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Keller E, Botha W, Chambers GM. Does in vitro fertilization (IVF) treatment provide good value for money? A cost-benefit analysis. Front Glob Womens Health 2023; 4:971553. [PMID: 36937042 PMCID: PMC10014591 DOI: 10.3389/fgwh.2023.971553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023] Open
Abstract
Background Using traditional health technology assessment (HTA) outcome metrics, such as quality-adjusted life-years, to assess fertility treatments raises considerable methodological challenges because the objective of fertility treatments is to create new life rather than extend, save, or improve health-related quality of life. Objective The aim of this study was to develop a novel cost-benefit framework to assess value for money of publicly funded IVF treatment; to determine the number of cost-beneficial treatment cycles for women of different ages; and to perform an incremental cost-benefit analysis from a taxpayer perspective. Methods We developed a Markov model to determine the net monetary benefit (NMB) of IVF treatment by female age and number of cycles performed. IVF treatment outcomes were monetized using taxpayers' willingness-to-pay values derived from a discrete choice experiment (DCE). Using the current funding environment as the comparator, we performed an incremental analysis of only funding cost-beneficial cycles. Similar outputs to cost-effectiveness analyses were generated, including net-benefit acceptability curves and cost-benefit planes. We created an interactive online app to provide a detailed and transparent presentation of the results. Results The results suggest that at least five publicly funded IVF cycles are cost-beneficial in women aged <42 years. Cost-benefit planes suggest a strong taxpayer preference for restricting funding to cost-beneficial cycles over current funding arrangements in Australia from an economic perspective. Conclusions The provision of fertility treatment is valued highly by taxpayers. This novel cost-benefit method overcomes several challenges of conventional cost-effectiveness methods and provides an exemplar for incorporating DCE results into HTA. The results offer new evidence to inform discussions about treatment funding arrangements.
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Lim AH, Ng SW, Teh XR, Ong SM, Sivasampu S, Lim KK. Conjoint analyses of patients’ preferences for primary care: a systematic review. BMC PRIMARY CARE 2022; 23:234. [PMID: 36085032 PMCID: PMC9463739 DOI: 10.1186/s12875-022-01822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
While patients’ preferences in primary care have been examined in numerous conjoint analyses, there has been little systematic effort to synthesise the findings. This review aimed to identify, to organise and to assess the strength of evidence for the attributes and factors associated with preference heterogeneity in conjoint analyses for primary care outpatient visits.
Methods
We searched five bibliographic databases (PubMed, Embase, PsycINFO, Econlit and Scopus) from inception until 15 December 2021, complemented by hand-searching. We included conjoint analyses for primary care outpatient visits. Two reviewers independently screened papers for inclusion and assessed the quality of all included studies using the checklist by ISPOR Task Force for Conjoint Analysis. We categorized the attributes of primary care based on Primary Care Monitoring System framework and factors based on Andersen’s Behavioural Model of Health Services Use. We then assessed the strength of evidence and direction of preference for the attributes of primary care, and factors affecting preference heterogeneity based on study quality and consistency in findings.
Results
Of 35 included studies, most (82.4%) were performed in high-income countries. Each study examined 3–8 attributes, mainly identified through literature reviews (n = 25). Only six examined visits for chronic conditions, with the rest on acute or non-specific / other conditions. Process attributes were more commonly examined than structure or outcome attributes. The three most commonly examined attributes were waiting time for appointment, out-of-pocket costs and ability to choose the providers they see. We identified 24/58 attributes with strong or moderate evidence of association with primary care uptake (e.g., various waiting times, out-of-pocket costs) and 4/43 factors with strong evidence of affecting preference heterogeneity (e.g., age, gender).
Conclusions
We found 35 conjoint analyses examining 58 attributes of primary care and 43 factors that potentially affect the preference of these attributes. The attributes and factors, stratified into evidence levels based on study quality and consistency, can guide the design of research or policies to improve patients’ uptake of primary care. We recommend future conjoint analyses to specify the types of visits and to define their attributes clearly, to facilitate consistent understanding among respondents and the design of interventions targeting them.
Word Count: 346/350 words.
Trial registration
On Open Science Framework: https://osf.io/m7ts9
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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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Bazirete O, Nzayirambaho M, Umubyeyi A, Uwimana MC, Evans M. Influencing factors for prevention of postpartum hemorrhage and early detection of childbearing women at risk in Northern Province of Rwanda: beneficiary and health worker perspectives. BMC Pregnancy Childbirth 2020; 20:678. [PMID: 33167935 PMCID: PMC7654175 DOI: 10.1186/s12884-020-03389-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reduction of maternal mortality and morbidity is a major global health priority. However, much remains unknown regarding factors associated with postpartum hemorrhage (PPH) among childbearing women in the Rwandan context. The aim of this study is to explore the influencing factors for prevention of PPH and early detection of childbearing women at risk as perceived by beneficiaries and health workers in the Northern Province of Rwanda. METHODS A qualitative descriptive exploratory study was drawn from a larger sequential exploratory-mixed methods study. Semi-structured interviews were conducted with 11 women who experienced PPH within the 6 months prior to interview. In addition, focus group discussions were conducted with: women's partners or close relatives (2 focus groups), community health workers (CHWs) in charge of maternal health (2 focus groups) and health care providers (3 focus groups). A socio ecological model was used to develop interview guides describing factors related to early detection and prevention of PPH in consideration of individual attributes, interpersonal, family and peer influences, intermediary determinants of health and structural determinants. The research protocol was approved by the University of Rwanda, College of Medicine and Health Sciences Institutional Ethics Review Board. RESULTS We generated four interrelated themes: (1) Meaning of PPH: beliefs, knowledge and understanding of PPH: (2) Organizational factors; (3) Caring and family involvement and (4) Perceived risk factors and barriers to PPH prevention. The findings from this study indicate that PPH was poorly understood by women and their partners. Family members and CHWs feel that their role for the prevention of PPH is to get the woman to the health facility on time. The main factors associated with PPH as described by participants were multiparty and retained placenta. Low socioeconomic status and delays to access health care were identified as the main barriers for the prevention of PPH. CONCLUSIONS Addressing the identified factors could enhance early prevention of PPH among childbearing women. Placing emphasis on developing strategies for early detection of women at higher risk of developing PPH, continuous professional development of health care providers, developing educational materials for CHWs and family members could improve the prevention of PPH. Involvement of all levels of the health system was recommended for a proactive prevention of PPH. Further quantitative research, using case control design is warranted to develop a screening tool for early detection of PPH risk factors for a proactive prevention.
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Affiliation(s)
- Oliva Bazirete
- College of Medicine and Health Sciences, University of Rwanda, 3286 Kigali, Rwanda
| | - Manassé Nzayirambaho
- College of Medicine and Health Sciences, University of Rwanda, 3286 Kigali, Rwanda
| | - Aline Umubyeyi
- College of Medicine and Health Sciences, University of Rwanda, 3286 Kigali, Rwanda
| | | | - Marilyn Evans
- University of Western Ontario, Arthur Labatt Family School of Nursing, 1151 Richmond St, London, ON N6A 3K7 Canada
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Villeneuve E, Landa P, Allen M, Spencer A, Prosser S, Gibson A, Kelsey K, Mujica-Mota R, Manktelow B, Modi N, Thornton S, Pitt M. A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BackgroundThere is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale.Objectives(1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives.Main outcome measuresThe ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents.DesignDescriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study.SettingNHS neonatal services across England.DataNeonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey.ResultsLocation analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling > 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families.LimitationsThe following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface.ConclusionsAn evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents.Future workTo extend the modelling to encompass the interface between maternity and neonatal services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Emma Villeneuve
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Paolo Landa
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Michael Allen
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anne Spencer
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sue Prosser
- Neonatal Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - Andrew Gibson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Katie Kelsey
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ruben Mujica-Mota
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Brad Manktelow
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neena Modi
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
| | - Steve Thornton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin Pitt
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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Gurung B, Jackson LJ, Monahan M, Butterworth R, Roberts TE. Identifying and assessing the benefits of interventions for postnatal depression: a systematic review of economic evaluations. BMC Pregnancy Childbirth 2018; 18:179. [PMID: 29783936 PMCID: PMC5963067 DOI: 10.1186/s12884-018-1738-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 04/10/2018] [Indexed: 01/30/2023] Open
Abstract
Background Economic evaluations of interventions for postnatal depression (PND) are essential to ensure optimal healthcare decision-making. Due to the wide-ranging effects of PND on the mother, baby and whole family, there is a need to include outcomes for all those affected and to include health and non-health outcomes for accurate estimates of cost-effectiveness. This study aimed to identify interventions to prevent or treat PND for which an economic evaluation had been conducted and to evaluate the health and non-health outcomes included. Methods A systematic review was conducted applying a comprehensive search strategy across eight electronic databases and other sources. Full or partial economic evaluations of interventions involving preventive strategies (including screening), and any treatments for women with or at-risk of PND, conducted in OECD countries were included. We excluded epidemiological studies and those focussing on costs only. The included studies underwent a quality appraisal to inform the analysis. Results Seventeen economic evaluations met the inclusion criteria, the majority focused on psychological /psychosocial interventions. The interventions ranged from additional support from health professionals, peer support, to combined screening and treatment strategies. Maternal health outcomes were measured in all studies; however child health outcomes were included in only four of them. Across studies, the maternal health outcomes included were quality-adjusted-life-years gained, improvement in depressive symptoms, PND cases detected or recovered, whereas the child health outcomes included were cognitive functioning, depression, sleep and temperament. Non-health outcomes such as couples’ relationships and parent-infant interaction were rarely included. Other methodological issues such as limitations in the time horizon and perspective(s) adopted were identified, that were likely to result in imprecise estimates of benefits. Conclusions The exclusion of relevant health and non-health outcomes may mean that only a partial assessment of cost-effectiveness is undertaken, leading to sub-optimal resource allocation decisions. Future research should seek ways to expand the evaluative space of economic evaluations and explore approaches to integrate health and non-health outcomes for all individuals affected by this condition. There is a need to ensure that the time horizon adopted in studies is appropriate to allow true estimation of the long-term benefits and costs of PND interventions. Electronic supplementary material The online version of this article (10.1186/s12884-018-1738-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Binu Gurung
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Louise J Jackson
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Mark Monahan
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Ruth Butterworth
- Cheshire and Mersey Specialist Perinatal Mental Health Service, Thorn Road Clinic, Thorn Road, Runcorn, WA7 5HQ, UK
| | - Tracy E Roberts
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Vermeulen J, Peersman W, Quadvlieg L, Fobelets M, De Clercq G, Swinnen E, Beeckman K. Development and validation of the Midwife Profiling Questionnaire assessing women's preferred perinatal care professional and knowledge of midwives' legal competences. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:23-32. [PMID: 29804771 DOI: 10.1016/j.srhc.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/19/2017] [Accepted: 01/14/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Currently maternity care organisation is developing worldwide. Therefore insight in the position of the midwife is important. The 'Midwife Profiling Questionnaire' (MidProQ) measures women's preferred perinatal care professional and their knowledge of midwives' legal competences. MidProQ is based on the European legal framework and was tested in a pilot study. This study aims to determine its content and face validity. STUDY DESIGN A two-phase validation study with a Delphi method questioning content experts (n = 10) on items relevance and clarity as well as its scale and face validity. Further semi-structured interviews were performed with lay experts (n = 10) to evaluate the questionnaire's clarity, layout, phrasing and wording. RESULTS After round one, most questions (42/47) were considered content valid for relevance and clarity (Item Content Validity Index 0.80-1.00). Scale (Scale Content Validity Index 0.92) and face validity (Face Validity Index 0.89) of the entire instrument was obtained. Five questions were revised until item content (0.83-1.00), scale content (0.92) and face validity (1.00) were appropriate. Lay experts' suggestions for improving the readability and usability were taken into account. CONCLUSIONS We developed a valid instrument to elicit women's preferred health professional for uncomplicated pregnancy, labour and childbirth and to determine their knowledge about midwives' legal competences. Our instrument can be valuable in identifying knowledge gaps and improving the knowledge of the general population about the midwifery profession and maternity care. Finally, the MidProQ may improve research in the domain of maternity care culture, scale up midwifery and facilitate a more women-centred care.
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Affiliation(s)
- Joeri Vermeulen
- Department Health Care, Midwifery Department, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Laarbeeklaan 121, 1090 Brussels, Belgium.
| | - Wim Peersman
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Primary Health Care, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Linda Quadvlieg
- Verloskundepraktijk De Tantes, Franeker, Hertog van Saxenlaan 36C, 8801 ES Franeker, The Netherlands
| | - Maaike Fobelets
- Department Health Care, Midwifery Department, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Laarbeeklaan 121, 1090 Brussels, Belgium; Faculty of Medicine and Pharmacy, I-CHER (Interuniversity Centre for Health Economics Research), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Gerlinde De Clercq
- Department Health Care, Midwifery Department, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Laarbeeklaan 121, 1090 Brussels, Belgium
| | - Eva Swinnen
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050 Brussels, Belgium
| | - Katrien Beeckman
- Department Health Care, Midwifery Department, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Laarbeeklaan 121, 1090 Brussels, Belgium; Faculty of Medicine and Pharmacy, Department Medical Sociology, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; Nursing and Midwifery Research Unit, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
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Tinelli M, Ryan M, Bond C. What, who and when? Incorporating a discrete choice experiment into an economic evaluation. HEALTH ECONOMICS REVIEW 2016; 6:31. [PMID: 27472943 PMCID: PMC4967060 DOI: 10.1186/s13561-016-0108-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/19/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND Economic evaluation focuses on Quality-Adjusted-Life-Years (QALYs) as the main valuation method. However, it is well known that factors beyond health related quality of life are important to patients and the public. Whilst discrete-choice-experiments (DCE) have been extensively used to value such factors, their incorporation within an economic evaluation framework is limited. This study is the first to incorporate patient preferences for factors beyond QALYs into an economic evaluation and compare results with the standard cost-per-QALY approach, using randomised-controlled-trial (RCT) participants. METHODS Costings, clinical-effectiveness (appropriateness-of-treatment), QALYs and patient satisfaction data were collected at baseline and 12-month follow-up for a new pharmacy-service within a randomised-controlled-trial. Trial participants who replied to the follow-up survey and had not subsequently withdrawn from the study were mailed a DCE questionnaire at 24-months. WTP for the standard and new service was derived from the DCE. Results from QALYs and the DCE were compared. RESULTS At 12 months, costs, clinical-effectiveness and QALYs did not differ between the intervention and control; however there was a significant increase in satisfaction in the intervention. The DCE valued this increased satisfaction in the intervention (positive net-benefit). The longer the time patients experienced the new service the greater the reported net-benefit. CONCLUSION When incorporating a DCE into an economic evaluation a number of questions are raised: what factors should be valued, whose values (trial-groups vs. all-trial-population) and when should they be elicited (still-receiving-the-intervention or afterwards). Consideration should also be given to status quo bias.
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Affiliation(s)
- Michela Tinelli
- LSE Health and Social Care, the London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill campus, AB25 2ZD, Aberdeen, Scotland
| | - Christine Bond
- Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill campus, AB25 2ZD, Aberdeen, Scotland
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Gerard K, Tinelli M, Latter S, Smith A, Blenkinsopp A. Patients' valuation of the prescribing nurse in primary care: a discrete choice experiment. Health Expect 2015; 18:2223-35. [PMID: 24720861 PMCID: PMC5810682 DOI: 10.1111/hex.12193] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recently, primary care in the United Kingdom has undergone substantial changes in skill mix. Non-medical prescribing was introduced to improve patient access to medicines, make better use of different health practitioners' skills and increase patient choice. There is little evidence about value-based patient preferences for 'prescribing nurse' in a general practice setting. OBJECTIVE To quantify value-based patient preferences for the profession of prescriber and other factors that influence choice of consultation for managing a minor illness. DESIGN Discrete choice experiment patient survey. SETTING AND PARTICIPANTS Five general practices in England with non-medical prescribing services, questionnaires completed by 451 patients. MAIN OUTCOME MEASURE Stated choice of consultation. MAIN RESULTS There was a strong general preference for consulting 'own doctor' for minor illness. However, a consultation with a nurse prescriber with positive patient-focused attributes can be more acceptable to patients than a consultation provided by a doctor. Attributes 'professional's attention to Patients' views' and extent of 'help offered' were pivotal. Past experience influenced preference. DISCUSSION AND CONCLUSION Respondents demonstrated valid preferences. Preferences for consulting a doctor remained strong, but many were happy to consult with a nurse if other aspects of the consultation were improved. Findings show who to consult is not the only valued factor in choice of consultation for minor illness. The 'prescribing nurse' role has potential to offer consultation styles that patients value. Within the study's limitations, these findings can inform delivery of primary care to enhance patient experience and substitute appropriate nurse prescribing consultations for medical prescribing consultations.
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Affiliation(s)
- Karen Gerard
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| | | | - Sue Latter
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Alesha Smith
- School of PharmacyUniversity of QueenslandBrisbaneQldAustralia
- School of PharmacyUniversity of OtagoOtagoNew Zealand
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Clark MD, Determann D, Petrou S, Moro D, de Bekker-Grob EW. Discrete choice experiments in health economics: a review of the literature. PHARMACOECONOMICS 2014; 32:883-902. [PMID: 25005924 DOI: 10.1007/s40273-014-0170-x] [Citation(s) in RCA: 512] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Discrete choice experiments (DCEs) are increasingly used in health economics to address a wide range of health policy-related concerns. OBJECTIVE Broadly adopting the methodology of an earlier systematic review of health-related DCEs, which covered the period 2001-2008, we report whether earlier trends continued during 2009-2012. METHODS This paper systematically reviews health-related DCEs published between 2009 and 2012, using the same database as the earlier published review (PubMed) to obtain citations, and the same range of search terms. RESULTS A total of 179 health-related DCEs for 2009-2012 met the inclusion criteria for the review. We found a continuing trend towards conducting DCEs across a broader range of countries. However, the trend towards including fewer attributes was reversed, whilst the trend towards interview-based DCEs reversed because of increased computer administration. The trend towards using more flexible econometric models, including mixed logit and latent class, has also continued. Reporting of monetary values has fallen compared with earlier periods, but the proportion of studies estimating trade-offs between health outcomes and experience factors, or valuing outcomes in terms of utility scores, has increased, although use of odds ratios and probabilities has declined. The reassuring trend towards the use of more flexible and appropriate DCE designs and econometric methods has been reinforced by the increased use of qualitative methods to inform DCE processes and results. However, qualitative research methods are being used less often to inform attribute selection, which may make DCEs more susceptible to omitted variable bias if the decision framework is not known prior to the research project. CONCLUSIONS The use of DCEs in healthcare continues to grow dramatically, as does the scope of applications across an expanding range of countries. There is increasing evidence that more sophisticated approaches to DCE design and analytical techniques are improving the quality of final outputs. That said, recent evidence that the use of qualitative methods to inform attribute selection has declined is of concern.
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Affiliation(s)
- Michael D Clark
- Department of Economics, University of Warwick, Coventry, CV4 7AL, UK,
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van Haaren-ten Haken T, Pavlova M, Hendrix M, Nieuwenhuijze M, de Vries R, Nijhuis J. Eliciting preferences for key attributes of intrapartum care in the Netherlands. Birth 2014; 41:185-94. [PMID: 24702440 DOI: 10.1111/birt.12081] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND As part of the move toward "patient-centered care," women's preferences with regard to maternity services have become increasingly important to policy makers. To realize optimal patient-centered care, knowledge of patients' preferences is essential. The aim of our study was to assess the strength and relative importance of women's preferences for different aspects of intrapartum care in The Netherlands, where women have easy access to both home and hospital birth. METHODS A discrete choice experiment was conducted at 16 weeks of gestation as part of a Dutch multicenter, prospective cohort study from 2007 to 2011 of low-risk, nulliparous women. Responses were analyzed per intended place of birth group: midwifery-led home (n = 191) and hospital birth (n = 152) and obstetric-led hospital birth (n = 188). RESULTS We analyzed 562 questionnaires. Women in all groups preferred the possibility of influencing decision making and pain-relief treatment during birth and no co-payment for childbirth. Women with an intended home birth preferred a home-like birth setting with the assistance of a midwife and transport during birth in case of complications. Type of birth setting and transport during birth were not considered important to women with an intended midwifery- or obstetric-led hospital birth. CONCLUSION Policies aimed at the improvement of maternity care must take into account women's preferences for the possibility of pain-relief treatment and the fact that all women desire a high level of involvement in decision making. Furthermore, efforts to change maternity care systems must consider how to counter the culturally embedded nature of women's preferences.
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Affiliation(s)
- Tamar van Haaren-ten Haken
- Department midwifery science of Midwifery Education & Studies Maastricht-ZUYD, Maastricht, The Netherlands
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van der Pol M, Currie G, Kromm S, Ryan M. Specification of the utility function in discrete choice experiments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:297-301. [PMID: 24636390 DOI: 10.1016/j.jval.2013.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 11/18/2013] [Accepted: 11/27/2013] [Indexed: 05/24/2023]
Abstract
BACKGROUND The specification of the utility function has received limited attention within the discrete choice experiment (DCE) literature. This lack of investigation is surprising given that evidence from the contingent valuation literature suggests that welfare estimates are sensitive to different specifications of the utility function. OBJECTIVE This study investigates the effect of different specifications of the utility function on results within a DCE. METHODS The DCE elicited the public's preferences for waiting time for hip and knee replacement and estimated willingness to wait (WTW). RESULTS The results showed that the WTW for the different patient profiles varied considerably across the three different specifications of the utility function. Assuming a linear utility function led to much higher estimates of marginal rates of substitution (WTWs) than with nonlinear specifications. The goodness-of-fit measures indicated that nonlinear specifications were superior.
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Affiliation(s)
| | | | | | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Abedeen, UK
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Naik-Panvelkar P, Armour C, Rose JM, Saini B. Patient preferences for community pharmacy asthma services: a discrete choice experiment. PHARMACOECONOMICS 2012; 30:961-976. [PMID: 22823521 DOI: 10.2165/11594350-000000000-00000] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Specialized community pharmacy services, involving the provision of disease state management and care by pharmacists, have been developed and trialled and have demonstrated very good health outcomes. Most of these services have been developed from a healthcare professional perspective. However, for the future uptake and long-term sustainability of these services as well as for better and sustained health outcomes for patients, it is vital to gain an understanding of patients' preferences. We can then structure healthcare services to match these preferences and needs rather than around clinical viewpoints alone. OBJECTIVE The aim of this study was to elicit patient preferences for pharmacy-based specialized asthma services using a discrete choice experiment and to explore the value/importance that patients place on the different attributes of the asthma service. The existence of preference heterogeneity in the population was also investigated. METHODS The study was conducted with asthma patients who had recently experienced a specialized asthma management service at their pharmacy in New South Wales, Australia. Pharmacists delivering the asthma service mailed out the discrete choice questionnaires to participating patients at the end of 6 months of service provision. A latent class (LC) model was used to investigate each patient's strength of preference and preference heterogeneity for several key attributes related to asthma service provision: frequency of visits, access to pharmacist, interaction with pharmacy staff, availability of a private area for consultation, provision of lung function testing, type and depth of advice provision, number of days with asthma symptoms and cost of service. RESULTS Eighty useable questionnaires (of 170 questionnaires sent out) were received (response rate 47.1%). The study identified various key elements of asthma services important to patients. Further, the LC analysis revealed three classes with differing patient preferences for levels of asthma service provision. Patients in the Minimalistic Model class valued provision of lung function testing and preferred more frequent service visits. Cost of service had a negative effect on service preference for patients in this class. Patients in the Partial Model class mainly derived utility from the provision of lung function testing and comprehensive advice at the pharmacy and also wanted more frequent service visits. The Holistic Model class patients considered all attributes of the service to be important when making a choice. While the majority of the service attributes had a positive effect on preference for patients in this class, cost of service and days with symptoms of asthma had a negative effect on service preference. These patients also preferred fewer service visits. CONCLUSION The study identified various key attributes that are important to patients with respect to community pharmacy-based asthma services. The results also demonstrate the existence of preference heterogeneity in the population. Asthma service providers need to take these findings into consideration in the design and development of future service models so as to increase their uptake and ensure their long-term sustainability.
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Jowsey T, Yen L, Wells R, Leeder S. National Health and Hospital Reform Commission final report and patient-centred suggestions for reform. Aust J Prim Health 2011; 17:162-8. [PMID: 21645472 DOI: 10.1071/py10033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 12/10/2010] [Indexed: 11/23/2022]
Abstract
The final report of the National Health and Hospital Reform Commission (NHHRC) called for a strengthened consumer voice and empowerment. This has salience for the development of health policy concerning chronic illnesses. This paper compares the recommendations for chronic illness care made in the NHHRC final report with suggestions made by people with chronic illness and family carers of people with chronic illness in a recent Australian study. Sixty-six participants were interviewed in a qualitative research project of the Serious and Continuing Illness Policy and Practice Study (SCIPPS). Participants were people with type II diabetes mellitus, chronic obstructive pulmonary disease or chronic heart failure. Family carers were also interviewed. Content analysis was undertaken and participants' recommendations for improving care were compared with those proposed in the NHHRC final report. Many suggestions from the participants of the SCIPPS qualitative research project appeared in the NHHRC final report, including the need to improve care coordination, health literacy and the experience of Indigenous Australians. The research project also identified important issues of family carers, immigrants and people with multiple illnesses, which were not addressed in the NHHRC final report. More specific attention is needed in health reform to improve the experience of family carers, Indigenous peoples, immigrants to Australia and people with multiple illnesses. To align more closely with their needs, health reform must be explicitly informed by the voices of people with chronic illness and their family carers. The NHHRC recommendations must be supplemented with proposals that address the needs of these people for support and the problems associated with poor care coordination.
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Affiliation(s)
- Tanisha Jowsey
- Australian Primary Health Care Research Institute and Menzies Centre for Health Policy, Australian National University, 62 Eggleston Road, Australian National University, Acton, ACT 0200, Australia.
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