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Hill SR, Gibson A, Oluboyede Y, Longworth L, Bennett B, Shaw JW. A Methodological Study to Compare Alternative Modes of Administration With Value EQ-5D Using Preference-Elicitation Techniques. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:784-793. [PMID: 38467189 DOI: 10.1016/j.jval.2024.02.020] [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: 06/16/2023] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES Time trade-off (TTO) and discrete choice experiment (DCE) preference-elicitation techniques can be administered using face-to-face interviews (F2F), unassisted online (UO) surveys, or remote-assisted (RA) interviews. The objective of this study was to explore how the mode of administration affects the quality and reliability of preference-elicitation data. METHODS EQ-5D-5L health states were valued using composite TTO (cTTO) and DCE approaches by the UK general population. Participants were allocated to 1 of 2 study groups. Group A completed both F2F and UO surveys (n = 271), and group B completed both RA and UO surveys (n = 223). The feasibility of survey completion and the reliability and face-validity of data collected were compared across all modes of administration. RESULTS Fewer participants reported receiving sufficient guidance on the cTTO tasks during the UO survey compared with the 2 assisted modes. Participants across all modes typically reported receiving sufficient guidance on the DCE tasks. cTTO data were less reliable from the UO survey compared with both assisted modes, but there were no differences in DCE data reliability. cTTO data from all modes demonstrated face-validity; however, the UO survey produced higher utilities for moderate and severe health states than both assisted modes. Both F2F and RA modes provided comparably reliable data. CONCLUSIONS The reliability of DCE data is not affected by the mode of administration. Interviewer-assisted modes of administration (F2F or RA) yield more reliable cTTO data than unassisted surveys. Both F2F and RA surveys produced similar-quality data.
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Ozdemir S, Quaife M, Mohamed AF, Norman R. An Overview of Data Collection in Health Preference Research. THE PATIENT 2024:10.1007/s40271-024-00695-6. [PMID: 38662323 DOI: 10.1007/s40271-024-00695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
This paper focuses on survey administration and data collection methods employed for stated-preference studies in health applications. First, it describes different types of survey administration methods, encompassing web-based surveys, face-to-face (in-person) surveys, and mail surveys. Second, the concept of sampling frames is introduced, clarifying distinctions between the target population and survey frame population. The discussion then extends to different types of sampling methods, such as probability and non-probability sampling, along with an evaluation of potential issues associated with different sampling methods within the context of health preference research. Third, the paper provides information about different recruitment methods, including web-surveys, leveraging patient groups, and in-clinic recruitment. Fourth, a crucial aspect addressed is the calculation of response rate, with insights into determining an adequate response rate and strategies to improve response rates in stated-preference surveys. Lastly, the paper concludes by discussing data management plans and suggesting insights for future research in this field. In summary, this paper examines the nuanced aspects of survey administration and data collection methods in stated-preference studies, offering valuable guidance for researchers and practitioners in the health domain.
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Affiliation(s)
- Semra Ozdemir
- Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | | | | | - Richard Norman
- Curtin School of Population Health, Curtin University, Perth, Australia
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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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Cadham CJ, Prosser LA. Eliciting Trade-Offs Between Equity and Efficiency: A Methodological Scoping Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:943-952. [PMID: 36805575 DOI: 10.1016/j.jval.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/09/2023] [Accepted: 02/12/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To identify differences in the approaches and results of studies that elicit equity-efficiency trade-offs that can inform equity-informative cost-effectiveness analysis for healthcare resource allocation. METHODS We searched Ovid (Medline), EconLit, and Scopus prior to June 25, 2021. Inclusion criteria were: (1) peer-reviewed or (2) gray literature; (3) published in English; (4) survey-based; (5) parameterized a social welfare function to quantify inequality aversion or (6) elicited a trade-off in equity and efficiency characteristics of health interventions. Exclusion criteria were: (1) studies that did not conduct a trade-off or (2) theoretical studies. We abstracted details on study methods, results, and limitations. Studies were grouped by following approach: (1) social welfare function or (2) preference ranking and distributional weighting. We described findings separately for each approach category. RESULTS Seventy-seven papers were included, 28 parameterized social welfare functions and 49 were classified as preference ranking and distributional weighting. Study methods were heterogeneous. Studies were conducted across 29 countries. Sample sizes and composition, survey methods and question framing varied. Preferences for equity were mixed. Across both approach categories: 39 studies were classified as clear evidence of inequality aversion; 33 found mixed evidence; and 4 had no evidence of aversion. Evidence of between and within-study heterogeneity was found. Preferences for equity may differ by gender, profession, political ideology, income, and education. CONCLUSIONS Substantial variability in study methods limit the direct comparability of findings and their use in equity-informed cost-effectiveness analysis. Future researches using representative samples that explore within and between country heterogeneity is needed.
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Affiliation(s)
- Christopher J Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Lisa A Prosser
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, MI, USA
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Quinn KL, Krahn M, Stukel TA, Grossman Y, Goldman R, Cram P, Detsky AS, Bell CM. No Time to Waste: An Appraisal of Value at the End of Life. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:S1098-3015(22)01966-0. [PMID: 35690518 DOI: 10.1016/j.jval.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The use of economic evaluations of end-of-life interventions may be limited by an incomplete appreciation of how patients and society perceive value at end of life. The objective of this study was to evaluate how patients, caregivers, and society value gains in quantity of life and quality of life (QOL) at the end of life. The validity of the assumptions underlying the use of the quality-adjusted life-years (QALY) as a measure of preferences at end of life was also examined. METHODS MEDLINE, Embase, CINAHL, PsycINFO, and PubMed were searched from inception to February 22, 2021. Original research studies reporting empirical data on healthcare priority setting at end of life were included. There was no restriction on the use of either quantitative or qualitative methods. Two reviewers independently screened, selected, and extracted data from studies. Narrative synthesis was conducted for all included studies. The primary outcomes were the value of gains in quantity of life and the value of gains in QOL at end of life. RESULTS A total of 51 studies involving 53 981 participants reported that gains in QOL were generally preferred over quantity of life at the end of life across stakeholder groups. Several violations of the underlying assumptions of the QALY to measure preferences at the end of life were observed. CONCLUSIONS Most patients, caregivers, and members of the general public prioritize gains in QOL over marginal gains in life prolongation at the end of life. These findings suggest that policy evaluations of end-of-life interventions should favor those that improve QOL. QALYs may be an inadequate measure of preferences for end-of-life care thereby limiting their use in formal economic evaluations of end-of-life interventions.
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Affiliation(s)
- Kieran L Quinn
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, Sinai Health System, Toronto, ON, Canada.
| | - Murray Krahn
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
| | - Thérèse A Stukel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada
| | - Yona Grossman
- Arts and Science Program, McMaster University, Hamilton, ON, Canada
| | - Russell Goldman
- Interdepartmental Division of Palliative Care, Sinai Health System, Toronto, ON, Canada; Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
| | - Peter Cram
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Allan S Detsky
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, Sinai Health System, Toronto, ON, Canada
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Soare IA, Flint I, Savic N, Puricelli F, Medjedovic J, O'Flaherty ED, James S, Longworth L. Quality of life study for caregivers of people with uncontrolled focal-onset seizures. J Med Econ 2022; 25:66-76. [PMID: 34906033 DOI: 10.1080/13696998.2021.2018871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM The aim of this study was to capture and measure the impact of caregiving for an adult with uncontrolled drug-resistant focal-onset seizures (FOS) on the caregivers' quality of life (QoL), and to quantify the costs of productivity losses associated with providing informal care in this patient population. METHODS An online survey, which included the EQ-5D-5L, CarerQol-7D and the Work Productivity and Activity Impairment: Specific-Health Problem (WPAI:SHP) questionnaires, was administered to caregivers of individuals with uncontrolled drug-resistant FOS in the United Kingdom (UK), France, Spain, Germany, Italy, and Sweden. RESULTS The study included 345 caregivers. Most were males, aged between 25 and 34 years old whose caring responsibilities took between 15 and 24 h per week. The caregivers' mean EQ-5D-5L score was 0.6, with 95% confidence intervals (CI) of [0.58, 0.63], whilst the mean CarerQol-7D score was 72.61 [70.46, 74.76]. Caregivers' mental health was the most substantially affected aspect of their QoL. In addition, most caregivers reported deriving some or a lot of fulfilment out of their caregiving tasks. The WPAI:SHP showed that the mean percentage of work impairment due to caregiving responsibilities was 63%, [59.75, 66.26]. The mean annualised costs of productivity losses per caregiver were estimated at €14,872 [€11,908; €17,888]. LIMITATIONS One limitation consisted in the use of an online survey instead of a face-to-face interview. However, the medical terms were clearly explained, and examples were provided to help participants to give accurate responses. Another limitation was that the respondents self-reported as caregivers. Efforts were made to mitigate this weakness by using screener questions. CONCLUSION This study found that providing informal care for people with uncontrolled drug-resistant FOS had a negative impact on caregivers' QoL, with mental health being affected the most. However, caregivers found their role fulfilling and had support with their caring tasks.
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Affiliation(s)
| | | | - Natasa Savic
- Arvelle Therapeutics GmbH, A company of Angelini Pharma, Zug, Switzerland
| | | | - Jasmina Medjedovic
- Arvelle Therapeutics GmbH, A company of Angelini Pharma, Zug, Switzerland
| | | | - Samuel James
- Arvelle Therapeutics GmbH, A company of Angelini Pharma, Zug, Switzerland
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Kaur MN, Skolasky RL, Powell PA, Xie F, Huang IC, Kuspinar A, O'Dwyer JL, Cizik AM, Rowen D. Transforming challenges into opportunities: conducting health preference research during the COVID-19 pandemic and beyond. Qual Life Res 2021; 31:1191-1198. [PMID: 34661806 PMCID: PMC8521079 DOI: 10.1007/s11136-021-03012-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
The disruptions to health research during the COVID-19 pandemic are being recognized globally, and there is a growing need for understanding the pandemic’s impact on the health and health preferences of patients, caregivers, and the general public. Ongoing and planned health preference research (HPR) has been affected due to problems associated with recruitment, data collection, and data interpretation. While there are no “one size fits all” solutions, this commentary summarizes the key challenges in HPR within the context of the pandemic and offers pragmatic solutions and directions for future research. We recommend recruitment of a diverse, typically under-represented population in HPR using online, quota-based crowdsourcing platforms, and community partnerships. We foresee emerging evidence on remote, and telephone-based HPR modes of administration, with further studies on the shifts in preferences related to health and healthcare services as a result of the pandemic. We believe that the recalibration of HPR, due to what one would hope is an impermanent change, will permanently change how we conduct HPR in the future.
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Affiliation(s)
- Manraj N Kaur
- Patient-Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Richard L Skolasky
- Departments of Orthopedic Surgery and Physical Medicine & Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Philip A Powell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, and Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, and Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - John L O'Dwyer
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amy M Cizik
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Donna Rowen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Reis AM, Pinto Borges A, Araújo N. Managing NHS money in Portugal: who decides? INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2020. [DOI: 10.1108/ijhg-08-2020-0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe need to reduce health expenditures raises the discussion on rationing possibilities and there is a growing interest in considering society's perspectives. The aim of this paper was to evaluate Portuguese citizens' opinion regarding the imposition of limits on National Health Service (NHS) spending. We also asked who decides how NHS money is spent, in order to obtain the respondents' views on public involvement.Design/methodology/approachAn online questionnaire was used to collect data. Descriptive and inferential statistics, factorial analysis and a logit model were applied.FindingsOur results showed that most of the respondents believe citizens have low participation on NHS' financial decisions, confirming the lack of public involvement. Health professionals are more likely to agree with limits on NHS spending, which could indicate potential inefficiencies.Practical implicationsFrom a health policy perspective, we have concluded that different stakeholders should be involved before deciding how public spending limits should be implemented. Health professionals' perspectives should be considered, taking advantage of their experience.Originality/valueThe main novelty of this paper is the evaluation of whether there should be limits on NHS spending, comparing health professionals and non-health professionals.
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Time for Tele-TTO? Lessons Learned From Digital Interviewer-Assisted Time Trade-Off Data Collection. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:459-469. [PMID: 33345290 PMCID: PMC7750113 DOI: 10.1007/s40271-020-00490-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 10/27/2022]
Abstract
The preferred mode of administration of time trade-off (TTO) in large-scale valuation studies is face-to-face (personal) interviews facilitated by a trained interviewer. Geographical, financial or situational constraints could complicate personal TTO interviews. When facing such constraints, the use of digital interviews, in which trained interviewers facilitate through videotelephony software (i.e. tele-TTO) may be considered. This paper aims to guide researchers in how to approach tele-TTO interviews and discusses their advantages and disadvantages. The main advantages of tele-TTO compared to personal TTO are decreased need for travel and increased flexibility of interview scheduling, which could reduce costs and may foster representative sampling. Possible disadvantages of tele-TTO are partial loss of visual cues, complications with building rapport and possible selection effects that result from differences in interview preparation. Furthermore, the paper reports on lessons learned from a project in which both personal TTO and tele-TTO interviews were conducted. The results of this project suggest that although they require a different recruitment and interview process, tele-TTO interviews are feasible and provide flexibility to the interviewer. Furthermore, tele-TTO interviews yield largely similar results. Future research should explore the role of possible selection effects and respondents' perspective on tele-TTO interviews.
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Dalziel K, Catchpool M, García-Lorenzo B, Gorostiza I, Norman R, Rivero-Arias O. Feasibility, Validity and Differences in Adolescent and Adult EQ-5D-Y Health State Valuation in Australia and Spain: An Application of Best-Worst Scaling. PHARMACOECONOMICS 2020; 38:499-513. [PMID: 31974830 DOI: 10.1007/s40273-020-00884-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND The measurement and valuation of health-related quality of life for and by young people are increasingly important, yet research on the impact of study perspective and validity of preferences obtained from young populations remains limited. OBJECTIVE The objective of this study was to evaluate the feasibility and validity of collecting EQ-5D Youth version (EQ-5D-Y) preferences from adolescents, adults, and adults from a child perspective. METHODS A profile case best-worst scaling (BWS) online survey was administered to representative Australian and Spanish adult (age ≥ 18 years) and child (age 11-17 years) samples. Adults were told to either answer from their own perspective or for a hypothetical 10-year-old child. Marginal best- and worst-choice frequencies, analysis of dominant choices, self-reported difficulty completing the tasks, and time to complete tasks were used to determine the validity of responses. RESULTS In Australia, 2134 adults and 1010 adolescents completed the survey. In Spain, 2007 adults and 1000 adolescents completed it. Analysis of marginal choice frequencies and dominant choices indicated that the pattern of responses between adolescents and adults was similar. For Australian respondents, having no mobility problems was rated as best by adolescents, while adults rated having no pain and discomfort as 'best'. In Spain, both adults and adolescents rated no pain or discomfort as 'best'. Australian adolescents rated very worried, sad or unhappy as 'worst', while Spanish adolescents, Spanish adults and Australian adults rated a lot of pain and discomfort as 'worst'. CONCLUSIONS Results suggest preferences from adolescents using direct BWS are valid. Our descriptive analysis also suggest that there are age-related and country-specific differences in elicitation values for the EQ-5D-Y.
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Affiliation(s)
- Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Max Catchpool
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Borja García-Lorenzo
- Health Technology Assessment Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Tenerife, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Inigo Gorostiza
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Osakidetza Basque Health Service, Basurto University Hospital, Bilbao, Spain
| | - Richard Norman
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Oliver Rivero-Arias
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Tenerife, Spain.
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
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McNamara S, Holmes J, Stevely AK, Tsuchiya A. How averse are the UK general public to inequalities in health between socioeconomic groups? A systematic review. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:275-285. [PMID: 31650439 PMCID: PMC7072057 DOI: 10.1007/s10198-019-01126-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/07/2019] [Indexed: 05/20/2023]
Abstract
There is growing interest in the use of "distributionally-sensitive" forms of economic evaluation that capture both the impact of an intervention upon average population health and the distribution of that health amongst the population. This review aims to inform the conduct of distributionally sensitive evaluations in the UK by answering three questions: (1) How averse are the UK public towards inequalities in lifetime health between socioeconomic groups? (2) Does this aversion differ depending upon the type of health under consideration? (3) Are the UK public as averse to inequalities in health between socioeconomic groups as they are to inequalities in health between neutrally framed groups? EMBASE, MEDLINE, EconLit, and SSCI were searched for stated preference studies relevant to these questions in October 2017. Of the 2155 potentially relevant papers identified, 15 met the predefined hierarchical eligibility criteria. Seven elicited aversion to inequalities in health between socioeconomic groups, and eight elicited aversion between neutrally labelled groups. We find general, although not universal, evidence for aversion to inequalities in lifetime health between socioeconomic groups, albeit with significant variation in the strength of that preference across studies. Second, limited evidence regarding the impact of the type of health upon aversion. Third, some evidence that the UK public are more averse to inequalities in lifetime health when those inequalities are presented in the context of socioeconomic inequality than when presented in isolation.
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Affiliation(s)
- Simon McNamara
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, UK.
| | - John Holmes
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, UK
| | - Abigail K Stevely
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, UK
| | - Aki Tsuchiya
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, UK
- Department of Economics, University of Sheffield, Sheffield, S1 4DA, UK
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Ryan M, Mentzakis E, Matheson C, Bond C. Survey modes comparison in contingent valuation: Internet panels and mail surveys. HEALTH ECONOMICS 2020; 29:234-242. [PMID: 31828891 DOI: 10.1002/hec.3983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/16/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
Stated preferences methods are extensively applied in health economics to elicit preferences. Although mailed surveys were commonly used to collect data, internet panel (IP) surveys are being increasingly used. This raises questions about the validity of responses and estimated willingness-to-pay (WTP) values generated from IP surveys. We conduct the first study in health to compare a contingent valuation IP survey with a mailed survey using the electoral roll. Our IP has a higher response rate and lower item missing response rate. The difference is reduced but remains when restricting comparisons with valid WTPs. Sample characteristics differ, with significant differences between modes for gender, age, income, and attitudes and knowledge. Although difference in WTP values exist, with the IP resulting in higher values, we find limited evidence that such differences are statistically significant. The mail survey has lower initial cost per response; however, once restricting samples to valid WTP responses with nonmissing respondent information, the cost per response across modes is similar. Our results, suggesting that IPs generate valid and cost-effective values, are encouraging as researchers move increasingly to IPs to collect preference data.
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Affiliation(s)
- Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Christine Bond
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
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Watson V, Porteous T, Bolt T, Ryan M. Mode and Frame Matter: Assessing the Impact of Survey Mode and Sample Frame in Choice Experiments. Med Decis Making 2019; 39:827-841. [PMID: 31524051 PMCID: PMC6843610 DOI: 10.1177/0272989x19871035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/26/2019] [Indexed: 11/15/2022]
Abstract
Background. Choice experiments (CE) are applied in health economics to elicit public preferences and willingness to pay (WTP). CEs are frequently administered as Internet-based surveys. Internet surveys have recognized advantages, but concerns exist about the representativeness of Internet samples, data quality, and the impact on elicited values. Aim. We conducted the first study in health comparing an Internet-based CE survey with the more traditional general population mail survey. We also compared the Internet-based and mail CE surveys with computer-assisted personal interviews (CAPIs), which are commonly used to elicit health state valuations. Methods. Two separate samples were drawn from 2 United Kingdom (UK) volunteer Internet panels (IPs), CAPIs were undertaken with respondents sampled from UK Census Output Areas, and mail surveys were sent to UK households drawn from the postcode address file (PAF). Each mode received more than 1000 respondents. We compared modes and frames using objective measures (response rate, sample representativeness of the UK population, elicited values, theoretical validity, and cost per response) and subjective/self-reported measures (time taken to complete the study, perceived study consequentiality, and stated attribute nonattendance). This study intentionally confounded the survey modes and sample frame by choosing sample frames that are typically used by researchers for each mode. Results. Estimated WTP differs across mode-frame pairs. On most measures, CAPIs dominated. They are more expensive, however. On all measures, except response rates, Internet surveys dominated the mail survey. They were also cheaper. Conclusion. Researchers using IPs should pay attention to response rates and be aware that the quality of IPs differs. Given the importance of perceived consequentiality and attribute attendance in CEs, future research should address their impact across modes and frames.
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Affiliation(s)
- Verity Watson
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, Scotland
| | - Terry Porteous
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, Scotland
| | - Tim Bolt
- Faculty of Economics, Saitama University, Sakura-ku, Saitama, Japan
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, Scotland
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A Scoring Index of Prioritization Factors Between Patients: An Iberian Comparison. Health Care Manag (Frederick) 2019; 38:267-275. [PMID: 31261196 DOI: 10.1097/hcm.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study intends to develop a Prioritization Scoring Index of Iberian Peninsula comprising Portuguese and Spanish citizens, to weigh the importance assigned to rationing criteria used to prioritize patients. Data were collected through an online survey from 2 samples of 355 Portuguese and 564 Spanish members of the general public. Respondents faced 12 hypothetical rationing scenarios and should reveal their level of agreement with each one according to a Likert scale. The statements comprise 3 allocative considerations: egalitarianism, efficiency, and equity. Findings suggest that Portuguese and Spanish respondents gave greater importance to the treatments outcomes, to the severity of the illness, and to younger patients. Furthermore, Iberian respondents assigned 57% of the weighting to equity considerations, 40% to efficiency considerations, and approximately only 3% to egalitarianism. Spaniards weighted more than Portuguese both equity and efficiency considerations while weighted less the egalitarian principle. Iberian Peninsula respondents require resource allocation decisions in health to be informed by considerations of equity as well as efficiency. As the first was most valued, it seems plausible that Portuguese and Spanish respondents are willing to sacrifice some efficiency to achieve a more equitable distribution of health.
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Pinho M, Pinto Borges A. The Views of Health Care Professionals and Laypersons Concerning the Relevance of Health-Related Behaviors in Prioritizing Patients. HEALTH EDUCATION & BEHAVIOR 2019; 46:728-736. [DOI: 10.1177/1090198119853604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article aims to investigate to what extent health care professionals in Portugal find health-related behaviors relevant as a criterion to priority setting, to study what type of risk behavior they consider relevant in such decisions and to compare their views with those of laypersons. An online questionnaire was used to collect data from a sample of 178 health care professionals and 295 laypersons. The statistical analysis was performed through the application of generalized linear models and logistic regressions. Health professionals consider more than laypersons that information about health-related behaviors is relevant in prioritization between individuals. Both groups regard information about illegal drug abuse, excessive alcohol consumption, and smoking more important to priority setting decisions than information about overweight or lack of physical exercise. The findings are important for the definition of rationing policies as the professionals’ decisions are those that, ultimately, influence health expenditure.
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Affiliation(s)
- Micaela Pinho
- Universidade Portucalense, Porto, Portugal
- University of Aveiro, Aveiro, Portugal
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Pinho M, Pinto Borges A. Economic decisions on who to treat when resources are not enough for everyone. Evidence from a Spanish survey. ACTA ACUST UNITED AC 2018; 20:584-590. [PMID: 33111891 DOI: 10.15446/rsap.v20n5.69558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 08/20/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To analyze the attitudes of Spanish citizens towards the criteria that should be used as a guide to make decisions regarding the prioritization of patients, namely, medical, economic and person-based criteria. METHODS An online self-administered questionnaire was used to collect data from a sample of 546 Spanish respondents. The questionnaire was made up of three questions. In the first two questions respondents faced a hypothetical rationing dilemma involving four patients (differentiated by personal characteristics and health conditions) where they were asked to: (i) choose only one patient to be treated and (ii) rank the patients' assistance priority order. As for the third question, respondents were asked to state their level of agreement with 14 healthcare rationing criteria through a five-point Likert scale. Descriptive statistics, factor analysis and multinomial regressions were used. RESULTS Findings suggest that Spanish respondents support a plurality of views on the rationing principles on which healthcare micro allocation decisions should be based. Despite the fact respondents support the idea that all patients should receive healthcare assistance equally, they also consider the age of the patient, as well as economic factors when establishing assistance priories among patients. CONCLUSIONS If it is not possible to provide health care assistance and treatments to all people, then age and economic factors should guide healthcare priority setting.
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Affiliation(s)
- Micaela Pinho
- MP: Assistant Professor. Ph.D. Economics. Portucalense University (Research on Economics, Management and Information Technologies -REMIT and Portucalense Institute for Legal Research - IJP). Porto. Aveiro University (Research Unit in Governance, Competitiveness and Public Policies - GOVCOPP). Aveiro. Portugal.
| | - Ana Pinto Borges
- AP: Coordinator Professor. Ph.D. Economics. ISAG - European Business School and Research Group of ISAG (NIDISAG). Porto. Portugal.
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Pinho M, Botelho A. Inference Procedures to Quantify the Efficiency-Equality Trade-Off in Health from Stated Preferences: A Case Study in Portugal. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:503-513. [PMID: 29675693 DOI: 10.1007/s40258-018-0394-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This article develops two inference procedures to calculate the inequality aversion and alpha parameters of a health-related social welfare function with constant elasticity (CES-HRSWF) using stated preferences. Based on the relative concept of inequality, a range of values were proposed for the trade-offs between improving total population health and reducing health inequalities. METHODS A self-administered questionnaire was used to collect data from a sample of 422 college students in Portugal. Respondents faced three hypothetical allocation scenarios where they needed to decide between two health programmes that assign different health gains to two anonymous sub-groups of the population and to two sub-groups identified by socioeconomic class. Combinations of the median response to these three questions were used to estimate the parameters of the CES-HRSWF. RESULTS Findings suggest that the quantification of the efficiency-equality trade-off is not independent of the inference procedure used. Plausible values for the inequality aversion and for the alpha parameters were obtained ranging from 2.24 to 4.85 and from 0.5 to 0.58, respectively. CONCLUSIONS Respondents revealed some aversion to health inequality. However, the extent of this aversion seems to be sensitive to (1) the identification of the groups by occupation status, (2) the size of the health gain, and (3) the inference procedure used.
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Affiliation(s)
- Micaela Pinho
- Research on Economics, Management and Information Technologies (REMIT), University Portucalense, Rua Dr. Bernardino de Almeida, 541-619, 4200-072, Porto, Portugal.
- Research Unit in Governance, Competitiveness and Public Policies (GOVCOPP), University of Aveiro, Aveiro, Portugal.
| | - Anabela Botelho
- Research Unit in Governance, Competitiveness and Public Policies (GOVCOPP), University of Aveiro, Aveiro, Portugal
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Relative Importance Assigned to Health Care Rationing Principles at the Bedside: Evidence From a Portuguese and Bulgarian Survey. Health Care Manag (Frederick) 2018; 36:334-341. [PMID: 28984698 DOI: 10.1097/hcm.0000000000000187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Activity was undertaken to develop a Prioritization Scoring Index for Portugal and Bulgaria that weights the importance given to ethical rationing principles that should guide decisions at the bedside. Data from two random samples of 355 Portuguese and 298 Bulgarian members of the public were collected from an online questionnaire. Questions asked about the level of importance given to specific issues related to patient's prioritization criteria. Responses were analyzed quantitatively with the SPSS. In the process of selecting the patient to treat, Portuguese and Bulgarian respondents seem unanimous in giving greater importance to (i) the treatment outcomes, (ii) the severity of illness, (iii) children, and (iv) patients' fragility. In general, Portuguese and Bulgarian respondents allocate more than 50% of the prioritization weight to equity considerations, approximately 35% to efficiency considerations, and 5% to lottery selection. Even so, Bulgarian respondents rate highly the equity and less the efficiency consideration than Portuguese respondents. Although the pursuit of efficiency seems to be valued by respondents, their major concern seems to be with the reduction of inequalities in health.
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Pinho M, Pinto Borges A, Petricevic D. Bedside healthcare rationing dilemmas: a survey from Croatia. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTH CARE 2018. [DOI: 10.1108/ijhrh-02-2018-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore Croatian views about issues regarding bedside rationing decisions.
Design/methodology/approach
An online questionnaire was used to collect data from a sample of 243 Croatian citizens. In a context of hypothetical scenarios involving priority setting decisions taking by physicians, the present study elicits Croatian respondents’ views concerning: the ethical principles that should guide patients prioritization; the parties that should make prioritization decisions; and the likelihood of healthcare rationing becoming a reality. Descriptive analysis, factor analysis and parametric and non-parametric tests were performed.
Findings
Findings suggest that Croatian respondents: support multiple substantive rationing criteria, with an incident in favoring the worst-off, reducing inequalities in health, translated in the fair-innings argument and efficiency achievement; appoint health professionals as rationing decision makers; and do not seem to believe in the possibility of patient selection becoming a reality.
Practical implications
Favoring the worst-off, equalizing life time health and the pursuit of efficiency seem to be the criteria most preferred by Croatian respondents to guide rationing policy at the micro level.
Originality/value
This study is the first attempt to elicit Croatian opinions concerning several rationing criteria inherent in healthcare micro allocation decisions. Healthcare rationing is a serious challenge to Croatian policy makers and so it would be useful for the public’s perceptions and beliefs to be considered.
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Valuing health at the end of life: A review of stated preference studies in the social sciences literature. Soc Sci Med 2018; 204:39-50. [DOI: 10.1016/j.socscimed.2018.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/26/2018] [Accepted: 03/05/2018] [Indexed: 11/17/2022]
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Bedsides healthcare rationing dilemmas: A survey from Bulgaria and comparison with Portugal. SOCIAL THEORY & HEALTH 2017. [DOI: 10.1057/s41285-017-0029-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gill TK, Tucker GR, Avery JC, Shanahan EM, Menz HB, Taylor AW, Adams RJ, Hill CL. The use of self-report questions to examine the prevalence of musculoskeletal problems: a test-retest study. BMC Musculoskelet Disord 2016; 17:100. [PMID: 26911879 PMCID: PMC4766689 DOI: 10.1186/s12891-016-0946-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/13/2016] [Indexed: 12/22/2022] Open
Abstract
Background Case definition has long been an issue for comparability of results obtained for musculoskeletal pain prevalence, however the test-retest reliability of questions used to determine joint pain prevalence has not been examined. The objective of this study was to determine question reliability and the impact of question wording, ordering and the time between questions on responses. Methods A Computer Assisted Telephone Interviewing (CATI) survey was used to re-administer questions collected as part of a population-based longitudinal cohort study. On two different occasions questions were asked of the same sample of 203 community dwelling respondents (which were initially randomly selected) aged 18 years and over at two time points 14 to 27 days apart (average 15 days). Reliability of the questions was assessed using Cohen’s kappa (κ) and intraclass correlation coefficient (ICC) and whether question wording and period effects existed was assessed using a crossover design. Results The self-reported prevalence of doctor diagnosed arthritis demonstrated excellent reliability (κ = 0.84 and κ = 0.79 for questionnaires 1 and 2 respectively). The reliability of questions relating to musculoskeletal pain and/or stiffness ranged from moderate to excellent for both types of questions, that is, those related to ever having joint pain on most days for at least a month (κ = 0.52 to κ = 0.95) and having pain and/or stiffness on most days for the last month (κ = 0.52 to κ = 0.90). However there was an effect of question wording on the results obtained for hand, foot and back pain and/or stiffness indicating that the area of pain may influence prevalence estimates. Conclusions Joint pain and stiffness questions are reliable and can be used to determine prevalence. However, question wording and pain area may impact on estimates with issues such as pain perception and effect on activities playing a possible role in the recall of musculoskeletal pain.
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Affiliation(s)
- Tiffany K Gill
- NHMRC Early Career Fellow, School of Medicine, Faculty of Health Sciences, The University of Adelaide, Level 7, SAHMRI, North Tce, Adelaide, SA, 5000, Australia.
| | - Graeme R Tucker
- School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Jodie C Avery
- Population Research and Outcome Studies, Discipline of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia.
| | - E Michael Shanahan
- Rheumatology Department, Southern Adelaide Health Service, Repatriation General Hospital, Daws Rd, Daw Park, SA, 5042, Australia. .,School of Medicine, Flinders University, Bedford Park, SA, 5041, Australia.
| | - Hylton B Menz
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Vic, 3083, Australia.
| | - Anne W Taylor
- Population Research and Outcome Studies, Discipline of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Robert J Adams
- School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia. .,The Health Observatory, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Catherine L Hill
- The Health Observatory, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, SA, 5005, Australia. .,Rheumatology Department, The Queen Elizabeth Hospital, Woodville Rd, Woodville, SA, 5011, Australia.
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