The effect of including an opt-out option in discrete choice experiments

Public Preference for Off-Label Use of Drugs for Cancer Treatment and Relative Importance of Associated Adverse Events: A Discrete Choice Experiment and Best-Worst Scaling

BACKGROUND AND OBJECTIVE

Patients may get more treatment options with off-label use of drugs while exposed to unknown risks of adverse events. Little is known about the public or demand-side perspective on off-label drug use, which is important to understand how to use off-label treatment and devise financial assistance. This study aimed to quantify public preference for off-label cancer treatment outcomes, process, and costs, and perceived importance of associated adverse events.

METHODS

A discrete choice experiment and a best-worst scaling were conducted in Hong Kong in December 2022. Quota sampling was used to randomly select the study sample from a territory-wide panel of working-age adults. Preferences and willingness to pay (WTP) for treatment effectiveness, risk of adverse events, mode of drug administration, and availability of off-label treatment guidelines were estimated using a random parameter logit model and latent class model. The relative importance of different adverse events was elicited using Case 1 best-worst scaling.

RESULTS

A total of 435 respondents provided valid responses. In the discrete choice experiment, the respondents indicated that extra overall survival as treatment effectiveness (WTP: HK$448,000/US$57,400 for 12-month vs 3-month extra survival) was the most important attribute for off-label drugs, followed by the risk of adverse events (WTP: HK$318,000/US$40,800 for 10% chance to have adverse event vs 55%), mode of drug administration (WTP: HK$42,000/US$5300 for oral intake vs injection), and availability of guidelines (WTP: HK$31,000/US$4000 for available versus not available). Four groups with distinct preferences were identified, including effectiveness oriented, off-label use refusal, oral intake oriented, and adverse event risk aversion. In the best-worse scaling, hypothyroidism, nausea/vomiting, and arthralgia/joint pain were the three most important adverse events based on the perceptions of respondents. Risk-averse respondents, who were identified from the discrete choice experiment, had different perceived importance of the adverse events compared with those with other preferences.

CONCLUSIONS

Knowing the preference and WTP for cancer treatment-related characteristics from a societal perspective facilitates doctors' communications with patients on decision making and treatment goal-setting for off-label treatment, and enables devising financial assistance for related treatments. This study also provides important insight to inform evaluations of public acceptance and information dissemination in drug development as well as future economic evaluations.

Using stated preference methods to design gender-affirming long-acting PrEP programs for transgender and nonbinary adults

Integrating gender-affirming care with biomedical HIV prevention could help address the disproportionate HIV risk experienced by transgender and nonbinary (trans) adults. This discrete choice experiment assesses and identifies the most important programming factors influencing the decisions of trans adults to use injectable long-acting HIV pre-exposure prophylaxes (LA-PrEP). From March to April 2023 n = 366 trans adults in Washington state chose between four different choice profiles that presented hypothetical programs (each comprised of 5 attributes with 4 levels). We analyzed ranked choice responses using a mixed rank-ordered logit model for main effects. Respondents preferred to receive LA-PrEP from a gender-affirming care provider and a co-prescription for both oral and injectable hormones. Trans adults strongly favored 12-month protection and injection in the upper arm. No strong preferences emerged surrounding the type of health facility offering the gender-affirming LA-PrEP program. Our findings show that integrating and leveraging gender-affirming health systems, inclusive of medical services such as hormone therapy, with HIV biomedical products like LA-PrEP is strongly preferred and influential to trans adults' decision to use LA-PrEP. Leveraging choice-based design experiments provides informative results for optimizing gender-affirming LA-PrEP programming tailored to trans adults.

Health state utility values of type 2 diabetes mellitus and related complications: a systematic review and meta-regression

BACKGROUND

This study aimed to synthesize and quantitatively examine Health State Utility Values (HSUVs) for Type 2 Diabetes Mellitus (T2DM) and its complications, providing a robust meta-regression framework for selecting appropriate HSUV estimates.

METHOD

We conducted a systematic review to extract HSUVs for T2DM and its complications, encompassing various influencing factors. Relevant literature was sourced from a review spanning 2000-2020, supplemented by literature from PubMed, Embase, and the Web of Science (up to March 2024). Multivariate meta-regression was performed to evaluate the impact of measurement tools, tariffs, health status, and clinical and demographic variables on HSUVs.

RESULTS

Our search yielded 118 studies, contributing 1044 HSUVs. The HSUVs for T2DM with complications varied, from 0.65 for cerebrovascular disease to 0.77 for neuropathy. The EQ-5D-3L emerged as the most frequently employed valuation method. HSUV differences across instruments were observed; 15-D had the highest (0.89), while HUI-3 had the lowest (0.70) values. Regression analysis elucidated the significant effects of instrument and tariff choice on HSUVs. Complication-related utility decrement, especially in diabetic foot, was quantified. Age <70 was linked to increased HSUVs, while longer illness duration, hypertension, overweight and obesity correlated with reduced HSUVs.

CONCLUSION

Accurate HSUVs are vital for the optimization of T2DM management strategies. This study provided a comprehensive data pool for HSUVs selection, and quantified the influence of various factors on HSUVs, informing analysts and policymakers in understanding the utility variations associated with T2DM and its complications.

Eliciting Older Cancer Patients' Preferences for Follow-Up Care to Inform a Primary Healthcare Follow-Up Model in China: A Discrete Choice Experiment

BACKGROUND AND OBJECTIVES

Increasing longevity and advances in treatment have increased the cancer burden in the elderly, resulting in complex follow-up care needs; however, in China, little is known about the follow-up care preferences of these patients. This study quantified older cancer patients' preferences for follow-up care and examined the trade-offs they are willing to make to accept an alternative follow-up model.

METHODS

A discrete choice experiment was conducted among inpatients aged over 60 years with breast, prostate, or colorectal cancer, at two large tertiary hospitals in Nantong, China. Preference weights for follow-up care were estimated using mixed logit analysis. Subgroup analysis and latent class analysis were used to explore preference heterogeneity.

RESULTS

Complete results were obtained from 422 patients (144 with breast cancer, 133 with prostate cancer, 145 with colorectal cancer), with a mean age of 70.81 years. Older cancer patients stated a preference for follow-up by specialists over primary healthcare (PHC) providers ( β = -1.18, 95% confidence interval -1.40 to -0.97). The provider of follow-up care services was the most valued attribute among patients with breast cancer (relative importance [RI] 37.17%), while remote contact services were prioritized by patients with prostate (RI 43.50%) and colorectal cancer (RI 33.01%). The uptake rate of an alternative care model integrating PHC increased compared with the baseline setting when patients were provided with preferred services (continuity of care, individualized care plans, and remote contact services).

CONCLUSION

To encourage older cancer patients to use PHC-integrated follow-up care, alternative follow-up care models need to be based on patients' preferences before introducing them as a routine option.

Analyzing HPV Vaccination Service Preferences among Female University Students in China: A Discrete Choice Experiment

OBJECTIVE

Despite being primary beneficiaries of human papillomavirus (HPV) vaccines, female university students in China exhibit low vaccination rates. This study aimed to assess their preferences for HPV vaccination services and evaluate the relative importance of various factors to inform vaccination strategy development.

METHODS

Through a literature review and expert consultations, we identified five key attributes for study: effectiveness, protection duration, waiting time, distance, and out-of-pocket (OOP) payment. A D-efficient design was used to create a discrete choice experiment (DCE) questionnaire. We collected data via face-to-face interviews and online surveys from female students across seven universities in China, employing mixed logit and latent class logit models to analyze the data. The predicted uptake and compensating variation (CV) were used to compare different vaccination service scenarios.

RESULTS

From 1178 valid questionnaires, with an effective response rate of 92.9%, we found that effectiveness was the most significant factor influencing vaccination preference, followed by protection duration, OOP payment and waiting time, with less concern for distance. The preferred services included a 90% effective vaccine, lifetime protection, a waiting time of less than three months, a travel time of more than 60 min, and low OOP payment. Significant variability in preferences across different vaccination service scenarios was observed, affecting potential market shares. The CV analysis showed female students were willing to spend approximately CNY 5612.79 to include a hypothetical 'Service 5' (a vaccine with higher valency than the nine-valent HPV vaccine) in their prevention options.

CONCLUSIONS

The findings underscore the need for personalized, need-based HPV vaccination services that cater specifically to the preferences of female university students to increase vaccination uptake and protect their health.

Choice Consistency in Discrete Choice Experiments: Does Numeracy Skill Matter?

OBJECTIVES

This study investigated the relationship between numeracy skills (NS) and choice consistency in discrete choice experiments (DCEs).

METHODS

A DCE was conducted to explore patients' preferences for kidney transplantation in Italy. Patients completed the DCE and answered 3-item numeracy questions. A heteroskedastic multinomial logit model was used to investigate the effect of numeracy on choice consistency.

RESULTS

Higher NS were associated with greater choice consistency, increasing the scale to 1.63 (P < .001), 1.39 (P < .001), and 1.18 (P < .001) for patients answering 3 of 3, 2 of 3, and 1 of 3 questions correctly, respectively, compared with those with no correct answers. This corresponded to 63%, 39%, and 18% more consistent choices, respectively. Accounting for choice consistency resulted in varying willingness-to-wait (WTW) estimates for kidney transplant attributes. Patients with the lowest numeracy (0/3) were willing to wait approximately 42 months [95% CI: 29.37, 54.68] for standard infectious risk, compared with 33 months [95% CI: 28.48, 38.09] for 1 of 3, 28 months [95% CI: 25.13, 30.32] for 2 of 3, and 24 months [95% CI: 20.51, 27.25] for 3 of 3 correct answers. However, WTW differences for an additional year of graft survival and neoplastic risk were not statistically significant across numeracy levels. Supplementary analyses of 2 additional DCEs on COVID-19 vaccinations and rheumatoid arthritis, conducted online, supported these findings: higher NS were associated with more consistent choices across different disease contexts and survey formats.

CONCLUSIONS

The findings suggested that combining patients with varying NS could bias WTW estimates, highlighting the need to consider numeracy in DCE data analysis and interpretation.

What Can Discrete-Choice Experiments Tell Us about Patient Preferences? An Introduction to Quantitative Analysis of Choice Data

This paper provides an introduction to statistical analysis of choice data using example data from a simple discrete-choice experiment (DCE). It describes the layout of the analysis dataset, types of variables contained in the dataset, and how to identify response patterns in the data indicating data quality. Model-specification options include linear models with continuous attribute levels and non-linear continuous and categorical attribute levels. Advantages and disadvantages of conditional logit, mixed logit, and latent-class analysis are discussed and illustrated using the example DCE data. Readers are provided with links to various software programs for analyzing choice data. References are provided on topics for which there currently is limited consensus and on more advanced techniques to guide readers interested in exploring choice-modeling challenges in greater depth. Supplementary materials include the simulated example data used to illustrate modeling approaches, together with R and Matlab code to reproduce the estimates shown.

Patient preferences for generic substitution policies: a discrete choice experiment in China

Background: Generic substitution policies have been widely implemented worldwide to enhance the accessibility of medications. Nevertheless, certain patients have voiced discontent with these policies. This study aimed to evaluate the patient preferences for generic substitution policies and explore the potential for optimization to enhance patient acceptance. Methods: A discrete choice experiment (DCE) was conducted to estimate the relative importance (RI) of five attributes, including generic consistency evaluation (GCE), reimbursement rate, medication use control, information disclosure, and post-marketing surveillance. Respondents were recruited among inpatients and outpatients in three cities and surveys were conducted face-to-face. Preference coefficients, RI of attributes, and the uptake rate of various policies were computed using a mixed logit model. The interaction effects were also included to examine preference heterogeneity. Results: A total of 302 patients completed the survey. All five attributes significantly impacted policy acceptance. GCE held the highest RI value at 56.64%, followed by reimbursement rate (RI = 12.62%), information disclosure (RI = 12.41%), post-marketing surveillance (RI = 9.54%), and medication use control (RI = 8.80%). Patient preferences varied depending on their gender and income. The patient uptake rate of China's current policy was only 68.56%. If all generics were to pass GCE without altering the other attributes, the uptake rate of policies would rise to 82.63%. Similarly, implementing information disclosure without changing other attributes would result in a 78.67% uptake rate, which is comparable to the effect of a 10% increase in reimbursement rate for generics (78.81%). Combining these policies could mitigate the adverse effects of mandatory substitution on patient. Conclusion: Chinese patient preferences for generic substitution policies were mainly influenced by GCE. China's current generic substitution policy has room for further optimization to enhance patient acceptance.

Obtaining preference scores for an abbreviated self-completion version of the Teen-Addiction Severity Index (ASC T-ASI) to value therapy outcomes of systemic family interventions: a discrete choice experiment

BACKGROUND

Systemic family interventions for adolescents with problems of substance use and/or delinquency are increasingly focused subject of economic evaluations. Treatment effects go beyond improvements in commonly measured health-related quality of life (HRQOL). The Teen-Addiction Severity Index (T-ASI) was identified as capable of capturing these broad outcomes. However, it lacks preference-based scores. An abbreviated self-completion version (ASC T-ASI) was created and validated, covering the T-ASI domains substance use, school, work, family, social relationships, justice, and mental health. This study aimed to obtain societal preference scores for the ASC T-ASI.

METHODS

Preferences were elicited in a sample of the Dutch general adult population (n = 1500), using a web-based Discrete Choice Experiment. Choice tasks included two unlabeled alternatives with attributes and levels corresponding to the domains and levels of the ASC T-ASI. A pilot study (n = 106) informed priors, optimal presentation, and number of choice tasks applied in the main study. Data were analyzed using a mixed multinomial logit model.

RESULTS

Preference scores were logically ordered, with lower scores for worse ASC T-ASI states. Scores were most influenced by reductions in problems concerning the domains substance use, mental health, justice, and family. Tariffs were calculated for each ASC T-ASI state, ranging from 0 (worst situation) to 1 (best situation).

CONCLUSIONS

The tariffs enable preference-based assessments of the broad effects of systemic family interventions for adolescents with problems of substance use and/or delinquency. The outcome reflects addiction-related rather than health-related utility and can be used next to generic HRQOL instruments in relevant economic evaluations. Given the source used for the preferences, interpretations and valuation of scores require attention.

Public preferences and willingness to pay for a net zero NHS: a protocol for a discrete choice experiment in England and Scotland

INTRODUCTION

Climate change poses a major threat to our health, livelihoods and the planet. In 2020, the UK National Health Service (NHS) committed to reducing its Scope 1, 2 and 3 emissions to reach net zero by 2045. Although a net zero NHS would help to limit the consequences of climate change, little is known about the UK general public's values and preferences for the proposed service changes needed to reach net zero.

METHODS

This study will elicit the public's preferences for actions to help achieve net zero NHS in England and Scotland using a discrete choice experiment (DCE). The DCE attributes and levels describe actions that can be taken by the NHS across key areas: buildings and estates, outdoor space, travel and transport, provision of care, goods and services and food and catering. The survey was designed using online think-aloud interviews with 17 members of the public. Two versions of the survey will be administered to a sample of up to 2200 respondents. One will include a payment vehicle as income tax increases. We will estimate the relative importance of each attribute and, for the former survey, the monetary trade-offs which individuals are willing to make between attributes. Where possible, we will match both samples to gauge preference robustness with the inclusion of the monetary payment. We will test whether respondents' preferences differ based on their socioeconomic circumstances and attitudes toward the NHS and climate change.

ETHICS AND DISSEMINATION

The University of Aberdeen's School of Medicine, Medical Sciences and Nutrition Ethics Research Board has approved the study (reference: SERB/690090). All participants will provide informed consent. Results will be submitted to peer-reviewed publications and presented at relevant conferences and seminars. A lay summary of the research will be published on the Health Economics Research Unit website.

Treatment Preferences for Acute Allergic Reactions: A Discrete Choice Experiment

Background: Timely treatment of acute allergic reactions (AARs) is important to minimize reaction severity. Corticosteroid tablets dissolved in water are commonly used in mainstay treatment. A new oral film that dissolves on the tongue provides a faster and less cumbersome alternative to tablets for corticosteroid administration during AARs. This study evaluated patients' preferences for attributes related to administration mode of corticosteroids in AARs. Methods: A web-based survey was sent to a sample from the adult Swedish population (≥18 years) with experience of corticosteroid treatment for AAR. We assessed the willingness to pay (WTP) for attributes related to corticosteroid treatment by applying a discrete choice experiment (DCE) approach. DCE attributes were administration mode, time to symptom relief, and price. The WTP for each attribute was derived using the attribute's coefficient in a logistic regression analysis. We specified a forced choice (FC) and an unforced choice (UC) model. In the FC model, the respondents chose between 2 hypothetical treatments and in the UC model, between any of 2 hypothetical treatments and their current treatment. Results: The final study population included 348 subjects, of which 80% were women. All the evaluated DCE attributes were significant predictors for the treatment choice (p<.001). In the FC model, the incremental WTP for an oral film compared with tablets was 409 Swedish kronor (SEK [≈€36.7]), with no other factors considered. In the UC model, the incremental WTP for the oral film compared with tablets was 574 SEK (≈€51.7). After considering the value of the respondents' current treatment, the WTP for the oral film decreased to 336 SEK (≈€30.3). The total WTP was reduced by 17 SEK (≈€1.5) per minute of shorter time to symptom relief. Subgroup analyses showed that people with circulatory symptoms and experience of swallowing difficulties related to allergy medication had higher WTP for the oral film than the average respondent. Conclusion: The findings show a substantial economic benefit of the oral film vs tablets for patients with AARs in Sweden. This result remained also after compensation for the full value of the patients' current treatment.

A pilot study on preferences from surgeons to deal with an innovative customized and connected knee prosthesis - A discret choice experiment

Background

To address the increasing global demand for Total Knee Arthroplasty and reduce the need for revisions, several technologies combining 3D planning and artificial intelligence have emerged. These innovations aim to enhance customization, improve component positioning accuracy and precision. The integration of these advancements paves the way for the development of personalized and connected knee implant.

Questions/purposes

These groundbreaking advancements may necessitate changes in surgical practices. Hence, it is important to comprehend surgeons' intentions in integrating these technologies into their routine procedures. Our study aims to assess how surgeons' preferences will affect the acceptability of using this new implant and associated technologies within the entire care chain.

Methods

We employed a Discrete Choice Experiment, a predictive technique mirroring real-world healthcare decisions, to assess surgeons' trade-off evaluations and preferences.

Results

A total of 90 experienced surgeons, performing a significant number of procedures annually (mostly over 51) answered. Analysis indicates an affinity for technology but limited interest in integrating digital advancements like preoperative software and robotics. However, they are receptive to practice improvements and considering the adoption of future sensors.

Conclusions

In conclusion, surgeons prefer customized prostheses via augmented reality, accepting extra cost. Embedded sensor technology is deemed premature by them.

Putting the Choice in Choice Tasks: Incorporating Preference Elicitation Tasks in Health Preference Research

Choice-based preference elicitation methods such as the discrete choice experiment (DCE) present hypothetical choices to respondents, with an expectation that these hypothetical choices accurately reflect a 'real world' health-related decision context and that consequently the choice data can be held to be a true representation of the respondent's health or treatment preferences. For this to be the case, careful consideration needs to be given to the format of the choice task in a choice experiment. The overarching aim of this paper is to highlight important aspects to consider when designing and 'setting up' the choice tasks to be presented to respondents in a DCE. This includes the importance of considering the potential impact of format (e.g. choice context, choice set presentation and size) as well as choice set content (e.g. labelled and unlabelled choice sets and inclusion of reference alternatives) and choice questions (stated choice versus additional questions designed to explore complete preference orders) on the preference estimates that are elicited from studies. We endeavoure to instil a holistic approach to choice task design that considers format alongside content, experimental design and analysis.

Treatment Preferences of Adolescents and Young Adults with Depressive Symptoms: A Discrete Choice Experiment

BACKGROUND

Depression in adolescents and young adults is common and causes considerable disease burden while hampering their development, leading to adverse consequences in later life. Although treatment is available, young people are a vulnerable group regarding uptake and completion of treatment. To improve this, insight into youth's preferences for treatment is essential.

OBJECTIVE

The aim of this study was to investigate patient preferences for depression treatment in a Dutch sample aged 16-24 years using a discrete choice experiment (DCE).

METHODS

The study was conducted in The Netherlands between October 2018 and June 2019, and included 236 adolescents and young adults with current depressive symptoms or previous treatment. The DCE included five attributes (treatment type, frequency of appointment, waiting time, effectiveness, evaluation of therapeutic alliance) with corresponding levels. Results were analysed using latent class analysis.

RESULTS

Results show a general preference for individual psychotherapy, treatment with high frequency, high effectiveness, short waiting time and a standard evaluation of the therapeutic alliance ('click' with the therapist) early in treatment. Latent class analysis revealed three different patterns of preferences regarding treatment type and willingness to engage in therapy. The first class showed a strong preference for individual therapy. The second class, including relatively older, higher educated and treatment-experienced participants, preferred high frequency treatment and was more open to different forms of therapy. The third class, including lower educated, younger and treatment-naïve adolescents showed reluctance to engage in therapy overall and in group therapy specifically.

CONCLUSION

In this DCE, three classes could be identified that share similar preferences regarding treatment effectiveness, waiting time and evaluation of the therapeutic alliance, but varied considerably in their preference for treatment type (individual, group, or combined psychotherapy) and their willingness to engage. The results from this study may inform mental health care providers and institutions and help optimize professional care for adolescents and young adults with depressive symptoms, improving engagement in this vulnerable group.

Preferences for Genetic Testing to Predict the Risk of Developing Hereditary Cancer: A Systematic Review of Discrete Choice Experiments

BACKGROUND

Understanding service user preferences is key to effective health care decision making and efficient resource allocation. It is of particular importance in the management of high-risk patients in whom predictive genetic testing can alter health outcomes.

PURPOSE

This review aims to identify the relative importance and willingness to pay for attributes of genetic testing in hereditary cancer syndromes.

DATA SOURCES

Searches were conducted in Medline, Embase, PsycINFO, HMIC, Web of Science, and EconLit using discrete choice experiment (DCE) terms combined with terms related to hereditary cancer syndromes, malignancy synonyms, and genetic testing.

STUDY SELECTION

Following independent screening by 3 reviewers, 7 studies fulfilled the inclusion criteria, being a DCE investigating patient or public preferences related to predictive genetic testing for hereditary cancer syndromes.

DATA EXTRACTION

Extracted data included study and respondent characteristics, DCE attributes and levels, methods of data analysis and interpretation, and key study findings.

DATA SYNTHESIS

Studies covered colorectal, breast, and ovarian cancer syndromes. Results were summarized in a narrative synthesis and the quality assessed using the Lancsar and Louviere framework.

LIMITATIONS

This review focuses only on DCE design and testing for hereditary cancer syndromes rather than other complex diseases. Challenges also arose from heterogeneity in attributes and levels.

CONCLUSIONS

Test effectiveness and detection rates were consistently important to respondents and thus should be prioritized by policy makers. Accuracy, cost, and wait time, while also important, showed variation between studies, although overall reduction in cost may improve uptake. Patients and the public would be willing to pay for improved detection and clinician over insurance provider involvement. Future studies should seek to contextualize findings by considering the impact of sociodemographic characteristics, health system coverage, and insurance policies on preferences.

HIGHLIGHTS

Test effectiveness and detection rates are consistently important to respondents in genetic testing for hereditary cancer syndromes.Reducing the cost of genetic testing for hereditary cancer syndromes may improve uptake.Individuals are most willing to pay for a test that improves detection rates, identifies multiple cancers, and for which results are shared with a doctor rather than with an insurance provider.

Estimating preferences and willingness to pay for pharmacogenetic testing in populations who are medically underserved: a discrete choice experiment

Background: The implementation of pharmacogenetic (PGx) testing may contribute to health disparities if access to testing is inequitable, as medically underserved patients are prescribed higher rates of drugs with PGx guidelines and often experience the benefits of emerging health technologies last. Limited research has evaluated potential implementation of PGx testing in populations who are medically underserved and none have evaluated their preferences regarding PGx test characteristics and cost. Our study endeavored to assess the willingness to pay for PGx testing and key PGx test preferences in a nationwide cohort of medically underserved respondents. Methods: A survey was developed to assess willingness to pay and preferences for PGx testing through a discrete choice experiment (DCE). Five attributes of PGx tests were included in the DCE: doctor recommendation, wait time, number of actionable results, benefit of the test (avoid a side effect or address a health problem), and out-of-pocket cost. A convenience sample of U.S. adults with an average yearly household income of $42,000 or less was collected utilizing an online survey fielded by Qualtrics Research Services (Provo, UT). For the DCE analysis, conditional logit and mixed-logit regression models were utilized to determine relative utility of attributes and levels, conditional relative importance for each attribute, and marginal willingness to pay. Results: Respondents completed the survey with an 83.1% response completion rate. Following quality control procedures, 1,060 respondents were included in the final nationwide cohort. Approximately, 82% of respondents were willing to pay less than $100 for PGx testing, and a strong price ceiling was identified at $200. Out-of-pocket cost was the attribute identified as having the greatest relative importance on choice, while wait time had the lowest importance. Greater utility was observed if the PGx test was doctor recommended, had a higher number of actionable results, and resolved major or minor health problems compared with avoiding side effects. Conclusion: This first-of-its-kind study provides important insights into the willingness to pay for PGx testing and PGx test preferences of a large medically underserved population. Applying these findings can potentially lead to improvements in the successful implementation of PGx testing in this population.

Eliciting Depression Patients' Preferences for Medication Management: A Protocol for Discrete Choice Experiment

Introduction

Depression threatens people's lives and imposes huge economic burden. Antidepressant therapy is the first-line treatment for depression, and patient adherence to medication is the key to successful treatment. Depression patients have poor medication adherence, which leads to failure of depression management and significantly poorer clinical outcomes. Incorporating patient preferences into clinical decisions can improve uptake rates, optimize treatment adherence. A discrete choice experiment (DCE) can elicit and quantify individual preferences. Previous DCE studies were conducted in developed countries and ignored the influences of factors other than the medication. This paper outlines an ongoing DCE that aims to (1) explore medication-management-related characteristics that may affect depression patients' adherence to antidepressant, (2) elicit how depression patients consider the trade-offs among different medication managements.

Methods

The six attributes and their levels were developed through a literature review, semi-structured interviews and experts and focus group discussions. A fractional factorial design in the software Ngene 1.2 version was used to generate 36 choice sets, and they were divided into 3 blocks. A mixed logit model will be used to explore the patients' preferences, willingness to pay and uptake rate of depression patients for medication management attributes.

Results

The final questionnaire consists of three parts. The first is the introduction, which introduces the purpose of the study and the requirements of completing the questionnaire. This was followed by a general information questionnaire, which included sociodemographic characteristics. The last part is DCE tasks, which include 13 DCE choice sets, and each choice set include two alternative and one "opt-out" option. The pilot-test results showed the questionnaire was easy to understand and could be used in formal surveys.

Conclusion

Our study shows how the development process of the study can be conducted and reported systematically and rigorously according to the theoretical foundation and design principles in DCE.

Heterogeneity in physician's job preferences in a dual practice context - Evidence from a DCE

Many countries are facing challenges in recruiting and retaining physicians, particularly in regions where the public and private sectors compete for doctors. Understanding the factors influencing physicians' job choices can help inform policies aimed at attracting and retaining this valuable workforce. This study aims to elicit the strength of physicians' preferences regarding various job-related aspects, including earnings, time flexibility, discussion of clinical cases, frequency of facilities and equipment updates, training opportunities and autonomy in decision making. To achieve this, a Discrete Choice Experiment (DCE) was administered to 697 physicians. Each participant completed a series of eight choice tasks, where they had to choose between two hypothetical jobs differing in these attributes with levels mirroring positions in the public and private sectors in Portugal. The resulting choices were analysed using mixed logit, generalized multinomial logit and latent classes models to account for diverse unobserved variations in physicians' preferences and to explore preference heterogeneity across different observable characteristics. Jobs that offered more autonomy and training opportunities were strongly preferred, as physicians would require additional compensation to work with reduced autonomy (equivalent to 28.62% of gross income) or less frequent training (equivalent to 22.75%). This study also shows that the ranking of the job characteristics is similar between physicians working exclusively in the public sector and those engaged in dual practice. Nevertheless, public sector physicians place more emphasis on the availability of frequent training possibilities and frequent updates of facilities and equipment compared to their counterparts in dual practice. These findings contribute to existing knowledge by highlighting the significance of non-monetary attributes and shedding light on the preferences of physicians across various employment scenarios. They offer valuable insights for policy development aimed at influencing physicians' allocation of time between sectors.

Preferences and Willingness to Pay for Medication in Patients with Renal Cell Carcinoma in China: A Discrete-Choice Experiment

OBJECTIVE

We aimed to assess the relative importance of attributes and the willingness to pay for pharmacological therapies among patients with renal cell carcinoma in China.

METHODS

Patients with renal cell carcinoma completed a D-efficient-designed, discrete-choice experiment online survey that presented a series of ten trade-off questions and one examining scenario. Based on the literature review and consultations with patients with renal cell carcinoma and clinicians, each question included a pair of hypothetical renal cell carcinoma medication profiles characterized by seven attributes including progression-free survival, objective response rate, medication regimen, fatigue, gastrointestinal reaction, hand-foot syndrome, and monthly out-of-pocket costs. Relative importance and willingness to pay were calculated using coefficients estimated by mixed logit regression in the main analysis. Subgroup analyses were conducted considering the heterogeneity of the participants, based on sex, education level, and income level, using conditional logit regression.

RESULTS

The analysis incorporated responses from 182 Chinese respondents. Except for the medication regimen, all attributes were statistically significant. Progression-free survival was the most important attribute, followed by objective response rate, monthly out-of-pocket costs, fatigue, gastrointestinal reaction, and hand-foot syndrome. Patients were willing to pay ￥2010.51 ($298.30), ￥494.93 ($73.43) for 1 unit improvement of progression-free survival, and objective response rate, and￥7558.93 ($1121.50), ￥6927.24 ($1027.78) to avoid experiencing fatigue and gastrointestinal reaction, respectively. Differences in preferences and willingness to pay were found according to patients' gender, income, and education level.

CONCLUSIONS

In China, patients with renal cell carcinoma preferred medications with better efficacy (objective response rate and progression-free survival) and lower out-of-pocket costs. Heterogeneity can be found in preferences and willingness to pay based on patients' gender, income, and education levels.

Preferences for Living Arrangements in Dementia: A Discrete Choice Experiment

BACKGROUND

Dementia affects about 55 million people worldwide. Demographic change and shifting lifestyles challenge the organization of dementia care. A discrete choice experiment (DCE) was conducted to elicit preferences for living arrangements in dementia in urban and rural regions of Germany.

METHODS

Preliminary work included review of previous literature and focus groups. The DCE consists of seven attributes (group size, staff qualifications, organization of care, activities offered, support of religious practice, access to garden, consideration of food preferences) with three levels each. Individuals from the general population between the ages of 50 and 65 years were identified through population registration offices in three rural municipalities and one urban area, and 4390 individuals were approached via postal survey. A hierarchical Bayesian mixed logit model was estimated and interactions with sociodemographic characteristics were investigated.

RESULTS

A total of 428 and 412 questionnaires were returned by rural and urban respondents, respectively. Access to a garden was perceived as the most important attribute (average importance 36.0% in the rural sample and 33.4% in the urban sample), followed by consideration of food preferences (15.8%, 17.8%), staff qualification (14.6%, 15.3%), care organization (11.4%, 12.3%), group size (12.2%, 11.1%), and range of activities (8.0%, 10.1%). The attribute relating to religious practice was given the least importance (2.1%, 0%). Preferences vary according to gender, age, religious beliefs, experience as an informal caregiver, and migrant background.

CONCLUSION

Heterogeneous preferences for living arrangements for people with dementia were identified. The expansion of concepts with access to natural environments for persons with dementia might be a viable option for the formal care market in Germany. Further research is needed to meet the challenges of setting up and designing innovative living arrangements for people with dementia. Preferences vary by gender, age, religious beliefs, experience as an informal caregiver, and migrant background.

Preferences of pregnant women toward a future maternal Group B Streptococcus vaccine in China: A cross-sectional survey with a discrete choice experiment

Group B streptococcus (GBS) is a major cause of neonatal death worldwide. A GBS vaccine for pregnant women is under development and is expected to be available in the near future. The perceptions and preferences of pregnant women in China of GBS vaccines has not been investigated, and this study aimed to investigate pregnant women's awareness of GBS and their potential preferences for the GBS vaccine. A discrete choice experiment was conducted among pregnant women in hospitals from Shaanxi, Hunan, and Zhejiang provinces located in Western, Central, and Eastern China, respectively. A conditional logit model was used to analyze the data and calculate willingness to pay values and choice probabilities of different GBS vaccine programs. A total of 354 pregnant women were included in the final analysis, 45.8% of whom were willing to receive a GBS vaccine if it were licensed. Vaccine safety was the most important attribute of a future vaccine, while cost was the least important attribute. Compared with no vaccination, pregnant women had a strong preference for future GBS vaccination (ASC = 1.267, p < .001). Pregnant women's decisions were highly influenced by those of other pregnant women. Improving the safety, efficacy, and vaccination rate of the GBS vaccine in China is of great significance for future GBS vaccine development and vaccination. Compared to other variable options, the cost of a GBS vaccine was of the least importance among pregnant women in mainland China. These findings can inform public health policy decisions related to GBS vaccination in China.

Eliciting preferences in glaucoma management-a systematic review of stated-preference studies

BACKGROUND

In most cases, glaucoma patients require long-term medical and/or surgical treatment. Preference studies investigate how different aspects of glaucoma management, such as health or process outcomes, are valued and herewith help stakeholders make care more responsive to patients' needs. As, to our knowledge, no overview of these studies is currently available, this study aims to systematically review and critically appraise these studies.

METHODS

A systematic literature review was conducted using keywords for stated-preference studies and glaucoma up to October 2021. Studies were included if they were original research and used a stated-preference methodology to investigate preferences in patients or healthcare professionals for different aspects of glaucoma management. Data were extracted and summarized. Furthermore, a quality appraisal of the included studies was performed using two validated checklists.

RESULTS

The search yielded 1214 articles after removal of duplicates. Of those, 11 studies fulfilled the inclusion criteria. Studies aimed to elicit preferences for glaucoma treatment (27%), glaucoma related health state valuation (36%), and services (36%) from the patient (91%) or ophthalmologists' perspective (9%). Altogether studies included 69 attributes. The majority of attributes were outcome related (62%), followed by process (32%) and cost attributes (6%). Outcome attributes (e.g., effectiveness) were most often of highest importance to the population.

CONCLUSIONS

This systematic review provides an up-to-date and critical review of stated-preference studies in the field of glaucoma, suggesting that patients have preferences and are willing to trade-off between characteristics, and revealed that outcome attributes are the most influential characteristics of glaucoma management.

Preferences of People Living with HIV for Long-Acting Antiretroviral Treatment in Germany: Evidence from a Discrete Choice Experiment

OBJECTIVE

This study aimed to elicit preferences for attributes of current and novel long-acting antiretroviral therapy for human immunodeficiency virus treatment.

METHODS

Primary survey data were collected (July-October 2022) on a sample of 333 people living with human immunodeficiency virus in Germany from a patient recruitment agency. Respondents were invited by e-mail to respond to a web-based questionnaire. After performing a systematic literature review, we conducted qualitative semi-structured interviews to identify and select the key attributes of drug therapy for patients' preferences for human immunodeficiency virus treatment. Based on this, a discrete choice experiment survey elicited preferences for long-acting antiretroviral therapy characteristics, including the type of medication, frequency of dosing, the location of treatment, the risk of both short-term and long-term side effects, as well as possible interactions with other medications or (party) drugs. A statistical data analysis was performed using multinomial logit models. An additional latent class multinomial logit was performed to evaluate subgroup differences.

RESULTS

Overall, 226 respondents (86% male, mean age 46.1 years) were included in the analysis. The frequency of dosing (36.1%) and the risk of long-term side effects (28.2%) had the greatest influence on preferences. The latent class analysis identified two patient groups. While the first class (n = 135; 87% male, mean age 44.4 years) found the frequency of dosing (44.1%) to be most important, the second class (n = 91; 85% male, mean age 48.6 years) focused on the risk of long-term side effects (50.3%). The evaluation of structural variables showed that male respondents, those living in small cities or villages, and those with better health status results were significantly more likely to be assigned to the second class (p < 0.05 each).

CONCLUSIONS

All attributes included in our survey were important to participants when choosing an antiretroviral therapy. We found evidence that the frequency of dosing as well as the risk of long-term side effects have a particular impact on the acceptance of novel therapy regimens and should be considered in order to optimize adherence and satisfaction.

Preference for daily oral pills over long-acting antiretroviral therapy options among people with HIV

OBJECTIVE

To examine the characteristics of people with HIV (PWH) who prefer remaining on daily oral antiretroviral therapy (ART), rather than switching to long-acting ART (LA-ART).

DESIGN

Building upon a discrete choice experiment (DCE), we examined characteristics of individuals who always selected their current daily oral tablet regimen over either of two hypothetical LA-ART options presented in a series of 17 choice tasks.

METHODS

We used LASSO to select sociodemographic, HIV-related, and other health-related predictors of preferring current therapy over LA-ART, and logistic regression to measure the associations with those characteristics.

RESULTS

Among 700 PWH in Washington State and Atlanta, Georgia, 11% of participants ( n  = 74) chose their current daily treatment over LA-ART in all DCE choice tasks. We found that people with lower educational attainment, good adherence, more aversion to injections, and who participated from Atlanta to be more likely to prefer their current daily regimen over LA-ART.

CONCLUSIONS

Gaps in ART uptake and adherence remain, and emerging LA-ART treatments show promise to address these challenges and help a larger portion of PWH to achieve viral suppression, but preferences for these new treatments are understudied. Our results show that certain drawbacks of LA-ART may help to maintain demand for daily oral tablets, especially for PWH with certain characteristics. Some of these characteristics (lower educational attainment and Atlanta participation) were also associated with a lack of viral suppression. Future research should focus on overcoming barriers that impact preferences for LA-ART among those patients who could benefit most from this innovation.

Discrete choice experiment versus swing-weighting: A head-to-head comparison of diabetic patient preferences for glucose-monitoring devices

INTRODUCTION

Limited evidence exists for how patient preference elicitation methods compare directly. This study compares a discrete choice experiment (DCE) and swing-weighting (SW) by eliciting preferences for glucose-monitoring devices in a population of diabetes patients.

METHODS

A sample of Dutch adults with type 1 or 2 diabetes (n = 459) completed an online survey assessing their preferences for glucose-monitoring devices, consisting of both a DCE and a SW exercise. Half the sample completed the DCE first; the other half completed the SW first. For the DCE, the relative importance of the attributes of the devices was determined using a mixed-logit model. For the SW, the relative importance of the attributes was based on ranks and points allocated to the 'swing' from the worst to the best level of the attribute. The preference outcomes and self-reported response burden were directly compared between the two methods.

RESULTS

Participants reported they perceived the DCE to be easier to understand and answer compared to the SW. Both methods revealed that cost and precision of the device were the most important attributes. However, the DCE had a 14.9-fold difference between the most and least important attribute, while the SW had a 1.4-fold difference. The weights derived from the SW were almost evenly distributed between all attributes.

CONCLUSIONS

The DCE was better received by participants, and generated larger weight differences between each attribute level, making it the more informative method in our case study. This method comparison provides further evidence of the degree of method suitability and trustworthiness.

Development of a discrete choice experiment questionnaire to elicit preferences by pregnant women and policymakers for the expansion of non-invasive prenatal screening

OBJECTIVE

An instrument for measuring intervention preferences applicable to both patients and policymakers would make it possible to better confront the needs of the supply and demand sides of the health care system. This study aimed to develop a discrete choice experiments (DCE) questionnaire to elicit the preferences of patients and policymakers. The instrument was specifically developed to estimate preferences for new conditions to be added to a screening program for fetal chromosomal anomalies.

METHODS

A DCE development study was conducted. The methods employed included a literature review, a qualitative study (based on individual semi-structured interviews, consultations, and a focus group discussion) with pregnant women and policymakers, and a pilot project with 33 pregnant women to validate the first version of the instrument and test the feasibility of its administration.

RESULTS

An initial list of 10 attributes was built based on a literature review and the qualitative research components of the study. Five attributes were built based on the responses provided by the participants from both groups. Eight attributes were consensually retained. A pilot project performed on 33 pregnant women led to a final instrument containing seven attributes: 'conditions to be screened', 'test performance', 'moment at gestational age to obtain the test result', 'degree of test result certainty to the severity of the disability', 'test sufficiency', 'information provided from test result', and 'cost related to the test'.

CONCLUSION

It is possible to reach a consensus on the construction of a DCE instrument intended to be administered to pregnant women and policymakers. However, complete validation of the consensual instrument is limited because there are too few voting members of health technology assessment agencies committees to statistically ascertain the relevance of the attributes and their levels.

Preferences for support in managing symptoms of an asthma flare-up: a pilot study of a discrete choice experiment

Objective: Information on the preferences of people with asthma for support in managing a flare-up can inform service design which may facilitate appropriate help-seeking. To date, little is known about support preferences for managing a flare-up. The aim of this study was to develop and pilot a discrete choice experiment (DCE) to elicit the preferences of people with asthma with regards to support in managing a flare-up.Methods: Steps in developing the DCE included identification and selection of attributes and levels of the support services, construction of choice tasks, experimental design, construction of DCE instrument, and pretest (n=16) and pilot (n=38) studies of the DCE instrument. A multinomial logit model was used to examine the strength and direction of the six attributes in the pilot study.Results: Our results indicate that from a patient perspective, having a healthcare professional that listens to their concerns was the most valued attribute of support in asthma flare-up management. The other features of support valued by participants were timely access to consultation, a healthcare professional with knowledge of their patient history, a specialist doctor and face-to-face communication. Having a written action plan was the least valued attribute.Conclusions: Our findings suggest patient preference for a model of support in managing their symptoms which includes timely, face-to-face access to a healthcare professional that knows them and listens to their concerns. The findings of the pilot study need to be verified with a larger sample and using models to account for preference heterogeneity.

The Impact of Video-Based Educational Materials with Voiceovers on Preferences for Glucose Monitoring Technology in Patients with Diabetes: A Randomised Study

INTRODUCTION

Ensuring patients have enough information about healthcare choices prior to completing a preference study is necessary to support the validity of the findings. Patients are commonly informed using text-based information with supporting graphics. Video-based information may be more engaging for the general patient population. This study aimed to assess (1) the impact that educating patients using video-based educational materials with a voiceover has on patient preferences compared to traditional text, and (2) whether this impact is consistent between two countries.

MATERIALS AND METHODS

A video-based educational tool was developed to inform patients prior to completing a discrete choice experiment assessing preferences for glucose monitors. Patients with diabetes from the Netherlands and Poland were recruited through an online research panel. Respondents were randomised to receive information in either a text or a video with animations and a voiceover. Data were analysed using a mixed-logit model.

RESULTS

N = 981 completed surveys were analysed from the Netherlands (n = 459) and Poland (n = 522). Differences were found between the countries, but no interpretable pattern of differences was found between the two types of educational materials. Patients spent less time in the educational material than would be necessary to fully review all of the content.

CONCLUSIONS

Simply providing educational material in a video with animations and voiceovers does not necessarily lead to better engagement from respondents or different preference outcomes in a sample of diabetes patients when compared to text. Increasing engagement with educational materials should be a topic of future research for those conducting patient preference research as no amount of educational material will be helpful if respondents do not access it.

Diabetes patient preferences for glucose-monitoring technologies: results from a discrete choice experiment in Poland and the Netherlands

INTRODUCTION

New glucose-monitoring technologies have different cost-benefit profiles compared with traditional finger-prick tests, resulting in a preference-sensitive situation for patients. This study aimed to assess the relative value adults with diabetes assign to device attributes in two countries.

RESEARCH DESIGN AND METHODS

Adults with type 1 or 2 diabetes from the Netherlands (n=226) and Poland (n=261) completed an online discrete choice experiment. Respondents choose between hypothetical glucose monitors described using seven attributes: precision, effort to check, number of finger pricks required, risk of skin irritation, information provided, alarm function and out-of-pocket costs. Panel mixed logit models were used to determine attribute relative importance and to calculate expected uptake rates and willingness to pay (WTP).

RESULTS

The most important attribute for both countries was monthly out-of-pocket costs. Polish respondents were more likely than Dutch respondents to choose a glucose-monitoring device over a standard finger prick and had higher WTP for a device. Dutch respondents had higher WTP for device improvements in an effort to check and reduce the number of finger pricks a device requires.

CONCLUSION

Costs are the primary concern of patients in both countries when choosing a glucose monitor and would likely hamper real-world uptake. The costs-benefit profiles of such devices should be critically reviewed.

Salary, flexibility or career opportunity? A choice experiment on gender specific job preferences

Using the evaluation of hypothetical job offers in a discrete choice experiment, we analyse which characteristics of employment positions are relevant to men and women when deciding between job offers. Thereby, we investigate whether preferences for work arrangements are gender specific. The analysis shows that on average, women have a stronger preference for part-time work than men, and that the career prospect of a job is more important to men than to women. Furthermore, we use heterogeneity within genders to study whether gender specific preference patterns result from gendered considerations of family formation. We find that certain men and women, especially those who plan to have children and have traditional intentions about the division of labor in the household, evaluate work relationships more strongly according to gender roles than others. This analysis of hypothetical employment choices provides valuable insight into the preference structure of men and women, which proves to be heterogeneous within and between genders.

How Do Treatment Preferences of Patients With Cancer Compare With Those of Oncologists and Family Members? Evidence From a Discrete Choice Experiment in China

OBJECTIVES

This study aimed to compare the treatment preference among oncologists, patients with lung cancer, and their family members in China.

METHODS

A face-to-face discrete choice experiment survey was conducted among oncologists, patients, and their family members. Participants completed 13 choice sets describing 6 key attributes, namely, overall survival time, risk of severe adverse effect, severity of pain, appetite, physical functioning status, and monthly cost. Mixed logit model and latent class analysis were used to estimate attribute level preference weights and the relative importance (RI) for attributes. The willingness to pay (WTP) and maximum acceptable risk (MAR) were also estimated. The RI, WTP, and MAR of oncologists, patients, and family members were compared.

RESULTS

A total of 121 oncologists and 161 dyads of patients and family members completed the survey. Overall survival time, physical functioning status, and pain were the 3 most important attributes across all 3 groups. Oncologists and family members had higher RI on overall survival time than patients (48% and 51% vs 38%). Patients had higher RI on physical functioning status and pain (23% and 14%) than oncologists (13% and 12%) and family members (16% and 11%). For extending survival, patients had the least WTP, and family members had the highest MAR. The latent class analysis identified 2 classes in the patient group and 3 classes in oncologist and family member groups.

CONCLUSIONS

There were differences in preferences for survival, risk, quality of life, and costs associated with cancer treatments among patients, oncologists, and family members. This finding highlights the need of involving patients in treatment decision making in China.

Preferences for private health insurance in China: A discrete choice experiment

Introduction

There is limited evidence on the sustainability and optimal design of China's private health insurance market, especially from the demand-side. With the increasing medical cost burden on both patients and the social security system, policy makers need data on potential clients' demand for private health insurance.

Methods

A discrete choice experiment was conducted to explore potential clients' preferences for a type of government-involved private supplementary health insurance, Huimin Insurance, in China. A mixed logit model was used to evaluated participants' preferences for six attributes. Willingness to pay, subgroup analysis and interaction effects were estimated based on the initial model.

Results

Among the 947 participants, 883 (93.2%) were aged 18 to 59 years and 578 (61.0%) were female. Participants had a strong preference for government involvement, extensive benefit packages, high reimbursement ratio and compensation for pre-existing conditions. With respect to the attribute of deductible, participants were indifferent between the level of CNY15,000 and CNY18,000 but had strong and significant preference for the level of CNY15,000 than CNY20,000. The premium was significantly correlated with a decline in the utility of PHI.

Conclusions

All attributes had a significant impact on participants' preference for Huimin Insurance. Providing a reference point for the development of private health insurance in China, our results inform the optimal design of PHI, especially Huimin Insurance's products.

Methodology to derive preference for health screening programmes using discrete choice experiments: a scoping review

BACKGROUND

While involving users in healthcare decision-making has become increasingly common and important, there is a lack of knowledge about how to best design community-based health screening programs. Reviews of methods that incorporate discrete choice experiments (DCEs) are scarce, particularly for non-cancer illnesses like cardiovascular disease, diabetes and liver disease. We provide an overview of currently available applications and methods available by using DCEs in health screening programs, for chronic conditions.

METHODS

A scoping review was undertaken, where four electronic databases were searched for key terms to identify eligible DCE studies related to community health screening. We included studies that met a pre-determined criteria, including being published between 2011 and 2021, in English and reported findings on human participants. Data were systematically extracted, tabulated, and summarised in a narrative review.

RESULTS

A total of 27 studies that used a DCE to elicit preferences for cancer (n = 26) and cardiovascular disease screening (n = 1) programmes were included in the final analysis. All studies were assessed for quality, against a list of 13 criteria, with the median score being 9/13 (range 5-12). Across the 27 studies, the majority (80%) had the same overall scores. Two-thirds of included studies reported a sample size calculation, approximately half (13/27) administered the survey completely online and over 75% used the general public as the participating population.

CONCLUSION

Our review has led to highlighting several areas of current practice that can be improved, particularly greater use of sample size calculations, increased use of qualitative methods, better explanation of the chosen experimental design including how choice sets are generated, and methods for analysis.

Food Choices and Hypertension Among Rural Thais: Evidence From a Discrete Choice Experiment

Objective: The rural northern region of Thailand exhibits the highest rate of hypertension. This study explored hypertensive-related food choices between normotensive and hypertensive people residing in rural northern Thailand to determine which food attributes influence their choices. Methods: The study conducted a discrete choice experiment (DCE) survey among Thai adults residing in rural northern Thailand (n = 403) to estimate the relative importance of four food attributes, including food preparation, price, taste, and amount of salt. A mixed logit model was used to analyze the data from the DCE. Results: The first and second most important attributes in both hypertensive and normotensive groups were the amount of salt and food preparation at home, respectively, followed by price and taste. Specifically, the normotensive group was more attentive to the amount of salt in their food than their hypertensive counterparts. Conclusion: Intervention programs in rural communities may benefit from focusing their attention on embracing low-salt cultural foods and providing guidance on how to add flavor without additional salt or reduce high sodium seasonings without losing flavor when cooking.

Choice experiment selection of tourism destinations in a dual process theory framework: The role of decision style and potential to promote deliberation

Models of consumer choice that assume rational decision processes are too simplistic, as they ignore intuitive processes and combinations of intuition and rationality. In dual process theory, System 1 processes are intuitive, fast, require low cognitive effort, and involve autonomous systems, while System 2 processes are deliberative, slower, reflect greater cognitive effort, and involve controlled attention. The dual process framework facilitates understanding of decision processes that may be diverse and complex. Based on response time as an indicator of System 2 use, we fill gaps in the tourism and choice experiment literatures by i) assessing the dimensionality of a decision style scale and its role in predicting System 2 use and ii) assessing whether researcher interventions, such as instructions, can promote System 2 use. The study is based on survey-based choice experiment responses of 483 domestic and international visitors across two Norwegian nature-based tourism destination contexts. Each visitor completed four choice experiment tasks for a total of 1,932 choice occasions. Results indicated diversity in extent of System 2 use. The decision style scale was multidimensional with both the intuitive and rational subscales predicting response time. We encourage inclusion of decision style scales–and specifically multidimensional scales–in future tourism choice and choice experiment applications. Statistically significant coefficients for instructions and unhurriedness suggest potential for researchers to increase System 2 processing in survey tasks. We encourage future use of this intervention, especially when survey tasks are intended to replicate “real world” decisions that rely heavily on System 2 use.

Preferences for in-kind and in-cash home care insurance

We study preferences for different types of home care insurance using a discrete choice experiment. We consider domestic, personal, and social care, a home care annuity, and a lump-sum for home adaptations. To understand variation in preferences, we relate willingness to pay to personal circumstances, preferences, and expectations. We find that the majority value in-kind and in-cash insurance above the actuarial premium. While most respondents value coverage for basic levels of support, we find diminishing marginal utility for higher levels of support. For in-kind care, willingness to pay is positively associated with respondent characteristics: being single, household income, home ownership, risk aversion, low bequest motives, expected length of home care use, expected expenditures when in need of care, and low expected availability of informal care. In contrast, in-cash support is valued regardless of respondent characteristics, possibly because its inherent flexibility. These results contribute to the design of insurance schemes for home care.

Preferences for oral nutritional supplement therapy among postoperative patients with gastric cancer: a discrete choice experiment

Purposes

Patients after gastrectomy have poor compliance with oral nutritional supplement (ONS) therapy. Incorporating patient preferences into treatment decisions allows possible product improvements or treatment focus adjustments. The purpose of this research was to investigate the preferences for ONS therapy among postoperative patients with gastric cancer, and to provide person-centered oral nutrition management strategies.

Methods

A discrete choice experiment was designed and implemented within a Chinese cancer population. The survey was administered via paper-based questionnaires during face-to-face interviews with assistance from health professionals. A mixed logit model was used to estimate respondents’ preferences for different levels of nutrition therapy attributes.

Results

One hundred ninety respondents valued “Adverse reactions-almost none” (β 3.43 [SE, 0.28]) the most, followed by “Flavor-good taste” (β 0.68 [SE, 0.13]) and “Follow-up frequency-once every 2 weeks” (β 0.52 [SE, 0.13]), and were willing to pay more for these attribute levels. Respondents would be 93.73% more likely to accept a nutrition therapy program if there were almost no adverse reactions compared to the frequent adverse reactions.

Conclusions

Health professionals should pay attention to the management and prevention of adverse reactions when prescribing nutritional products, and provide diversified ONS products when necessary to meet patient preferences. When formulating intervention strategies, health professionals should also consider the different characteristics of patients, acknowledge the importance of the role of nurse specialists in a novel model of multidisciplinary nutritional care, standardize ONS information, follow up regularly, and encourage patients’ families to participate in daily nutrition care.

Supplementary information

The online version contains supplementary material available at 10.1007/s00520-022-07154-8.

Preference of caregivers on residential care homes for older persons with versus without communication problems: a discrete choice experiment

Background

A residential care service voucher scheme has been introduced to expand the capacity and enhance choice of public-funded long-term care (LTC) in Hong Kong, enabling users to have greater choices over the types of LTC facilities. Older persons with communication problems have difficulties in understanding the care options available to them and expressing their preferences to care homes and daily service delivery, therefore hindering their ability to exercise control and choice. Thus, they may have different needs and preferences for the facilities than others due to their conditions. This study therefore aimed to investigate their preference for care homes in comparison with those without communication problems.

Methods

A discrete choice experiment was conducted to elicit preference for six attributes derived from prior studies. The family caregivers of a random sample of older voucher holders were invited to undertake face-to-face interview. Willingness-to-pay (WTP) for the attributes was estimated for those with or without communication problems separately.

Results

Two hundred eighty-three caregivers provided valid responses (74% response rate). Caregivers of those with communication problem preferred facilities operated by non-governmental organizations (WTP=HK$1777.4) and shorter travelling time (WTP=HK$1502.5 for <=0.5 hours), while those without the problem had greater preference for fewer roommates (WTP=HK$3048.1 for single room) and extra healthcare professionals (WTP=HK$1765.5). Heterogenous WTPs were identified from those with different income, marital status and caregivers’ age.

Conclusions

The reputation, greater space and staff, and proximity/familiarity of the facilities were important for those with communication problems. To help meet these preferences, the facilities could establish collaborations with local community-based service providers and build their own outreach team to familiarize themselves with older persons. Additionally, household income and informal support availability should be considered for care planning.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03073-9.

COVID-19 Vaccination Preferences of University Students and Staff in Hong Kong

Importance

COVID-19 has required universities to rapidly develop vaccination policies for students and staff, yet little is known about the preferences of these individuals toward vaccination.

Objective

To quantify student and staff preferences for COVID-19 vaccination at a university in Hong Kong.

Design, Setting, and Participants

A cross-sectional online survey study was conducted from July 20 to September 21, 2021, before the announcement of a campus-wide vaccine mandate. A survey of 42 451 eligible university students and staff used discrete-choice experiment methods to quantify 7 attributes of COVID-19 vaccination: risk of a mild or moderate adverse event after vaccination, risk of a severe adverse event after vaccination, efficacy against COVID-19 infection, efficacy against severe manifestation of COVID-19 infection, duration of protection after vaccination, incentive for completing vaccination, and out-of-pocket costs.

Main Outcomes and Measures

A mixed logit regression model was used to estimate the preferences of attributes for COVID-19 vaccines and marginal willingness to pay (mWTP) adjusted for background characteristics, role, vaccination, and COVID-19 infection status of family or friends, adverse event status after vaccination among family and friends of participants, and scenario block.

Results

Among 42 451 eligible university students and staff invited, 3423 individuals completed the survey (mean [SD] age, 27.1 [9.9] years; 2053 [60.0%] women). Participants included 2506 students (73.2%) and 917 staff (26.8%), with a response rate of 8.1%. Quarantine-free travel was preferred (β = 0.86; 95% CI, 0.72-0.99; mWTP: $235.9; 95% CI, $190.3-$294.2), followed by efficacy against any COVID-19 infection (β = 0.30; 95% CI, 0.29-0.32; mWTP: $84.1; 95% CI, $71.8-$100.8), against severe manifestation of COVID-19 infection (β = 0.25; 95% CI, 0.24-0.27; mWTP: $69.7; 95% CI, $465-$653), and risk of severe adverse events following vaccination (β = -0.24; 95% CI, -0.27 to -0.21; mWTP: -$66.8; 95% CI, -$81.5 to -$55.3). Participants were less concerned about protection duration (β = 0.17; 95% CI, 0.15-0.18; mWTP: $46.0; 95% CI, $38.6-$56.2) and risk of mild to moderate adverse events (β = -0.12; 95% CI, -0.13 to -0.10; mWTP: -$32.7; 95% CI, -$41.2 to -$26.4).

Conclusions and Relevance

Preference of all attributes were significant and were considered important by the participants for vaccine decision-making. Insights drawn could assist policy makers in future vaccination decisions, such as campus vaccine mandate and requirement of a third dose.

The use of composite time trade-off and discrete choice experiment methods for the valuation of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS): a think-aloud study

Purpose

To identify patterns and problems in completing composite time trade-off (C-TTO) and discrete choice experiment (DCE) exercises for the valuation of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) to inform the optimisation of a valuation protocol.

Methods

Fourteen cognitive interviews were conducted in the UK using concurrent and retrospective think-aloud and probing techniques. Each participant completed 8 C-TTO tasks and 8 DCE tasks within a computer-assisted personal interview setting. Verbal information was transcribed verbatim. Axial coding and thematic analysis were used to organise the qualitative data and identify patterns and problems with the completion of tasks.

Results

While participants found the tasks generally manageable, five broad themes emerged to explain and optimise the response to the tasks. (1) Format and structure: attention to the design of practice examples, instructions, and layout were needed. (2) Items and levels: underlying relationships were discovered across different combinations of levels of SWEMWBS items. (3) Decision heuristics: participants engaged in diverse strategies to assist trade-off decisions. (4) Valuation feasibility: certain states were difficult to imagine, compare and quantify. (5) Valuation outcome: the data quality was affected by participants’ discriminatory ability across states and their time trade-off decisions.

Conclusion

The interviews contributed insights regarding the robustness of the proposed methods. The application of C-TTO and DCE valuation techniques was practical and suitable for capturing individual attitudes towards different mental well-being scenarios. A modified protocol informed by the results is being tested in a larger sample across the UK.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-022-03123-0.

Socioeconomic factors and parents' preferences for internet- and mobile-based parenting interventions to prevent youth mental health problems: A discrete choice experiment

BACKGROUND

The positive impact of parenting programs for youth mental health is undermined by difficulties engaging parents. Low engagement disproportionately impacts parents of lower-socioeconomic positions (SEPs). Internet- and mobile-based interventions hold potential for overcoming barriers to enrolment, but additional research is needed to understand how programs can appropriately meet the needs of parents across SEPs. Consumer preference methods such as discrete choice experiments may be valuable in this endeavour.

METHOD

A discrete choice experiment was used to determine the relative influence of modifiable program features on parents' intent to enrol. 329 Australian parents of children aged 0-18 repeatedly selected their preferred program from randomized sets of hypothetical programs in an online survey. Each hypothetical program was unique, varying across four program features: module duration, program platform, user control, and program cost. Cumulative link models were used to predict choices, with education, household income, and community advantage used as indicators of SEP.

RESULTS

Overall, parents preferred cheaper programs and briefer modules. Parents' preferences differed based on their socioeconomic challenges. Lower-income parents preferred briefer modules, cheaper programs and application-based programs compared to higher-income parents. Parents with less education preferred briefer modules and a predefined module order. Parents living in areas of less advantage preferred website-based programs, user choice of module order, and more expensive programs.

CONCLUSIONS

This study offers program developers evidence-based strategies for tailoring internet- and mobile-based parenting interventions to increase lower-SEP parent enrolment. Findings also highlight the importance of considering parents' socioeconomic challenges to ensure programs do not perpetuate existing mental health inequalities, as "one-size-fits-all" approaches are likely insufficient for reaching lower-SEP parents.

Consumers’ Willingness to Buy CRISPR Gene-Edited Tomatoes: Evidence from a Choice Experiment Case Study in Germany

The CRISPR gene-editing (GE) breeding method is used to increase the resilience of high-yielding tomato cultivars against pests and diseases, reducing crop protection requirements. This study investigated consumers’ willingness to buy CRISPR GE tomatoes in a repeated discrete-choice experiment. We observed a strong positive effect of providing information on the CRISPR breeding technology, while the sensory experience of the CRISPR GE tomatoes in a visit to a greenhouse had a rather weak, predominantly negative effect on the participants’ willingness to buy CRISPR GE tomatoes. We found that roughly half of the 32 participants demonstrated constant CRISPR GE tomato choices during the experiments, and these participants were mainly employed as scientists. However, the rest of the participants changed their CRISPR GE tomato choices, with the majority showing an increase in their willingness to buy CRISPR GE tomatoes; these “changers” were dominated by non-scientists. Science communication on CRISPR GE breeding technology should target people with little knowledge about the technology, and consumers of organic tomatoes seem to have more specified, stable preferences regarding the technology. Further, scientific information about the CRISPR GE methodology should preferentially be provided when new technology and information about it are not yet widespread and people have not yet formed a strong opinion about the technology.

Does It Matter How You Ask? Assessing the Impact of Failure or Effectiveness Framing on Preferences for Antibiotic Treatments in a Discrete Choice Experiment

PURPOSE

Studies assessing framing effects in discrete choice experiments (DCE) primarily focused on attributes related to mortality/survival information. Little is known about framing effects for other attributes in health-related DCEs. This study aimed to investigate how framing treatment outcome as effective, failure, or a combined frame impacts respondent choices and DCE outcomes.

PATIENTS AND METHODS

Three Bayesian D-efficient designed DCE surveys measuring preferences for antibiotic treatments were randomly distributed to a representative sample of the Swedish population aged 18-65 years (n=1119). Antibiotic treatments were described using five attributes. Four attributes were static: Contribution to Antibiotic Resistance, Treatment Duration, Likelihood of Side-Effects, and Costs. A fifth treatment attribute was framed in three ways: Effectiveness, Failure Rate, or both. Mixed logit models were used to analyze attribute level estimates, importance value, and choice predictions.

RESULTS

Significant differences between the frames were found for the parameter estimates of the attributes of Treatment Duration and Likelihood of Side-Effects, but not Treatment Outcome which was the alternatively framed attribute. Contribution to Antibiotic Resistance and Costs were the most important attributes for all participants regardless of framing. Choice predictions for the "best option" antibiotic only slightly differed between the groups based on the frame seen (95.2-92.4%).

CONCLUSION

Our study showed that attribute framing can impact preferences regardless of the attribute's importance value in alternative valuation. However, the practical implication of this effect may be limited. A theoretical discussion is needed to identify how researchers should accommodate and report any potential framing effect in their studies.

Impact of information framing and vaccination characteristics on parental COVID-19 vaccine acceptance for children: a discrete choice experiment

This study aimed to test the influence of vaccination characteristics and gain/loss-framing of information, on parental acceptance of the coronavirus disease 2019 (COVID-19) vaccination for their minor children. A discrete choice experiment was conducted among parents of children aged 0-17 years from September to October 2021 in Hong Kong. Respondents were randomly assigned to four groups with different framing of information and asked to choose hypothetical vaccination alternatives, described by seven attributes that were derived from prior qualitative interviews. A mixed logit model was adopted to analyze the effect of attributes and information framing on parental vaccination acceptance. The vaccine acceptance rates under different scenarios were also estimated. A total of 298 valid responses were obtained. It was found that the BioNTech brand, higher efficacy, less serious adverse events and more vaccination coverage in children significantly improved parental acceptance. Additionally, loss-framing increased parental acceptance compared with gain-framing, while the presentation of mortality information did not make a difference. Acceptance was also associated with parental uptake of the COVID-19 vaccine and the children's age.

CONCLUSION

The findings imply that factors including gain/loss information framing, importance of vaccine characteristics, and peer influence have a significant effect on parents' decisions to get their children vaccinated. Parents with younger children had greater vaccine hesitancy, and information framing techniques should be considered in vaccination promotion for combating such vaccine hesitancy. Future studies could be conducted to identify the moderators and mediators of information framing to facilitate its implementation.

WHAT IS KNOWN

• Parental acceptance of COVID-19 vaccine was found to be associated with various socio-economic and psychosocial factors, while the evidence on impact of vaccination characteristics was limited. • Behavioral interventions, including information framing, have been used to promote various health behaviors.

WHAT IS NEW

• Loss-framing of information on vaccine effectiveness improves vaccine acceptance, while additional information on how the vaccine reduces death does not make a difference, which can be used to inform communication with the public in vaccination promotion. • The social norm (i.e., the vaccine uptake amongst other people) is important for increasing the parental vaccine acceptance rate.

Preferences for healthcare services among hypertension patients in China: a discrete choice experiment

OBJECTIVES

Our study aimed to support evidence-informed policy-making on patient-centred care by investigating preferences for healthcare services among hypertension patients.

DESIGN

We identified six attributes of healthcare services for a discrete choice experiment (DCE), and applied Bayesian-efficient design with blocking techniques to generate choice sets. After conducting the DCE, we used a mixed logit regression model to investigate patients' preferences for each attribute and analysed the heterogeneities in preferences. Estimates of willingness to pay were derived from regression coefficients.

SETTING

The DCE was conducted in Jiangsu province and Shanghai municipality in China.

PARTICIPANTS

Patients aged 18 years or older with a history of hypertension for at least 2 years and who took medications regularly were recruited.

RESULTS

Patients highly valued healthcare services that produced good treatment effects (β=4.502, p<0.001), followed by travel time to healthcare facilities within 1 hour (β=1.285, p<0.001), and the effective physician-patient communication (β=0.771, p<0.001). Continuity of care and minimal waiting time were also positive predictors (p<0.001). However, the out-of-pocket cost was a negative predictor of patients' choice (β=-0.168, p<0.001). Older adults, patients with good health-related quality of life, had comorbidities, and who were likely to visit secondary and tertiary hospitals cared more about favourable effects (p<0.05). Patients were willing to pay ¥2489 (95% CI ¥2013 to ¥2965) as long as the clinical benefits gained were substantial.

CONCLUSIONS

Our findings highlight the importance of effective, convenient, efficient, coordinated and patient-centred care for chronic diseases like hypertension. Policy-makers and healthcare providers are suggested to work on aligning the service provision with patients' preferences.

"Please, you go first!" preferences for a COVID-19 vaccine among adults in the Netherlands

Background

Vaccination is generally considered the most direct way to restoring normal life after the outbreak of COVID-19, but the available COVID-19 vaccines are simultaneously embraced and dismissed. Mapping factors for vaccine hesitancy may help the roll-out of COVID-19 vaccines and provide valuable insights for future pandemics.

Objectives

We investigate how characteristics of a COVID-19 vaccine affect the preferences of adult citizens in the Netherlands to take the vaccine directly, to refuse it outright, or to wait a few months and first look at the experiences of others.

Methods

An online sample of 895 respondents participated between November 4th and November 10th, 2020 in a discrete choice experiment including the attributes: percentage of vaccinated individuals protected against COVID-19, month in which the vaccine would become available and the number of cases of mild and severe side effects. The data was analysed by means of panel mixed logit models.

Results

Respondents found it important that a safe and effective COVID-19 vaccine becomes available as soon as possible. However, the majority did not want to be the first in line and would rather wait for the experiences of others. The predicted uptake of a vaccine with the optimal combination of attributes was 87%, of whom 55% preferred to take the vaccine after a waiting period. This latter group tends to be lower-educated. Older respondents gave more weight to vaccine effectiveness than younger respondents.

Conclusions

The willingness to take a COVID-19 vaccine is high among adults in the Netherlands, but a considerable proportion prefers to delay their decision to vaccinate until experiences of others are known. Offering this wait-and-see group the opportunity to accept the invitation at a later moment may stimulate vaccination uptake. Our results further suggest that vaccination campaigns targeted at older citizens should focus on the effectiveness of the vaccine.

Paediatric tuberculosis preventive treatment preferences among HIV-positive children, caregivers and healthcare providers in Eswatini: a discrete choice experiment

OBJECTIVE

Isoniazid preventive therapy initiation and completion rates are suboptimal among children. Shorter tuberculosis (TB) preventive treatment (TPT) regimens have demonstrated safety and efficacy in children and may improve adherence but are not widely used in high TB burden countries. Understanding preferences regarding TPT regimens' characteristics and service delivery models is key to designing services to improve TPT initiation and completion rates. We examined paediatric TPT preferences in Eswatini, a high TB burden country.

DESIGN

We conducted a sequential mixed-methods study utilising qualitative methods to inform the design of a discrete choice experiment (DCE) among HIV-positive children, caregivers and healthcare providers (HCP). Drug regimen and service delivery characteristics included pill size and formulation, dosing frequency, medication taste, treatment duration and visit frequency, visit cost, clinic wait time, and clinic operating hours. An unlabelled, binary choice design was used; data were analysed using fixed and mixed effects logistic regression models, with stratified models for children, caregivers and HCP.

SETTING

The study was conducted in 20 healthcare facilities providing TB/HIV care in Manzini, Eswatini, from November 2018 to December 2019.

PARTICIPANTS

Ninety-one stakeholders completed in-depth interviews to inform the DCE design; 150 children 10-14 years, 150 caregivers and 150 HCP completed the DCE.

RESULTS

Despite some heterogeneity, the results were fairly consistent among participants, with palatability of medications viewed as the most important TPT attribute; fewer and smaller pills were also preferred. Additionally, shorter waiting times and cost of visit were found to be significant drivers of choices.

CONCLUSION

Palatable medication, smaller/fewer pills, low visit costs and shorter clinic wait times are important factors when designing TPT services for children and should be considered as new paediatric TPT regimens in Eswatini are rolled out. More research is needed to determine the extent to which preferences drive TPT initiation, adherence and completion rates.

What Are the Important Factors Influencing the Recruitment and Retention of Doctoral Students in a Public Health Setting? A Discrete Choice Experiment Survey in China

Objectives: This study aims to investigate the employment preferences of doctoral students majoring in social medicine and health care management (SMHCM), to inform policymakers and future employers on how to address recruitment and retention requirements at CDCs across China. Methods: An online discrete choice experiment (DCE) was conducted to elicit doctoral SMHCM students’ job preferences. The scenarios were described with seven attributes: monthly income, employment location, housing benefits, children’s education opportunities, working environment, career promotion speed, and bianzhi. A conditional logit model and a mixed logit model were used to evaluate the relative importance of the selected attributes. Results: A total of 167 doctoral SMHCM students from 24 universities completed the online survey. All seven attributes were statistically significant with the expected sign and demonstrated the existence of preference heterogeneity. Monthly income and employment location were of most concern for doctoral SMHCM students when deciding their future jobs. Among the presented attributes, working environment was of least concern. For the sub-group analysis, employment located in a first-tier city was more likely to lead to a higher utility value for doctoral students who were women, married, from an urban area, and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. Conclusions: Our study suggests that monthly income and employment location were valued most by doctoral SMHCM students when choosing a job. A more effective human resource policy intervention to attract doctoral SMHCM students to work in CDCs, especially CDCs in third-tier cities should consider both the incentives provided by the job characteristics and the background of students. Doctoral students are at the stages of career preparation, so the results of this study would be informative for policymakers and help them to design the recruitment and retention policies for CDCs.

A Systematic Review of Discrete Choice Experiment Studies in Rheumatoid Arthritis Biological Medicines

Objective:

Rheumatoid arthritis is a chronic disease with various clinical characteristics. The introduction of biological drugs has enhanced the efficacy and increased diversity of treatment options. Considering the patients’ preferences in decision-making about treatment can improve their adherence. A discrete choice experiment is a type of conjoint method that can elicit preferences in more realistic scenarios. This article reviewed discrete choice experiment (DCE) studies to extract which attributes and levels were included in surveys. In addition, we focused on the process of designing surveys and the method that they used. Method: PubMed, EMBASE, Web of Science, Scopus, Ovid (Medline) and ProQuest were systematically searched in order to find studies that evaluated rheumatoid arthritis patients’ preferences about biological medicines. Studies published in peer-reviewed journals between 1/1/1990 and 12/31/2019 were included. The included studies were analyzed using a narrative synthesis method and descriptive statistics.

Results:

A total of 7124 studies were initially found. After deleting irrelevant and duplicate studies, 15 studies were included. The most common attributes that were used in surveys were efficacy, adverse effect, route of administration, frequency of administration, and cost. Most studies used a literature review for developing attributes and levels. The median number of included attributes and levels were seven and three, respectively. Eight studies explained their experimental design while seven studies did not. Conditional logit and mixed logit were the most common methods for modeling reciprocally.

Conclusion:

Several aspects of DCE studies investigating biological drugs in RA were assessed. Explaining the sample size, experimental design, and qualitative work for developing attributes can improve this type of study.