent to a stratified random sample (n = 5000) of 50-, 55-, and 60-year-old insurees of the AOK (Allgemeine Ortskrankenkasse) Lower Saxony, who had previously received an invitation to participate in the organized screening program including evidence-based information. Preferences were analyzed using conditional logit, mixed logit, and latent-class model. RESULTS From 1282 questionnaires received (26% [1282 of 4945]), 1142 were included in the analysis. Approximately 42% of the respondents chose the dominated alternative in the internal validity test. Three heterogeneous preference classes were identified. Most important attributes were preparation (class 1; n = 505, 44%), CRC mortality (class 2; n = 347, 30%), and CRC incidence (class 3; n = 290, 25%). Contrary to a priori expectations, a higher effort was preferred for bowel cleansing (class 1) and accompaniment home (classes 1 and 2). CONCLUSION Internal validity issues of choice data need further research and warrant attention in future discrete choice experiment surveys. The observed preference heterogeneity suggests different informational needs, although the underlying reasons remained unclear.
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Affiliation(s)
- Melanie Brinkmann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
| | - Leonie Diedrich
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | | | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Bernt-Peter Robra
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jona T Stahmeyer
- Health Services Research Unit, AOK Niedersachsen, Hannover, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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Broderick L, Bjorner JB, Lauher-Charest M, White MK, Kosinski M, Mulhern B, Brazier J. Deciding Between SF-6Dv2 Health States: A Think-Aloud Study of Decision-Making Strategies Used in Discrete Choice Experiments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:2034-2043. [PMID: 36064513 DOI: 10.1016/j.jval.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/11/2022] [Accepted: 07/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aimed to gain insight into decision-making strategies individuals used when evaluating pairs of SF-6Dv2 health states in discrete choice experiments (DCEs). METHODS This qualitative, cross-sectional, noninterventional study asked participants to use a think-aloud approach to compare SF-6Dv2 health states in DCEs. Thematic analysis focused on comprehension and cognitive strategies used to compare health states and make decisions. RESULTS Participants (N = 40) used 3 main strategies when completing DCEs: (1) trading, (2) reinterpretation, and (3) relying on previous experience. Trading was the most common strategy, used by everyone at least once, and involved prioritizing key attributes, such as preferring a health state with significant depression but no bodily pain. Reinterpretation was used by 17 participants and involved reconstructing health states by changing underlying assumptions (eg, rationalizing selecting a health state with significant pain because they could take pain medications). Finally, some (n = 13) relied on previous experience when making decisions on some choice tasks. Participants with experience dealing with pain, for instance, prioritized health states with the least impact in this dimension. CONCLUSIONS Qualitatively evaluating the decision-making strategies used in DCEs allows researchers to evaluate whether the tasks and attributes are interpreted accurately. The findings from this study add to the understanding of the generation of SF-6Dv2 health utility weights and the validity of these weights (e.g., reinterpreting health states could undermine the validity of DCEs and utility weights), and the overall usefulness of the SF-6Dv2. The methodology described in this study can and should be carried forth in valuing other health utility measures, not just the SF-6Dv2.
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Affiliation(s)
| | - Jakob B Bjorner
- QualityMetric, Johnston, RI, USA; University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - John Brazier
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
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Bruni C, Heidenreich S, Duenas A, Hoffmann-Vold AM, Gabrielli A, Allanore Y, Chatelus E, Distler JHW, Hachulla E, Hsu VM, Hunzelmann N, Khanna D, Truchetet ME, Walker UA, Alves M, Schoof N, Saketkoo LA, Distler O. Patient preferences for the treatment of systemic sclerosis-associated interstitial lung disease: a discrete choice experiment. Rheumatology (Oxford) 2022; 61:4035-4046. [PMID: 35238334 PMCID: PMC9536797 DOI: 10.1093/rheumatology/keac126] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/17/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Treatments for SSc-associated interstitial lung disease (SSc-ILD) differ in attributes, i.e. mode of administration, adverse events (AEs) and efficacy. As physicians and patients may perceive treatments differently, shared decision-making can be essential for optimal treatment provision. We therefore aimed to quantify patient preferences for different treatment attributes. METHODS Seven SSc-ILD attributes were identified from mixed-methods research and clinician input: mode of administration, shortness of breath, skin tightness, cough, tiredness, risk of gastrointestinal AEs (GI-AEs) and risk of serious and non-serious infections. Patients with SSc-ILD completed an online discrete choice experiment (DCE) in which they were asked to repeatedly choose between two alternatives characterized by varying severity levels of the included attributes. The data were analysed using a multinomial logit model; relative attribute importance and maximum acceptable risk measures were calculated. RESULTS Overall, 231 patients with SSc-ILD completed the DCE. Patients preferred twice-daily oral treatments and 6-12 monthly infusions. Patients' choices were mostly influenced by the risk of GI-AEs or infections. Improvement was more important in respiratory symptoms than in skin tightness. Concerning trade-offs, patients accepted different levels of increase in GI-AE risk: +21% if it reduced the infusions' frequency; +15% if changing to an oral treatment; up to +37% if it improved breathlessness; and up to +36% if it reduced the risk of infections. CONCLUSIONS This is the first study to quantitatively elicit patients' preferences for treatment attributes in SSc-ILD. Patients showed willingness to make trade-offs, providing a firm basis for shared decision-making in clinical practice.
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Affiliation(s)
- Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | | | | | | | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Yannick Allanore
- Department of Rheumatology A, Cochin Hospital, Paris Descartes University, Paris
| | - Emmanuel Chatelus
- Department of Rheumatology, University Hospital of Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Jörg H W Distler
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO), CHU Lille, University of Lille, Inserm, U1286 - INFINITE—Institute for Translational Research in Inflammation, Lille, France
| | - Vivien M Hsu
- Department of Medicine, Division of Rheumatology, Rutgers–Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Dinesh Khanna
- Scleroderma Program
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Margarida Alves
- TA Inflammation, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Nils Schoof
- TA Inflammation, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center
- Departments of Internal Medicine, Louisiana State University, and Tulane University Schools of Medicine, New Orleans, LA, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Abbott M, McKenzie L, Moran BVG, Heidenreich S, Hernández R, Hocking-Mennie L, Clark C, Gomes J, Lampe A, Baty D, McGowan R, Miedzybrodzka Z, Ryan M. Continuing the sequence? Towards an economic evaluation of whole genome sequencing for the diagnosis of rare diseases in Scotland. J Community Genet 2022; 13:487-501. [PMID: 34415556 PMCID: PMC9530076 DOI: 10.1007/s12687-021-00541-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/15/2021] [Indexed: 11/21/2022] Open
Abstract
Novel developments in genomic medicine may reduce the length of the diagnostic odyssey for patients with rare diseases. Health providers must thus decide whether to offer genome sequencing for the diagnosis of rare conditions in a routine clinical setting. We estimated the costs of singleton standard genetic testing and trio-based whole genome sequencing (WGS), in the context of the Scottish Genomes Partnership (SGP) study. We also explored what users value about genomic sequencing. Insights from the costing and value assessments will inform a subsequent economic evaluation of genomic medicine in Scotland. An average cost of £1,841 per singleton was estimated for the standard genetic testing pathway, with significant variability between phenotypes. WGS cost £6625 per family trio, but this estimate reflects the use of WGS during the SGP project and large cost savings may be realised if sequencing was scaled up. Patients and families valued (i) the chance of receiving a diagnosis (and the peace of mind and closure that brings); (ii) the information provided by WGS (including implications for family planning and secondary findings); and (iii) contributions to future research. Our costings will be updated to address limitations of the current study for incorporation in budget impact modelling and cost-effectiveness analysis (cost per diagnostic yield). Our insights into the benefits of WGS will guide the development of a discrete choice experiment valuation study. This will inform a user-perspective cost-benefit analysis of genome-wide sequencing, accounting for the broader non-health outcomes. Taken together, our research will inform the long-term strategic development of NHS Scotland clinical genetics testing services, and will be of benefit to others seeking to undertake similar evaluations in different contexts.
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Affiliation(s)
- Michael Abbott
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
| | - Lynda McKenzie
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Sebastian Heidenreich
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
- Evidera Inc., London, UK
| | - Rodolfo Hernández
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Caroline Clark
- Department of Medical Genetics, University of Aberdeen, Aberdeen, UK
- NHS Grampian Regional Genetics Service, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Joana Gomes
- NHS Grampian Regional Genetics Service, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Anne Lampe
- South East Scotland Clinical Genetics Service, Western General Hospital, Edinburgh, UK
| | - David Baty
- NHS Tayside Regional Genetics Service, Ninewells Hospital, Dundee, UK
| | - Ruth McGowan
- South East Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Thomas C, Raibouaa A, Wollenberg A, Capron JP, Krucien N, Karn H, Tervonen T. Patient preferences for atopic dermatitis medications in the UK, France and Spain: a discrete choice experiment. BMJ Open 2022; 12:e058799. [PMID: 35918108 PMCID: PMC9351316 DOI: 10.1136/bmjopen-2021-058799] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES We aimed to quantify patient preferences for efficacy, safety and convenience features of atopic dermatitis (AD) treatments. DESIGN AND SETTING Online discrete choice experiment survey. PARTICIPANTS Adults in the UK, France and Spain who had used AD treatments during the past 2 years. PRIMARY AND SECONDARY OUTCOME MEASURES Preferences for attributes were analysed using a multinomial logit model. Willingness to make trade-offs was expressed as the maximum acceptable decrease (MAD) in the probability of achieving clear/almost clear skin at week 16. RESULTS The survey was completed by 404 patients (44.1±12.0 years; 65% women; 64% moderate/severe eczema). Most patients (68%) had no prior experience of using self-injectable treatments for AD or any other illness. Participants most valued increasing the chance of achieving a meaningful reduction in itch at week 16 from 20% to 50%, followed by reducing the risks of serious infections from 6% to 0% and of eye inflammation from 20% to 0%. Participants were willing to accept a decrease in the possibility of achieving clear/almost clear skin to obtain a treatment that can be paused (MAD=24.1%), requires occasional check-ups (MAD=16.1%) or no check-ups (MAD=20.9%) over frequent check-ups, is administered as a one time per day or two times per day oral pill versus a subcutaneous injection every 2 weeks (MAD=16.6%), has a 2-day over 2-week onset of action (MAD=11.3%), and can be used for flare management (MAD=5.8%). CONCLUSIONS Although patients with AD most valued treatment benefits and risks, they were willing to tolerate reduced efficacy to obtain a rapid onset, oral administration, less frequent monitoring and a treatment that can be paused. Understanding patients' preferences for AD therapies, including new targeted therapies, can aid shared decision-making between clinicians and patients and support health technology assessments.
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Affiliation(s)
| | | | - Andreas Wollenberg
- Department of Dermatology and Allergy, University Hospital of Ludwig-Maximilian University of Munich, Munich, Germany
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Yong ASJ, Lim YH, Cheong MWL, Hamzah E, Teoh SL. Willingness-to-pay for cancer treatment and outcome: a systematic review. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1037-1057. [PMID: 34853930 DOI: 10.1007/s10198-021-01407-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Understanding patient preferences in cancer management is essential for shared decision-making. Patient or societal willingness-to-pay (WTP) for desired outcomes in cancer management represents their preferences and values of these outcomes. OBJECTIVE The aim of this systematic review is to critically evaluate how current literature has addressed WTP in relation to cancer treatment and achievement of outcomes. METHODS Seven databases were searched from inception until 2 March 2021 to include studies with primary data of WTP values for cancer treatments or achievement of outcomes that were elicited using stated preference methods. RESULTS Fifty-four studies were included in this review. All studies were published after year 2000 and more than 90% of the studies were conducted in high-income countries. Sample size of the studies ranged from 35 to 2040, with patient being the most studied population. There was a near even distribution between studies using contingent valuation and discrete choice experiment. Based on the included studies, the highest WTP values were for a quality-adjusted life year (QALY) ($11,498-$589,822), followed by 1-year survival ($3-$198,576), quality of life (QoL) improvement ($5531-$139,499), and pain reduction ($79-$94,662). Current empirical evidence suggested that improvement in QoL and pain reduction had comparable weights to survival in cancer management. CONCLUSION This systematic review provides a summary on stated preference studies that elicited patient preferences via WTP and summarised their respective values. Respondents in this review had comparable WTP for 1-year survival and QoL, suggesting that improvement in QoL should be emphasised together with survival in cancer management.
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Affiliation(s)
- Alene Sze Jing Yong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Yi Heng Lim
- School of Biosciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Mark Wing Loong Cheong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
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Hutchinson C, Milte R, Stanley M, Duff G, Ratcliffe J. Using discrete choice experiments to elicit the service preferences of people with mild intellectual disability: An exploratory study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1396-e1405. [PMID: 34418195 DOI: 10.1111/hsc.13547] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/14/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
The National Disability Insurance Scheme (NDIS) in Australia and other similar international movements towards consumer direction have highlighted the importance of including consumers to ensure their service preferences are operationalised. Discrete Choice Experiments (DCEs) are an established method to quantify consumer preferences. The feasibility of using DCEs with people with intellectual disability is largely untested. Consenting participants eligible for disability support services (n = 18) participated in the mixed methods exploratory study. The DCE comprised a series of choices between two hypothetical service providers offering a combination of services relating to social and economic participation (e.g. support with finding and keeping a job), with four levels of service (no service, online support, group support, one to one support). Pictographs and simplified English were used to represent the hypothetical services and levels and a 'think aloud' protocol adopted. Most participants (N = 16, 89%) completed the DCE task. The findings from the think aloud task indicated that some participants were weighing up the options and making decisions based on their goals and personal preferences. However, other participants did not focus on all presented attributes and levels when making a decision; a common 'short-cut' heuristic also observed in DCE tasks with general population participants. Further research including investigating other DCE techniques, such as best-worst scaling, would be beneficial to identify how preference-elicitation tasks can be developed and applied with people with intellectual disabilities to ensure that future service innovations are designed and administered in ways which best meet their needs and preferences.
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Affiliation(s)
- Claire Hutchinson
- School of Commerce, University of South Australia, Adelaide, South Australia, Australia
| | - Rachel Milte
- School of Commerce, University of South Australia, Adelaide, South Australia, Australia
| | - Mandy Stanley
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Gordon Duff
- National Disability Services, Sydney, New South Wales, Australia
| | - Julie Ratcliffe
- School of Commerce, University of South Australia, Adelaide, South Australia, Australia
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Ge G, Godager G, Wang J. Exploring physician agency under demand-side cost sharing-An experimental approach. HEALTH ECONOMICS 2022; 31:1202-1227. [PMID: 35373436 PMCID: PMC9325440 DOI: 10.1002/hec.4489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 11/29/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
The assumption of patient-regarding physicians has been widely adopted in the health economics literature. Physicians' patient-regarding preferences are often described as the concern for the health benefits of medical treatments, and thus closely related to the norms and ethics of the medical profession. In this paper, we ask whether physicians' patient-regarding preferences include a concern for their patient's consumption opportunities alongside patient's health benefits. To identify and quantify physicians' preferences, we design and conduct an incentivized laboratory experiment where choices determine separately the health benefits and the consumption opportunities of a real patient admitted to the nearest hospital. We find strong evidence that future physicians care about their patients' consumption opportunities.
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Affiliation(s)
- Ge Ge
- Department of Health Management and Health EconomicsUniversity of OsloOsloNorway
| | - Geir Godager
- Department of Health Management and Health EconomicsUniversity of OsloOsloNorway
- Health Services Research UnitAkershus University HospitalOsloNorway
| | - Jian Wang
- Department of Health Management and Health EconomicsUniversity of OsloOsloNorway
- Dong Fureng Institute of Economic and Social Development, Wuhan UniversityWuhanChina
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Bonner KE, Ssekyanzi H, Sicsic J, Mueller JE, Toomey T, Ulrich AK, Horvath KJ, Neaton JD, Banura C, Basta NE. What drives willingness to receive a new vaccine that prevents an emerging infectious disease? A discrete choice experiment among university students in Uganda. PLoS One 2022; 17:e0268063. [PMID: 35587501 PMCID: PMC9119467 DOI: 10.1371/journal.pone.0268063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background There is a critical need to identify the drivers of willingness to receive new vaccines against emerging and epidemic diseases. A discrete choice experiment is the ideal approach to evaluating how individuals weigh multiple attributes simultaneously. We assessed the degree to which six attributes were associated with willingness to be vaccinated among university students in Uganda. Methods We conducted a single-profile discrete choice experiment at Makerere University in 2019. Participants were asked whether or not they would be vaccinated in 8 unique scenarios where attributes varied by disease risk, disease severity, advice for or against vaccination from trusted individuals, recommendations from influential figures, whether the vaccine induced indirect protection, and side effects. We calculated predicted probabilities of vaccination willingness using mixed logistic regression models, comparing health professional students with all other disciplines. Findings Of the 1576 participants, 783 (49.8%) were health professional students and 685 (43.5%) were female. Vaccination willingness was high (78%), and higher among health students than other students. We observed the highest vaccination willingness for the most severe disease outcomes and the greatest exposure risks, along with the Minister of Health’s recommendation or a vaccine that extended secondary protection to others. Mild side effects and recommendations against vaccination diminished vaccination willingness. Interpretation Our results can be used to develop evidence-based messaging to encourage uptake for new vaccines. Future vaccination campaigns, such as for COVID-19 vaccines in development, should consider acknowledging individual risk of exposure and disease severity and incorporate recommendations from key health leaders.
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Affiliation(s)
- Kimberly E. Bonner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Henry Ssekyanzi
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Judith E. Mueller
- EHESP French School of Public Health, La Plaine St Denis, France
- Institute Pasteur, Paris, France
| | - Traci Toomey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Angela K. Ulrich
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, United States of America
| | - James D. Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Cecily Banura
- Child Health and Development Centre, College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
| | - Nicole E. Basta
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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The Importance of Sustainability Aspects When Purchasing Online: Comparing Generation X and Generation Z. SUSTAINABILITY 2022. [DOI: 10.3390/su14095689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
As research on sustainability orientation across generations is still sparse, we contribute to literature by enriching this research field, focusing on Generation Z (‘Zers’) and X (‘Xers’). Moreover, no other study has analyzed cross-generational differences in the sustainability context by making use of choice experiments, which overcome issues related to (Likert) scale item investigations, and allow respondents to evaluate the trade-off between different purchase factors simultaneously. We thus applied one of the most recent advancements in choice experiments, named Adaptive Choice-Based Conjoint analysis, which appears to be more realistic than previous alternatives. The results indicate Zers consume more sustainably (inter alia higher importance of social labels; higher purchase likelihood) when shopping online; however, differences within each generation were uncovered, especially among Xers (e.g., gender differences regarding importance of price).
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Arora N, Quaife M, Hanson K, Lagarde M, Woldesenbet D, Seifu A, Crastes dit Sourd R. Discrete choice analysis of health worker job preferences in Ethiopia: Separating attribute non-attendance from taste heterogeneity. HEALTH ECONOMICS 2022; 31:806-819. [PMID: 35178825 PMCID: PMC9305885 DOI: 10.1002/hec.4475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
When measuring preferences, discrete choice experiments (DCEs) typically assume that respondents consider all available information before making decisions. However, many respondents often only consider a subset of the choice characteristics, a heuristic called attribute non-attendance (ANA). Failure to account for ANA can bias DCE results, potentially leading to flawed policy recommendations. While conventional latent class logit models have most commonly been used to assess ANA in choices, these models are often not flexible enough to separate non-attendance from respondents' low valuation of certain attributes, resulting in inflated rates of ANA. In this paper, we show that semi-parametric mixtures of latent class models can be used to disentangle successfully inferred non-attendance from respondent's "weaker" taste sensitivities for certain attributes. In a DCE on the job preferences of health workers in Ethiopia, we demonstrate that such models provide more reliable estimates of inferred non-attendance than the alternative methods currently used. Moreover, since we find statistically significant variation in the rates of ANA exhibited by different health worker cadres, we highlight the need for well-defined attributes in a DCE, to ensure that ANA does not result from a weak experimental design.
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Affiliation(s)
- Nikita Arora
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Matthew Quaife
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Kara Hanson
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Mylene Lagarde
- Department of Health PolicyLondon School of Economics and Political ScienceLondonUK
| | | | - Abiy Seifu
- School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
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Camacho EM, Smyth R, Danna VA, Kimaro D, Kuzenza F, Laisser R, Mdoe P, Nsemwa L, Shayo H, Lavender T. Women's preferences for antenatal care in Tanzania: a discrete choice experiment. BMC Pregnancy Childbirth 2022; 22:296. [PMID: 35392853 PMCID: PMC8991681 DOI: 10.1186/s12884-022-04634-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background The stillbirth rate in Tanzania remains high. Greater engagement with antenatal care may help to reduce stillbirths. We investigated which characteristics of antenatal care clinics are preferred by pregnant women in Tanzania. Methods We conducted an unlabelled discrete choice experiment (DCE) with think-aloud interviews. Participants were pregnant women, regardless of parity/gestation, from the Mwanza and Manyara regions of Tanzania. We asked participants to choose which of two hypothetical antenatal clinics they would rather attend. Clinics were described in terms of transport mode, cleanliness, comfort, visit content, and staff attitude. Each participant made 12 choices during the experiment, and a purposively selected sub-set simultaneously verbalised the rationale for their choices. We analysed DCE responses using a multinomial logit model adjusted for study region, and think-aloud data using the Framework approach. Results We recruited 251 participants split evenly between the 2 geographical regions. Staff attitude was the most important attribute in clinic choice and dominated the think-aloud narratives. Other significant attributes were mode of transport (walking was preferred) and content of clinic visit (preference was stronger with each additional element of care provided). Cleanliness of the clinic was not a significant attribute overall and the think-aloud exercise identified a willingness to trade-off cleanliness and comfort for respectful care. Conclusion Women would prefer to attend a clinic with kind staff which they can access easily. This study suggests that exploration of barriers to providing respectful care, and enabling staff to deliver it, are important areas for future investment. The DCE shows us what average preferences are; antenatal care that is aligned with identified preferences should increase uptake and engagement versus care which does not acknowledge them. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04634-x.
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Affiliation(s)
| | - Rebecca Smyth
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Valentina Actis Danna
- Centre for Childbirth, Women's and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Deborah Kimaro
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Flora Kuzenza
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Rose Laisser
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Paschal Mdoe
- Department of Research, Haydom Lutheran Hospital, Mbulu, Tanzania
| | - Livuka Nsemwa
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Happiness Shayo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Tina Lavender
- Centre for Childbirth, Women's and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Yiu HHE, Al-Janabi H, Stewart-Brown S, Petrou S, Madan J. The use of composite time trade-off and discrete choice experiment methods for the valuation of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS): a think-aloud study. Qual Life Res 2022; 31:2739-2751. [PMID: 35322304 PMCID: PMC8942805 DOI: 10.1007/s11136-022-03123-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/25/2022]
Abstract
Purpose To identify patterns and problems in completing composite time trade-off (C-TTO) and discrete choice experiment (DCE) exercises for the valuation of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) to inform the optimisation of a valuation protocol. Methods Fourteen cognitive interviews were conducted in the UK using concurrent and retrospective think-aloud and probing techniques. Each participant completed 8 C-TTO tasks and 8 DCE tasks within a computer-assisted personal interview setting. Verbal information was transcribed verbatim. Axial coding and thematic analysis were used to organise the qualitative data and identify patterns and problems with the completion of tasks. Results While participants found the tasks generally manageable, five broad themes emerged to explain and optimise the response to the tasks. (1) Format and structure: attention to the design of practice examples, instructions, and layout were needed. (2) Items and levels: underlying relationships were discovered across different combinations of levels of SWEMWBS items. (3) Decision heuristics: participants engaged in diverse strategies to assist trade-off decisions. (4) Valuation feasibility: certain states were difficult to imagine, compare and quantify. (5) Valuation outcome: the data quality was affected by participants’ discriminatory ability across states and their time trade-off decisions. Conclusion The interviews contributed insights regarding the robustness of the proposed methods. The application of C-TTO and DCE valuation techniques was practical and suitable for capturing individual attitudes towards different mental well-being scenarios. A modified protocol informed by the results is being tested in a larger sample across the UK. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03123-0.
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Affiliation(s)
- Hei Hang Edmund Yiu
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Hareth Al-Janabi
- College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, UK
| | - Jason Madan
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Collacott H, Soekhai V, Thomas C, Brooks A, Brookes E, Lo R, Mulnick S, Heidenreich S. A Systematic Review of Discrete Choice Experiments in Oncology Treatments. THE PATIENT 2021; 14:775-790. [PMID: 33950476 DOI: 10.1007/s40271-021-00520-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND As the number and type of cancer treatments available rises and patients live with the consequences of their disease and treatments for longer, understanding preferences for cancer care can help inform decisions about optimal treatment development, access, and care provision. Discrete choice experiments (DCEs) are commonly used as a tool to elicit stakeholder preferences; however, their implementation in oncology may be challenging if burdensome trade-offs (e.g. length of life versus quality of life) are involved and/or target populations are small. OBJECTIVES The aim of this review was to characterise DCEs relating to cancer treatments that were conducted between 1990 and March 2020. DATA SOURCES EMBASE, MEDLINE, and the Cochrane Database of Systematic Reviews were searched for relevant studies. STUDY ELIGIBILITY CRITERIA Studies were included if they implemented a DCE and reported outcomes of interest (i.e. quantitative outputs on participants' preferences for cancer treatments), but were excluded if they were not focused on pharmacological, radiological or surgical treatments (e.g. cancer screening or counselling services), were non-English, or were a secondary analysis of an included study. ANALYSIS METHODS Analysis followed a narrative synthesis, and quantitative data were summarised using descriptive statistics, including rankings of attribute importance. RESULT Seventy-nine studies were included in the review. The number of published DCEs relating to oncology grew over the review period. Studies were conducted in a range of indications (n = 19), most commonly breast (n =10, 13%) and prostate (n = 9, 11%) cancer, and most studies elicited preferences of patients (n = 59, 75%). Across reviewed studies, survival attributes were commonly ranked as most important, with overall survival (OS) and progression-free survival (PFS) ranked most important in 58% and 28% of models, respectively. Preferences varied between stakeholder groups, with patients and clinicians placing greater importance on survival outcomes, and general population samples valuing health-related quality of life (HRQoL). Despite the emphasis of guidelines on the importance of using qualitative research to inform attribute selection and DCE designs, reporting on instrument development was mixed. LIMITATIONS No formal assessment of bias was conducted, with the scope of the paper instead providing a descriptive characterisation. The review only included DCEs relating to cancer treatments, and no insight is provided into other health technologies such as cancer screening. Only DCEs were included. CONCLUSIONS AND IMPLICATIONS Although there was variation in attribute importance between responder types, survival attributes were consistently ranked as important by both patients and clinicians. Observed challenges included the risk of attribute dominance for survival outcomes, limited sample sizes in some indications, and a lack of reporting about instrument development processes. PROTOCOL REGISTRATION PROSPERO 2020 CRD42020184232.
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Affiliation(s)
- Hannah Collacott
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK.
| | - Vikas Soekhai
- Erasmus University, Rotterdam, The Netherlands
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Caitlin Thomas
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK
| | - Anne Brooks
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - Ella Brookes
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK
| | - Rachel Lo
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK
| | - Sarah Mulnick
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
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Colorectal Cancer Screening: Have We Addressed Concerns and Needs of the Target Population? GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3040018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite the recognized benefits of colorectal cancer (CRC) screening, uptake is still suboptimal in many countries. In addressing this issue, one important element that has not received sufficient attention is population preference. Our review provides a comprehensive summary of the up-to-date evidence relative to this topic. Four OVID databases were searched: Ovid MEDLINE® ALL, Biological Abstracts, CAB Abstracts, and Global Health. Among the 742 articles generated, 154 full texts were selected for a more thorough evaluation based on predefined inclusion criteria. Finally, 83 studies were included in our review. The general population preferred either colonoscopy as the most accurate test, or fecal occult blood test (FOBT) as the least invasive for CRC screening. The emerging blood test (SEPT9) and capsule colonoscopy (nanopill), with the potential to overcome the pitfalls of the available techniques, were also favored. Gender, age, race, screening experience, education and beliefs, the perceived risk of CRC, insurance, and health status influence one’s test preference. To improve uptake, CRC screening programs should consider offering test alternatives and tailoring the content and delivery of screening information to the public’s preferences. Other logistical measures in terms of the types of bowel preparation, gender of endoscopist, stool collection device, and reward for participants can also be useful.
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Parent clinical trial priorities for fragile X syndrome: a best-worst scaling. Eur J Hum Genet 2021; 29:1245-1251. [PMID: 34163011 PMCID: PMC8385075 DOI: 10.1038/s41431-021-00922-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/19/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023] Open
Abstract
An expansion in the availability of clinical drug trials for genetic neurodevelopmental conditions is underway. Delineating patient priorities is key to the success of drug development and clinical trial design. There is a lack of evidence about parent decision-making in the context of clinical drug trials for genetic neurodevelopmental conditions. We assessed parents' priorities when making a decision whether to enroll their child with fragile X syndrome (FXS) in a clinical drug trial. An online survey included a best-worst scaling method for parents to prioritize motivating and discouraging factors for child enrollment. Parents were recruited through the National Fragile X Foundation and FRAXA. Sequential best-worst with conditional logit analysis was used to determine how parents prioritize motivating and discouraging factors about trial enrollment decisions. Respondents (N = 354) were largely biological mothers (83%) of an individual with FXS who ranged in age from under 5 to over 21 years. The highest motivating factor was a trial to test a drug targeting the underlying FXS mechanism (coeff = 3.28, p < 0.001), followed by the potential of the drug to help many people (coeff = 3.03, p < 0.001). Respondents rated requirement of blood draws (coeff = -3.09, p < 0.001), loss of access to the drug post trial (coeff = -3.01, p < 0.001), and drug side effects (coeff = -2.96, p < 0.001) as most discouraging. The priorities defined by parents can be incorporated into evidence-based trial design and execution to enhance the enrollment process.
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Discrete Choice Experiments to Elicit Patient Preferences for Decision Making in Transplantation. Transplantation 2021; 105:960-967. [PMID: 33093407 DOI: 10.1097/tp.0000000000003500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Providing care for transplant recipients is challenging given the need to maintain optimal graft function and survival while managing the debilitating side effects and complications associated with immunosuppression including infection, cancer, new-onset diabetes mellitus, and cardiovascular disease. Given the complexity of treatment options and the uncertainty about long-term benefits and harms of treatment, understanding patient preferences and values are key to ensuring that clinical decisions take into consideration patient priorities to support shared decision making and self-management. Choice experiments are increasingly used to quantify patient and community preferences, including in the field of transplantation. Discrete choice experiments (DCEs) are a well-established, validated methodology used to elicit preferences for decision making in health and other settings. In transplantation, for example, DCEs have been used to elicit patient preferences for outcomes following kidney transplantation, to identify community preferences factors for organ allocation and in establishing core outcomes. This article provides an overview of the concepts and methods used in the design of DCEs and how patients' preferences can be applied in shared decision making in transplantation.
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Genie MG, Krucien N, Ryan M. Weighting or aggregating? Investigating information processing in multi-attribute choices. HEALTH ECONOMICS 2021; 30:1291-1305. [PMID: 33740258 DOI: 10.1002/hec.4245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/18/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Multi-attribute choices are commonly analyzed in economics to value goods and services. Analysis assumes individuals consider all attributes, making trade-offs between them. Such decision-making is cognitively demanding, often triggering alternative decision rules. We develop a new model where individuals aggregate multi-attribute information into meta-attributes. Applying our model to a choice experiment (CE) dataset, accounting for attribute aggregation (AA) improves model fit. The probability of adopting AA is greater for: homogenous attribute information; participants who had shorter response time and failed the dominance test; and for later located choices. Accounting for AA has implications for welfare estimates. Our results underline the importance of accounting for information processing rules when modelling multi-attribute choices.
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Affiliation(s)
- Mesfin G Genie
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
- Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | | | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Chyderiotis S, Sicsic J, Raude J, Bonmarin I, Jeanleboeuf F, Le Duc Banaszuk AS, Gauchet A, Bruel S, Michel M, Giraudeau B, Thilly N, Mueller JE. Optimising HPV vaccination communication to adolescents: A discrete choice experiment. Vaccine 2021; 39:3916-3925. [PMID: 34088507 DOI: 10.1016/j.vaccine.2021.05.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/28/2021] [Accepted: 05/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Human Papillomavirus (HPV) vaccine coverage in France is below 30%, despite proven effectiveness against HPV infections and (pre-)cancerous cervical lesions. To optimise vaccine promotion among adolescents, we used a discrete choice experiment (DCE) to identify optimal statements regarding a vaccination programme, including vaccine characteristics. METHODS Girls and boys enrolled in the last two years of five middle schools in three French regions (aged 13-15 years) participated in an in-class cross-sectional self-administered internet-based study. In ten hypothetical scenarios, participants decided for or against signing up for a school-based vaccination campaign against an unnamed disease. Scenarios included different levels of four attributes: the type of vaccine-preventable disease, communication on vaccine safety, potential for indirect protection, and information on vaccine uptake among peers. One scenario was repeated with an added mention of sexual transmission. RESULTS The 1,458 participating adolescents (estimated response rate: 89.4%) theoretically accepted vaccination in 80.1% of scenarios. All attributes significantly impacted theoretical vaccine acceptance. Compared to a febrile respiratory disease, protection against cancer was motivating (odds ratio (OR) 1.29 [95%-CI 1.09-1.52]), but not against genital warts (OR 0.91 [0.78-1.06]). Compared to risk negation ("vaccine does not provoke serious side effects"), a reference to a positive benefit-risk balance despite a confirmed side effect was strongly dissuasive (OR 0.30 [0.24-0.36]), while reference to ongoing international pharmacovigilance without any scientifically confirmed effect was not significantly dissuasive (OR 0.86 [0.71-1.04]). The potential for indirect protection motivated acceptance among girls but not boys (potential for eliminating the disease compared to no indirect protection, OR 1.57 [1.25-1.96]). Compared to mentioning "insufficient coverage", reporting that ">80% of young people in other countries got vaccinated" motivated vaccine acceptance (OR 1.94 [1.61-2.35]). The notion of sexual transmission did not influence acceptance. CONCLUSION HPV vaccine communication to adolescents can be tailored to optimise the impact of promotion efforts.
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Affiliation(s)
- Sandra Chyderiotis
- Unité de Recherche et d'Expertise Epidémiologie des maladies émergentes, Institut Pasteur, 25 rue du Dr Roux 75724 Paris cedex 15, France.
| | | | - Jocelyn Raude
- EHESP Rennes, Université Sorbonne Paris Cité, Paris, France; Unité des Virus Emergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | | | - Florian Jeanleboeuf
- GIMAP: groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean Monnet, Université de Lyon, Saint-Etienne, France; Chaire PREVacCI Prévention, Vaccination et Contrôle de l'Infection, Institut PRESAGE, Université Jean Monnet, Université de Lyon, Saint-Etienne, France
| | | | - Aurélie Gauchet
- Université Grenoble Alpes, LIP/PC2S, EA 4145 Grenoble, France
| | - Sébastien Bruel
- HESPER EA7425, Saint-Etienne-Lyon University, Saint-Etienne, France; CIC-INSERM 1408, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Morgane Michel
- Université de Paris, ECEVE, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile-de-France/Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France; INSERM, ECEVE, UMR 1123, Paris, France
| | - Bruno Giraudeau
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France, INSERM CIC 1415, CHRU de Tours, Tours, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, Nancy, France
| | - Judith E Mueller
- Unité de Recherche et d'Expertise Epidémiologie des maladies émergentes, Institut Pasteur, 25 rue du Dr Roux 75724 Paris cedex 15, France; EHESP Rennes, Université Sorbonne Paris Cité, Paris, France
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Vass CM, Davison NJ, Vander Stichele G, Payne K. A Picture is Worth a Thousand Words: The Role of Survey Training Materials in Stated-Preference Studies. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:163-173. [PMID: 31565784 PMCID: PMC7075825 DOI: 10.1007/s40271-019-00391-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Online survey-based methods are increasingly used to elicit preferences for healthcare. This digitization creates an opportunity for interactive survey elements, potentially improving respondents’ understanding and/or engagement. Objective Our objective was to understand whether, and how, training materials in a survey influenced stated preferences. Methods An online discrete-choice experiment (DCE) was designed to elicit public preferences for a new targeted approach to prescribing biologics (“biologic calculator”) for rheumatoid arthritis (RA) compared with conventional prescribing. The DCE presented three alternatives, two biologic calculators and a conventional approach (opt out), described by five attributes: delay to treatment, positive predictive value, negative predictive value, infection risk, and cost saving to the national health service. Respondents were randomized to receive training materials as plain text or an animated storyline. Training materials contained information about RA and approaches to treatment and described the biologic calculator. Background questions included sociodemographics and self-reported measures of task difficulty and attribute non-attendance. DCE data were analyzed using conditional and heteroskedastic conditional logit (HCL) models. Results In total, 300 respondents completed the DCE, receiving either plain text (n = 158) or the animated storyline (n = 142). The HCL showed the estimated coefficients for all attributes aligned with a priori expectations and were statistically significant. The scale term was statistically significant, indicating that respondents who received plain-text materials had more random choices. Further tests suggested preference homogeneity after accounting for differences in scale. Conclusions Using animated training materials did not change the preferences of respondents, but they appeared to improve choice consistency, potentially allowing researchers to include more complex designs with increased numbers of attributes, levels, alternatives or choice sets. Electronic supplementary material The online version of this article (10.1007/s40271-019-00391-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caroline M Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK.,RTI Health Solutions, Manchester, UK
| | - Niall J Davison
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK.,BresMed, Manchester, UK
| | | | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK.
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To pay or not to pay? Cost information processing in the valuation of publicly funded healthcare. Soc Sci Med 2021; 276:113822. [PMID: 33752103 DOI: 10.1016/j.socscimed.2021.113822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 11/21/2022]
Abstract
Discrete choice experiments (DCEs) commonly include a monetary attribute. This enables willingness to pay (WTP), a monetary measure of benefit, to be estimated for non-monetary attributes. There has been concern that the inclusion of a cost attribute challenges the credibility of the experiment when valuing publicly funded healthcare systems. However, very little research has explored this issue. Using a UK sample, we allocated participants across two versions of a DCE: one including a cost attribute and the other excluding a cost attribute. The DCE was identical in all other respects. We find no significant difference in response time across the two surveys, monotonicity was higher for the COST DCE and cost was stated as the most commonly ignored attribute in the COST DCE. Whilst the inclusion of a cost attribute did not alter the structure of preferences, it resulted in a lower level of choice consistency. Using an unrestricted latent class model, we find evidence of a credibility effect: respondents with experience of paying for health services and who perceive the choices as realistic are less likely to ignore cost. Further, respondents with a higher response time are less likely to be cost minimisers. Results are robust across different model specifications and choice formats. DCE practitioners should give due consideration to cost credibility when including a cost attribute, ensuring participants engage with the cost attribute. Ways to do this are suggested, including careful motivation of the cost attribute, consideration to the appropriate payment vehicle and careful consideration to the cost attribute when developing and piloting the survey. Failure to do this will result in an invalid willingness to pay estimates and thus policy recommendations.
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Boyers D, van der Pol M, Watson V, Lamont T, Goulao B, Ramsay C, Duncan A, Macpherson L, Clarkson J. The Value of Preventative Dental Care: A Discrete-Choice Experiment. J Dent Res 2021; 100:723-730. [PMID: 33541186 PMCID: PMC8217903 DOI: 10.1177/0022034521989943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Scale and polish (SP) and oral hygiene advice (OHA) are commonly provided in primary care dental practice to help prevent periodontal disease. These services are widely consumed by service users, incurring substantial cost, without any clear evidence of clinical benefit. This article aims to elicit general population preferences and willingness to pay (WTP) for preventative dental care services and outcomes. An online discrete-choice experiment (DCE) was completed by a nationally representative sample of the UK general population. Respondents each answered 10 choice tasks that varied in terms of service attributes (SP, OHA, and provider of care), outcomes (bleeding gums and aesthetics), and cost. Choice tasks were selected using a pivoted segmented experimental design to improve task realism. An error components panel logit model was used to analyze the data. Marginal WTP (mWTP) for each attribute and level was calculated. In total, 667 respondents completed the DCE. Respondents valued more frequent SP, care provided by a dentist, and personalized OHA. Respondents were willing to pay for dental packages that generated less frequent ("never" or "hardly ever") bleeding on brushing and teeth that look and feel at least "moderately clean." Respondents were willing to pay more (+£145/y) for improvements in an aesthetic outcome from "very unclean" (-£85/y) to "very clean" (+£60/y) than they were for reduced bleeding frequency (+£100/y) from "very often" (-£54/y) to "never" (+£36/y). The general population value routinely provided SP, even in the absence of reductions in bleeding on brushing. Dental care service providers must consider service user preferences, including preferences for both health and nonhealth outcomes, as a key factor in any service redesign. Furthermore, the results provide mWTP estimates that can be used in cost-benefit analysis of these dental care services.
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Affiliation(s)
- D Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - M van der Pol
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - V Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - T Lamont
- School of Dentistry, University of Dundee, Dundee, UK
| | - B Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - C Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - A Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - L Macpherson
- School of Dentistry, University of Dundee, Dundee, UK
| | - J Clarkson
- School of Dentistry, University of Dundee, Dundee, UK
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Application of discrete choice experiments to estimate value of life: a national study protocol in Iran. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:6. [PMID: 33516226 PMCID: PMC7846904 DOI: 10.1186/s12962-021-00259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Global concerns regarding the significant burden of non-communicable diseases and injuries (NCDIs) exist from both public health and economic perspectives. Our research focuses on the reduction of fatal risks due to NCDIs and the citizens’ preferences about health programs and intervention to reduce premature death due to NCDIs. Governments and health authorities need reliable evidence and information to prioritize the interests of their citizens. One crucial piece of evidence to justify the resources spent on NCDIs is the value derived from the interventions on prevention and NCDIs control. This concept is usually called “Value of Statistical Life” (VSL), meaning the monetary value that individuals place on changes in the risk levels of life- threatening events. To the best of our knowledge, for the first time, our study will estimate the statistical value of life for selected interventions for the prevention and control of NCDIs at both national and sub-national levels in the context of Iran. This paper reports the development of a national protocol through Discrete Choice Experiments (DCEs) method. Methods and designs Our study comprises several stages: (a) a literature review to identify the attributes and levels of the prevention programs and Willingness to Pay (WTP) for reducing the NCDI’s fatal risks; (b) experimental design to assessing, prioritizing, and finalizing the identified attributes and levels; (c) instrumental design to conduct face-to-face structured survey interviews of 3180 respondents aged 18–69 across the entire country; (d) statistical analysis to estimate the results through the Mixed Multinomial logit (MMNL) model. Discussion We anticipate that our findings will help build a stronger empirical basis for monetizing the value of small changes in selected fatality risks. It paves the way for other national or vast VSL estimates for NCDIs, as well as other major causes of morbidity and mortality in the context of Iran, and perhaps other low and middle-income countries (LMICs).
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Rigby D, Vass C, Payne K. Opening the 'Black Box': An Overview of Methods to Investigate the Decision-Making Process in Choice-Based Surveys. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:31-41. [PMID: 31486021 DOI: 10.1007/s40271-019-00385-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The desire to understand the preferences of patients, healthcare professionals and the public continues to grow. Health valuation studies, often in the form of discrete choice experiments, a choice based survey approach, proliferate as a result. A variety of methods of pre-choice process analysis have been developed to investigate how and why people make their decisions in such experiments and surveys. These techniques have been developed to investigate how people acquire and process information and make choices. These techniques offer the potential to test and improve theories of choice and/or associated empirical models. This paper provides an overview of such methods, with the focus on their use in stated choice-based healthcare studies. The methods reviewed are eye tracking, mouse tracing, brain imaging, deliberation time analysis and think aloud. For each method, we summarise the rationale, implementation, type of results generated and associated challenges, along with a discussion of possible future developments.
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Affiliation(s)
- Dan Rigby
- Economics, School of Social Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Caroline Vass
- Division of Population Health, Health Services Research and Primary Care, Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Katherine Payne
- Division of Population Health, Health Services Research and Primary Care, Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Genie MG, Loría-Rebolledo LE, Paranjothy S, Powell D, Ryan M, Sakowsky RA, Watson V. Understanding public preferences and trade-offs for government responses during a pandemic: a protocol for a discrete choice experiment in the UK. BMJ Open 2020; 10:e043477. [PMID: 33444217 PMCID: PMC7682450 DOI: 10.1136/bmjopen-2020-043477] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Social distancing and lockdown measures are among the main government responses to the COVID-19 pandemic. These measures aim to limit the COVID-19 infection rate and reduce the mortality rate of COVID-19. Given we are likely to see local lockdowns until a treatment or vaccine for COVID-19 is available, and their effectiveness depends on public acceptability, it is important to understand public preference for government responses. METHODS AND ANALYSIS Using a discrete choice experiment (DCE), this study will investigate the public's preferences for pandemic responses in the UK. Attributes (and levels) are based on: (1) lockdown measures described in policy documents; (2) literature on preferences for lockdown measures and (3) a social media analysis. Attributes include: lockdown type; lockdown length; postponement of usual non-urgent medical care; number of excess deaths; number of infections; impact on household spending and job losses. We will prepilot the DCE using virtual think aloud interviews with respondents recruited via Facebook. We will collect preference data using an online survey of 4000 individuals from across the four UK countries (1000 per country). We will estimate the relative importance of the attributes, and the trade-offs individuals are willing to make between attributes. We will test if respondents' preferences differ based on moral attitudes (using the Moral Foundation Questionnaire), socioeconomic circumstances (age, education, economic insecurity, health status), country of residence and experience of COVID-19. ETHICS AND DISSEMINATION The University of Aberdeen's College Ethics Research Board (CERB) has approved the study (reference: CERB/2020/6/1974). We will seek CERB approval for major changes from the developmental and pilot work. Peer-reviewed papers will be submitted, and results will be presented at public health and health economic conferences nationally and internationally. A lay summary will be published on the Health Economics Research Unit blog.
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Affiliation(s)
- Mesfin G Genie
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Daniel Powell
- Health Psychology, University of Aberdeen, Aberdeen, UK
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Verity Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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