Discrete choice experiments in health economics: a review of the literature

Assessment of physicians' perception of pediatrics respiratory syncytial virus disease and preferences for immunization strategies in the United States

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection in infants and young children, placing substantial burden on patients, their families, and health systems. This observational, cross-sectional, web-based, survey study in the United States (during October - November 2023) assessed physicians' perceptions of RSV disease and new immunization strategies, including their preferences for monoclonal antibodies (mAbs) and maternal immunizations as RSV preventive measures. Immunization preferences were quantified through discrete choice experiment (DCE). Physicians aged ≥ 18 years, who spent at least 60% of their time in direct patient care and worked in a practice providing immunization to patients aged ≤ 2 years were recruited through online panels. Eighty pediatricians and 20 family practitioners participated. Mean (SD) age of physicians was 52.3 (12.7) years; majority were male (64.0%). Most physicians strongly agreed with supporting all types of recommended childhood immunizations (77.0%) and were aware of new RSV immunization strategies under development or recently approved (91.0%). A majority moderately/strongly agreed that maternal immunization and mAbs provide protection to the baby (77.0% and 87.0%, respectively). In DCE, physicians chose RSV immunization 96.1% of the time vs no immunization (3.9%). The most important attributes that drove physicians' preferences were: increasing durability of protection from 90 to 180 days (24.9%), increasing efficacy against RSV hospitalization from 57% to 80% (20.9%), and increasing efficacy against medically-attended RSV from 51% to 80% (20.2%). Understanding physicians' attitudes and preferences regarding RSV immunization strategies is important as new RSV prevention methods become available and are introduced into clinical practice.

Quantifying patient preferences for treatments for refractory chronic spontaneous urticaria

Background

In recent years, it has become increasingly common to incorporate the patient perspective into drug development and regulatory decision making.

Objective

This study aimed to measure and quantify patient preferences (priorities and trade-offs) for attributes that characterize current and emerging refractory chronic spontaneous urticaria (rCSU) treatments.

Methods

Adult patients with self-reported rCSU symptoms completed an online discrete choice experiment survey. The survey included 10 questions that asked respondents to choose between 2 hypothetical rCSU treatment profiles having similar attributes with varying levels. The attributes included the following: chance of control of symptoms, time to symptom control, return of symptoms after discontinuation of therapy (complete remission), allergic reaction, risk of kidney dysfunction (usually reversible), and mode and frequency of administration. Relative attribute importance and maximum acceptable risks were calculated.

Results

A total of 213 subjects with a mean age of 51 years completed the survey. Efficacy (symptom control) and mode of administration were the 2 most important attributes to treatment choice, followed by risk of kidney dysfunction and time to achieve symptom control. Complete remission of symptoms and risk of allergic reaction were identified as least important. With regard to mode of administration, topical treatment was the most preferred option and infusion therapy was least preferred. Respondents who were presented with a scenario of refractory and severe chronic spontaneous urticaria were willing to accept increased risk of reversible kidney dysfunction in exchange for improvement in symptom control or complete remission. Respondents were willing to accept infusion over topical treatment if there was significant increase in treatment efficacy.

Conclusion

These study results can be used to inform development and evaluation of future rCSU therapies by product developers and regulatory authorities, respectively.

Discrete Choice Experiment Versus Best-Worst Scaling: An Empirical Comparison in Eliciting Young People's Preferences for Web-Based Mental Health Interventions

BACKGROUND

Discrete choice experiments (DCEs) and best-worst scaling (BWS) profile cases (BWS case 2, or BWS-2) have been increasingly used in eliciting preferences towards health care interventions. However, it remains unclear which method is more suitable for preference elicitation, particularly in the mental health context. This study aims to compare: (1) the preference results elicited from a DCE and BWS-2; and (2) the acceptability of the two methods in the context of web-based mental health interventions (W-MHIs) for managing anxiety and depression in young people.

METHODS

Participants were aged 18-25 years, lived in Australia, and self-reported experiencing anxiety and/or depression in the past 12 months. They also had either an intention to use W-MHIs or previous experience with W-MHIs for managing anxiety and/or depression. Recruitment was conducted online via social media and Deakin University notice boards. Eligible participants completed an online survey containing eight DCE and eight BWS-2 choice tasks. Both types of choice tasks comprised six attributes. A multinominal logit model was used to estimate the preference weights and relative importance of attributes. Acceptability was assessed on the basis of dropout rate, completion time, task difficulty, understanding, and participants' preferred type of choice task.

RESULTS

A total of 198 participants (mean age: 21.42 ± 2.3 years, 64.65% female) completed the survey. Both DCE and BWS-2 predicted that cost was the most important attribute in young people's decision to engage with W-MHIs. However, the two methods differed in the relative importance of attributes and the preference ranking of levels within attributes. The DCE was perceived as easier to understand and answer, with nearly 64% of the participants preferring it over the BWS-2.

CONCLUSIONS

While both methods found cost was the most important attribute associated with engagement with W-MHIs, differences in the ranking of other attributes suggest that DCE and BWS-2 are not necessarily interchangeable. Increased acceptability by study participants of the DCE format suggests that this technique may have more merit than BWS-2-at least in the current study's context. Further research is required to identify the optimal method for determining the relative importance of attributes.

Comparison of four approaches in eliciting health state utilities with SF-6Dv2

OBJECTIVE

To empirically compare four preference elicitation approaches, the discrete choice experiment with time (DCETTO), the Best-Worst Scaling with time (BWSTTO), DCETTO with BWSTTO (DCEBWS), and the Standard Gamble (SG) method, in valuing health states using the SF-6Dv2.

METHODS

A representative sample of the general population in Quebec, Canada, completed 6 SG tasks or 13 DCEBWS (i.e., 10 DCETTO followed by 3 BWSTTO). Choice tasks were designed with the SF-6Dv2. Several models were used to estimate SG data, and the conditional logit model was used for the DCE or BWS data. The performance of SG models was assessed using prediction accuracy (mean absolute error [MAE]), goodness of fit using Bayesian information criterion (BIC), t-test, Jarque-Bera (JB) test,  Ljung-Box (LB) test, the logical consistency of the parameters, and significance levels. Comparison between approaches was conducted using acceptability (self-reported difficulty and quality levels in answering, and completion time), consistency (monotonicity of model coefficients), accuracy (standard errors), dimensions coefficient magnitude, correlation between the value sets estimated, and the range of estimated values. The variance scale factor was computed to assess individuals' consistency in their choices for DCE and BWS approaches.

RESULTS

Out of 828 people who completed SG and 1208 for DCEBWS tasks, a total of 724 participants for SG and 1153 for DCE tasks were included for analysis. Although no significant difference was observed in self-reported difficulties and qualities in answers among approaches, the SG had the longest completion time and excluded participants in SG were more prone to report difficulties in answering. The range of standard errors of the SG was the narrowest (0.012 to 0.015), followed by BWSTTO (0.023 to 0.035), DCEBWS (0.028 to 0.050), and DCETTO (0.028 to 0.052). The highest number of insignificant and illogical parameters was for BWSTTO. Pain dimension was the most important across dimensions in all approaches. The correlation between SG and DCEBWS utility values was the strongest (0.928), followed by the SG and BWSTTO values (0.889), and the SG and DCETTO (0.849). The range of utility values generated by SG tended to be shorter (-0.143 to 1) than those generated by the other three methods, whereas BWSTTO (-0.505 to 1) range values were shorter than DCETTO (-1.063 to 1) and DCEBWS (-0.637 to 1). The variance scale factor suggests that respondents had almost similar level of certainty or confidence in both DCE and BWS responses.

CONCLUSION

The SG had the narrowest value set, the lowest completion rates, the longest completion time, the best prediction accuracy, and produced an unexpected sign for one level. The BWSTTO had a narrower value set, lower completion time, higher parameter inconsistency, and higher insignificant levels compared to DCETTO and DCEBWS. The results of DCEBWS were more similar to SG in number of insignificant and illogical parameters, and correlation.

Risk-based innovations in cancer screening and diagnosis: a discrete choice experiment to explore priorities of the UK public

OBJECTIVE

To understand the importance and potential impact on uptake of different attributes of risk-based innovations in the context of risk-stratified healthcare for cancer screening and symptomatic diagnosis.

DESIGN

The online survey comprised a discrete choice experiment (DCE) in which participants chose between two risk assessment options or to opt out of risk stratification. There were six attributes: test method, type (genetic or non-genetic), location, frequency, sensitivity and specificity. Participants were randomly allocated to consider the choice in an asymptomatic or symptomatic context.

SETTING

Members of the public in the UK.

PARTICIPANTS

1202 participants completed the DCE.

OUTCOME MEASURES

Conditional logistic regression and latent class analysis informed modelling of predicted preferences for a range of innovations with different features.

RESULTS

Overall, participants preferred risk assessments over opting out and prioritised sensitivity, with test method and specificity also important. Genetic and non-invasive tests were favoured. With sensitivity and specificity of 80% or better, participants would be more likely to take up a risk assessment than not. Comparing the asymptomatic and symptomatic contexts, 65% and 73% of participants would be very likely to participate regardless of the innovation used, and 29% and 13% of participants might participate depending on the method, sensitivity and specificity. A minority showed strong dislike of risk-based innovations, particularly within screening.

CONCLUSIONS

There are high levels of public support for risk-based innovations within risk-stratified cancer healthcare, especially for referral decision-making and using genetic and non-invasive tests. Optimising risk-based innovations is needed to engage those whose participation is contingent on test methods and performance metrics.

Preferences for long-termcare among elderly patients who had a stroke with disabilities in Eastern China: protocol for a ditscrete choice experiment study

BACKGROUND

Stroke is a leading cause of disability among older adults worldwide, often resulting in significant physical, cognitive and emotional impairments that require long-term care. With ageing populations and increasing stroke prevalence, the demand for appropriate and sustainable long-term care is growing. However, designing care models that align with the complex needs and preferences of elderly patients who had a stroke remains a challenge. This study employs a discrete choice experiment (DCE) to measure and quantify patients' preferences for long-term care. The primary objectives of this study are as follows: (1) identify and examine the key attributes and levels of long-term care that are most valued by this patient population, (2) assess patients' preferences for long-term care and explore the role of each attribute on overall preference and (3) explore heterogeneity in preferences based on participants' characteristics through subgroup analyses.

METHODS

The research was conducted in accordance with the design programme of the DCE study. Seven attributes were developed through a systematic literature review, in-depth interviews and experts consultation. A partial factorial survey design was generated through an orthogonal experimental design to optimise the choice scenario sets. We plan to conduct a DCE questionnaire survey in Suzhou, Jiangsu Province, China, and recruit at least 500 participants. The final data will be analysed through a mixed logit model and a latent class model to explore the preference of elderly patients who had a stroke with disabilities for long-term care.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee of Nanjing Medical University-Affiliated Suzhou Hospital (K-2024-096 K01). All participants will be required to provide informed consent. The findings of this study will be disseminated and shared with interested patient groups and the general public through a variety of channels, including online blogs, policy briefs, national and international conferences, and peer-reviewed journals.

Patient preferences for treatments in hormone receptor-positive/HER2-negative metastatic breast cancer in Italy: a discrete choice experiment study

Hormone receptor (HR) positive (HR +) and human epidermal growth factor receptor 2 (HER2) negative (aka HER2 -) breast cancer (BC) is the most frequently diagnosed subtype. Recent development of next-generation endocrine therapies (e.g. selective estrogen receptor degraders (SERDs); third-generation aromatase inhibitors (AI) and targeted therapies (e.g., CDK4/6, PI3K, and mTOR inhibitors)) as well as antibody drugs conjugates (ADC, eg. T-DXd and SG) showed promising results with meaningful improvements in survival for patients with metastatic HR + HER2 - BC. Therapy selection is mainly based on clinical, tumor pathological and molecular characteristics as well as on efficacy based on trial data, nevertheless, side effect profiles are key differentiators of treatments in the metastatic setting. Therefore, understanding how patients evaluate various treatment attributes and how these change in different clinical situations is fundamental toward the choice of optimal therapeutic strategies for treating metastatic HR + HER2 - Stage IV patients. Here, we investigated treatment preferences of a total of 102 stage IV HR + HER2 - breast cancer patients in Italy by developing and applying a survey instrument based on discrete choice experiment (DCE). Treatment efficacy was the top valued attribute across all patient segments and the second most important attribute was the risk of grade ≥ 3 adverse events (AE). Overall, therapies with better outcomes of PFS or AE grade 3 or higher would have a higher impact on the preference to choose a treatment from a patient perspective.

The preferences of breast cancer patients regarding a digital social care platform

BACKGROUND

Breast cancer is a multifaceted condition affecting women globally, with patients often facing emotional, psychological, and social challenges. This study explored breast cancer patients' preferences for features of a digital social care platform.

METHODS

A cross-sectional study using Conjoint Analysis (CA), grounded in economic utility theory, was conducted. A Discrete Choice Experiment (DCE) questionnaire was administered to 158 breast cancer patients at a university hospital in Iran between November 2023 and January 2024. Data were analysed using ordered logistic regression in Stata 13.

RESULTS

All platform attributes significantly influenced preferences (P ≤ 0.05). Emotional support had the highest impact (β = 1.132), followed by informational (β = 0.973) and esteem support (β = 0.864). Instructional videos increased the likelihood of choosing a digital platform 2.45 times compared to text-based messages (P < 0.001). Personalized online support was 1.42 times more preferred than generic supportive messages (P < 0.001). Mindfulness affirmations were 1.14 times more preferred than inspirational messages (P < 0.001).

CONCLUSION

Digital tools that prioritize emotional, informational, and esteem support-especially through personalized online support and instructional videos can improve patient engagement and acceptability. These findings support the patient-centred design of digital social care platforms to enhance quality of life for breast cancer patients.

The Evolving Landscape of Discrete Choice Experiments in Health Economics: A Systematic Review

INTRODUCTION

Stakeholder preference evaluations are increasingly emphasized in healthcare policy and health technology assessment. Discrete choice experiments (DCEs) are the most common method for quantifying preferences among patients, the public, and healthcare professionals. While prior reviews (1990-2017) have examined DCE trends, no comprehensive synthesis exists for studies published since 2018. This updated review (2018-2023) provides critical insights into evolving methodologies and global trends in health-related DCEs.

METHODS

A systematic search (2018-2023) of Medline, Embase, and Web of Science identified relevant studies. Studies were screened for inclusion and data were extracted, including details on DCE design and analysis. To enable trend comparisons, the search strategy and extraction items aligned with previous reviews.

RESULTS

Of 2663 identified papers, 1279 met the inclusion criteria, reflecting a significant rise in published DCEs over time. DCEs were conducted globally, with a remarkable increase in publications from Asia and Africa compared with previous reviews. Experimental designs and econometric models have advanced, continuing prior trends. Notably, most recent DCEs were administered online.

DISCUSSION

The rapid growth of DCE applications underscores their importance in health research. While the methodology is advancing rapidly, it is crucial that researchers provide full transparency in reporting their methods, particularly in detailing experimental designs and validity tests, which are too often overlooked. Key recommendations include improving reporting of experimental designs, applying validity tests, following good practices for presenting benefit-risk attributes, and adopting open science practices. Ensuring methodological rigor will maximize the impact and reproducibility of DCE research in health economics.

Patient-centred Preferences for Biologic Therapies in Moderate to Severe Psoriasis in Vietnam: A Discrete Choice Experiment

Psoriasis is a chronic autoimmune disease that significantly impairs patients' quality of life. With the growing availability of biologic drugs - each varying in efficacy, safety, dosing, and cost - treatment decisions have become increasingly complex. A study conducted from March to July 2024 surveyed 302 Vietnamese patients with moderate to severe psoriasis to assess preferences for biologic therapies. Using a discrete choice experiment (DCE), participants evaluated 6 treatment attributes: short-term efficacy, long-term efficacy, sustained efficacy after drug withdrawal, frequency of administration, copayment, and risk of serious infection. Preference data were analysed using conditional logit models. Analysis revealed that treatment cost (relative importance [RI]: 31.4%) and long-term efficacy (RI: 25.3%) were the most critical factors influencing patient decisions, while sustained efficacy after withdrawal and early onset of efficacy were less impactful. Long-term efficacy and cost consistently ranked highest across all patient subgroups, with variations depending on demographic and clinical characteristics. These findings provide practical guidance for clinicians to incorporate patient preferences into the selection of biologic therapies, with particular emphasis on treatment cost and long-term efficacy. The significant influence of treatment cost also highlights the need for healthcare policymakers in Vietnam to enhance reimbursement policies and financial support programmes, improving access and equity in psoriasis care.

Do Treatment Choices by Artificial Intelligence Correspond to Reality? Retrospective Comparative Research with Necrotizing Enterocolitis as a Use Case

BackgroundIn cases of surgical necrotizing enterocolitis (NEC), the choice between laparotomy (LAP) or comfort care (CC) presents a complex, ethical dilemma. A behavioral artificial intelligence technology (BAIT) decision aid was trained on expert knowledge, providing an output as "x percentage of experts advise laparotomy for this patient." This retrospective study aims to compare this output to clinical practice.DesignVariables required for the decision aid were collected of preterm patients with NEC for whom the decision of LAP or CC had been made. These data were used in 2 BAIT model versions: one center specific, built on the input of experts from the same center as the patients, and a nationwide version, incorporating the input of additional experts. The Mann-Whitney U test compared the model output for the 2 groups (LAP/CC). In addition, model output was classified as advice for LAP or CC, after which the chi-square test assessed correspondence with observed decisions.ResultsForty patients were included in the study (20 LAP). Model output (x percentage of experts advising LAP) was higher in the LAP group than in the CC group (median 95.1% v. 46.1% in the center-specific version and 97.3% v. 67.5% in the nationwide version, both P < 0.001). With an accuracy of 85.0% by the center-specific and 80.0% by the nationwide version, both showed significant correspondence with observed decisions (P < 0.001).LimitationsWe are merely examining a proof of concept of the decision aid using a small number of participants from 1 center.ConclusionsThis retrospective study demonstrates that treatment choices by artificial intelligence align with clinical practice in at least 80% of cases.ImplicationsFollowing prospective validation and ongoing refinements, the decision aid may offer valuable support to practitioners in future NEC cases.HighlightsThis study assesses the output of behavioral artificial intelligence technology in deciding between laparotomy and comfort care in surgical necrotizing enterocolitis.The model output aligns with clinical practice in at least 80% of patient cases.Following prospective validation, the decision aid may offer valuable support to physicians working at the neonatal intensive care unit.

Examining national health insurance fund members' preferences and trade-offs for the attributes of contracted outpatient facilities in Kenya: A discrete choice experiment

Patient choice of health facilities is increasingly gaining recognition for potentially enhancing the attainment of health system goals globally. In Kenya, National Health Insurance Fund (NHIF) members are required to choose an NHIF-contracted outpatient facility before accessing care. Understanding their preferences could support resource allocation decisions, enhance the provision of patient-centered care, and deepen NHIF's purchasing decisions. We employed a discrete choice experiment to examine NHIF members' preferences for attributes of NHIF-contracted outpatient facilities in Kenya. We developed a d-efficient experimental design with six attributes, namely availability of drugs, distance from household to facility, waiting time at the facility until consultation, cleanliness of the facility, attitude of health worker, and cadre of health workers seen during consultation. Data were then collected from 402 NHIF members in six out of 47 counties. Choice data were analysed using panel mixed multinomial logit and latent class models. NHIF members preferred NHIF-contracted outpatient facilities that always had drugs [β=1.572], were closer to their households [β=-0.082], had shorter waiting times [β=-0.195], had respectful staff [β=1.249] and had either clinical officers [β=0.478] or medical doctors [β=1.525] for consultation. NHIF members indicated a willingness to accept travel 17.8km if drugs were always available, 17.7km to see a medical doctor for consultation, and 14.6km to see respectful health workers. Furthermore, NHIF members indicated a willingness to wait at a facility for 8.9 hours to ensure the availability of drugs, 8.8 hours to see a doctor for consultation, and 7.2 hours to see respectful health workers. Understanding NHIF member preferences and trade-offs can inform resource allocation at counties, service provision across providers, and purchasing decisions of purchasers such as the recently formed social health insurance authority in Kenya as a move towards UHC.

Using discrete choice experiments to elicit palliative care preferences in lower middle-income countries: An exploratory study in Bhutan

Background

Design and delivery of specific palliative care in many lower middle-income countries such as Bhutan remains limited. Designing care programmes to respond to the needs of patients and family networks is essential, but evidence on these preferences is limited.

Aim

We have conducted a discrete choice experiment on Bhutanese patients and family members to explore preferences for palliative care.

Design

The discrete choice experiment consisted of 15 choice tasks in which each respondent considered two competing palliative care services. Data were collected through the recruitment of respondents in conjunction with the clinician support teams, with data collected from both patients and their family members. All responses were pooled across the groups and analysed using the conditional logit regression model.

Setting/participants

Fifty-seven respondents (20 patients and 37 family members) out of 98 (50 patients and 48 family members) identified (58.2%) were recruited through the three large referral hospitals in Bhutan. Patients had to be diagnosed with an advanced illness or at the end-of-life phase, but be able to understand and be willing to complete the survey. Similarly, family members had to be willing and able to complete the survey, and to be defined as the primary caregiver by the patient.

Results

Transparent information provision, cost, family training and use of traditional healing practices were keen drivers of choice, with location of care and place of death relatively less important.

Conclusion

Our results will guide future service design decisions in Bhutan and demonstrate the need for localised preference studies to enable culturally appropriate care including the provision of traditional healing practices.

Preferences of nurses in the United Kingdom for attributes of pediatric hexavalent vaccines: a discrete-choice experiment

OBJECTIVES

Given the limited evidence on UK nurses' preferences for pediatric hexavalent vaccines, we aimed to evaluate their preferences for these vaccines' attributes.

METHODS

In a discrete-choice experiment study, 150 nurses chose between 2 hypothetical pediatric hexavalent vaccines with varying attribute levels (device type, plastic in packaging, time on the market, and time the vaccine can stay safely at room temperature) in a series of choice questions. Using random-parameters logit-model estimates, conditional relative attribute importance (CRAI) and odds ratios (ORs) were calculated.

RESULTS

Device type (with associated preparation time and risk of dosage errors) was the most important attribute (CRAI, 61%), followed by years on the market (CRAI, 25%). The odds of choosing a prefilled syringe were nearly 3 times the odds of choosing syringe-and-vial combinations requiring reconstitution (OR, 2.80; 95% confidence interval [CI], 1.93-3.68). Vaccines on the market for < 1 year were less likely to be preferred to vaccines available for > 3 years (OR, 0.66; 95% CI, 0.47-0.84). ORs for time a vaccine can stay at room temperature (3 vs. 6 days) (0.94; 95% CI, 0.71-1.16) and plastic blisters in packaging (1.19; 95% CI, 0.80-1.56) were not significant, indicating that these attributes did not influence choices.

CONCLUSIONS

In this survey, nurses' preferences were mainly influenced by device type.

Virtual Service Delivery in Mental Health and Substance Use Care: A Systematic Review of Preference Elicitation Studies

Mental health and substance use disorders affect the lives of many people worldwide. Prevention and treatment of these conditions is important for optimal health and wellbeing, yet service access barriers are common. Virtual models of care may help to reduce barriers to receiving care. However, to facilitate uptake and use of virtual services, they need to appeal to patients and clinicians. This systematic review aimed to synthesise preference elicitation studies to determine what features of virtual mental health and substance use care are preferred by service users and service providers. Following the PRISMA guidelines for systematic reviews, we searched PubMed, PsycINFO, EconLit, MEDLINE, CINAHL, Academic Search Ultimate, and ProQuest Central for all available studies from database inception until May 2023. The Mixed Methods Appraisal Tool was used to assess the methodological quality of included studies. Nineteen studies met the eligibility criteria. However, none examined preferences for elements of different models of virtual care. Across the included studies, we identified 41 unique features that mapped to four themes of mental health and substance use care ('service', 'treatment', 'clinician' and 'additional supports'). Participant preferences were for individual, in-person, effective, flexible, and low-cost treatment. These preferences varied based on demographic factors, such as culture, gender, and participant type (e.g., patients, clinicians, general population). A user-centred approach should be adopted when designing and implementing mental health and substance use services. While preferences for features of mental health and substance use services more broadly are known, preferences for different models of virtual care remain unexplored. Future research should examine what features of virtual services would lead to optimal uptake and use across different users and stakeholders.

Preferences of Non-Metropolitan Youth Towards Accessing Mental Health Services: A Choice-Based Conjoint Analysis

OBJECTIVE

To investigate the preferences of non-metropolitan youth towards mental health service access.

SETTING

Tasmania, Australia.

PARTICIPANTS

Youth aged 13 to 25 years (n = 214).

METHODS

Choice-based conjoint analysis (CBC) which is a quantitative study design, was employed. In this CBC study, an online survey presented twelve choice sets reflecting seven different mental health service attributes (mental health concern, service provider, cost, wait time, service delivery method, travel time and transport mode), with youth asked to choose their preferred option for access. Choice-based conjoint analysis determined preferred mental health service attributes and the relative weighting of different levels within each attribute.

RESULTS

Of the seven attributes, service provider, cost, wait time and service delivery method were of the highest importance to youth when considering mental health service access. Within the listed health service attributes, youth ranked: psychologists; no cost; no wait time; face-to-face delivery; travel time of 15 min; and travel by private car highest. Various socio-demographic variables were associated with attribute and level choices.

CONCLUSION

Tasmanian youth prefer to access mental health services when provided in person, by a psychologist, for free and with no waiting time. Further research is required to investigate whether mental healthcare preferences for non-metropolitan youth change depending on geographical location, mental health status, level of mental health literacy, a greater choice of service providers and service delivery methods.

Research on the preference of community health communication service utilization by patients with cardiovascular diseases in China

OBJECTIVES

This study sought to examine cardiovascular patients' preferences for community health communication and to offer recommendations to boost the engagement with health communication programs.

METHODS

We conducted a discrete choice experiment involving 914 cardiovascular patients, assessing their preferences across five attributes: Health information communicator, Health information communication content, Health information communication channel, Health information form, and Cost willing to pay each time. The data were analyzed using a mixed logit model to account for preference heterogeneity.

RESULTS

The results of discrete choice model showed that patients with cardiovascular disease were more inclined to choose doctors in terms of health information transmitter preference. In the content of health communication, disease-related knowledge and healthy lifestyle knowledge are more popular. In terms of health information communication channels, offline channels are more popular than online channels. Of the health information formats, "video + audio" is the most popular, followed by "video," while "text + picture" are less popular. Payment (β=-10.624, P < 0.05) had a negative effect on service utilization of health communication activities. Preferences were heterogeneous among different subgroups.

CONCLUSIONS

Chinese patients with cardiovascular diseases prefer health information scenarios that feature physicians as communicators, disease-related knowledge as the health communication content, and low-cost, offline "video + audio" services. Policymakers are advised to consider both monetary and nonmonetary incentives to engage these patients in health information activities. The identified preference heterogeneity suggests the need for tailored policy incentive packages to effectively address the diverse needs of patient subgroups.

Patient preferences for the treatment of Bowen disease

BACKGROUND

Discrete choice experiments (DCEs) are increasingly used to understand and quantify patient preferences for a variety of treatments, services or screening in order to analyse the choices patients make when faced with different alternatives.

OBJECTIVES

The aim of this DCE was to examine patient preferences for the treatment of Bowen disease.

METHODS

A DCE was conducted alongside a randomized controlled noninferiority trial comparing the effectiveness of surgical excision, methyl aminolaevulinate photodynamic therapy (MAL-PDT) and 5-fluorouracil (5-FU) cream as treatments for Bowen disease. Preferences were elicited by presenting patients with choice tasks between surgical excision, MAL-PDT and 5-FU cream with the following attributes: effectiveness, cosmetic outcome, side-effects, treatment duration and process. A mixed logit model was used to account for the panel nature of the data (repeated choices for each respondent) and heterogeneity in preference.

RESULTS

A total of 215 patients completed the DCE. Patients have a clear preference for excision and noninvasive therapies were less valued, as indicated by the large and negative label effect. Both moderate and good-to-excellent cosmetic outcomes were accepted and preferred to poor cosmetic outcomes for all treatments. In addition, none or mild-to-moderate side-effects were considered acceptable and preferred to severe side-effects.

CONCLUSIONS

Patients show a clear preference for surgical excision, and of the two noninvasive treatments, 5-FU cream is preferred to MAL-PDT. Treatment choice is also determined by attributes such as effectiveness, cosmetic outcome and side-effects. In the context of shared decision making for Bowen disease, it is important to discuss the elements of treatment that patients value to ensure that an informed decision is made.

Quantifying Patient Preferences for Risk Tolerance With Novel Dual Biologic Therapies for Inflammatory Bowel Disease

INTRODUCTION

Many patients with inflammatory bowel disease (IBD) experience treatment failures despite availability of effective advanced biologic and small-molecule therapies with differing mechanisms of action. Dual biologic therapy (DBT) is being explored to improve efficacy outcomes and address unmet needs in this difficult-to-treat population. This study aimed to understand patient preferences for DBT efficacy and risk tolerance.

METHODS

Built on evidence from existing treatment-preference studies, a focused discrete-choice experiment (DCE) was developed to measure preferences for treatment type, chance of remission, and risk of serious infection. Individuals with a physician-verified diagnosis of Crohn's disease or ulcerative colitis who had failed or were taking advanced therapy were recruited through an IBD registry. DCE responses were analyzed using a fully correlated random parameters logit model.

RESULTS

The DCE survey was completed by 280 respondents. The majority of respondents were White, female; had been previously hospitalized for IBD; and were receiving biologic monotherapy for their IBD disease. There was no meaningful difference in preference for DBT or monotherapy (P = 0.25), while there was strong preference to avoid corticosteroids (P < 0.001). To improve from a 50% to 70% in chance of remission, respondents would accept up to a 17.5% (95% confidence interval 17.0%-18.0%) risk of serious infection.

DISCUSSION

The findings suggest that patients prefer safe and efficacious treatments and DBT may be an acceptable option for those who have failed an advanced therapy for IBD. We demonstrate the value of building on existing evidence and designing efficient DCE studies to address knowledge gaps to improve IBD care.

What Next for the Science of Patient Preference? Interoperability, Standardization, and Transferability

Using patient preference information (PPI) to incorporate patient voices into the drug development lifecycle can help align therapies with the needs and values of patients. However, several barriers have limited the use of PPI, including a lack of clarity on its use by decision-makers, a need for greater decision-maker trust in PPI, and a lack of time, budgets, and access to specialist expertise. The value proposition for PPI could be enhanced by making it FAIR: Findable, Accessible, Interoperable, and Reusable. To support the development of a research agenda to deliver FAIR PPI, we reviewed related endeavors in the development of repositories of existing studies, disease models, benefit transfer, and common data standards. We concluded that developing FAIR PPI would require advances in the science of PPI, including the establishment of a consortium, mirroring the Clinical Data Interchange Standards Consortium (CDISC) or Observational Medical Outcomes Partnership (OPOM), to develop PPI data standards, and research into the sources of variation in patient preferences. This will require the science of PPI to graduate from being a body of empirical observations to developing theories that explain variations in patient preferences, simultaneously driving both efficiency in the generation of PPI and trust in PPI.

What Do People Want from an AI-Assisted Screening App for Sexually Transmitted Infection-Related Anogenital Lesions: A Discrete Choice Experiment

BACKGROUND

One of the World Health Organization (WHO) recommendations to achieve its global targets for sexually transmitted infections (STIs) is the increased use of digital technologies. Melbourne Sexual Health Centre (MSHC) has developed an AI-assisted screening application (app) called AiSTi for the detection of common STI-related anogenital skin conditions. This study aims to understand the community's preference for using the AiSTi app.

METHODS

We used a discrete choice experiment (DCE) to understand community preferences regarding the attributes of the AiSTi app for checking anogenital skin lesions. The DCE design included the attributes: data type; AI accuracy; verification of result by clinician; details of result; speed; professional support; and cost. The anonymous DCE survey was distributed to clients attending MSHC and through social media channels in Australia between January and March 2024. Participant preferences on various app attributes were examined using random parameters logit (RPL) and latent class analysis (LCA) models.

RESULTS

The median age of 411 participants was 32 years (interquartile range 26-40 years), with 64% assigned male at birth. Of the participants, 177 (43.1%) identified as same-sex attracted and 137 (33.3%) as heterosexual. In the RPL model, the most influential attribute was the cost of using the app (24.1%), followed by the clinician's verification of results (20.4%), the AI accuracy (19.5%) and the speed of receiving the result (19.1%). The LCA identified two distinct groups: 'all-rounders' (88%), who considered every attribute as important, and a 'cost-focussed' group (12%), who mainly focussed on the price. On the basis of the currently available app attributes, the predicted uptake was 72%. In the short term, a more feasible scenario of improving AI accuracy to 80-89% with clinician verification at a $5 cost could increase uptake to 90%. A long-term optimistic scenario with AI accuracy over 95%, no clinician verification and no cost could increase it to 95%.

CONCLUSIONS

Preferences for an AI-assisted screening app targeting STI-related anogenital skin lesions are one that is low-cost, clinician-verified, highly accurate and provides results rapidly. An app with these key qualities would substantially improve user uptake.

Preferences for breast cancer screening: Results of a discrete choice experiment

OBJECTIVES

This study aimed to assess the preferences of breast cancer patients in China for screening services using a discrete choice experiment (DCE) and latent class modeling (LCM). The findings are intended to inform the development of more patient-centered screening programs.

STUDY DESIGN

A cross-sectional, hospital-based survey employing discrete choice experiment methodology.

METHODS

A total of 278 breast cancer patients were recruited from the Department of Thyroid and Breast Surgery at a tertiary hospital in Guizhou Province. The study evaluated key attributes of screening services, including screening frequency, medical staff experience, referral sources, and out-of-pocket costs, through a DCE questionnaire. A mixed logit model was applied to assess overall patient preferences, while LCM was used to explore heterogeneity among patient subgroups. The development of the DCE questionnaire involved focus group discussions to ensure the relevance of attributes.

RESULTS

The analysis revealed that screening frequency, medical staff experience, and out-of-pocket costs were the most significant factors influencing patient preferences. Patients exhibited a strong preference for annual screenings (β = -1.622, p < 0.001) and for screening by experienced medical staff (β = 2.216, p < 0.001). Additionally, lower out-of-pocket costs significantly enhanced willingness to participate (β = -0.211, p < 0.05). LCM analysis identified two distinct patient subgroups: "process-driven" patients, who prioritized lower costs and multi-channel referral options, and "efficiency-driven" patients, who valued timely service and experienced staff.

CONCLUSION

This study emphasizes the diverse preferences of breast cancer patients for screening services and suggests that personalized screening programs could better meet the needs of different patient subgroups. Developing flexible, patient-centered screening programs will be essential to improving participation and satisfaction with breast cancer screening in China. Practical challenges in implementing such personalized approaches should be considered in future policy development.

The employment preferences of young people in Canada: a discrete choice experiment

BACKGROUND

Young people across the world are facing numerous challenges, with unemployment and precarious employment being substantial issues, impacting young people with all levels of education. For many young people, the pandemic exacerbated their employment precarity. While efforts were made to ameliorate these pandemic related challenges for young people, information about the employment preferences of Canadian young workers (YW) is limited. The aim of this study was to understand the employment needs, challenges and preferences of Canadian YW in the COVID-19 era and beyond.

METHODS

Using discrete choice experiment, YW from across Canada aged 18-29 years old were recruited to participate in an online survey October 2022 to April 2023 which was offered in both English and French. Nine job attributes were identified based on findings from the qualitative component of this mixed methods project: wage, earnings stability, job flexibility, vacation, sick time, health insurance, and workplace policies (respectful workplace, and being valued and understood as an employee). Respondents were presented with nine choice sets, each representing two scenarios that differ on policies or actions (attributes) related to their employment during the COVID-19 pandemic.

RESULTS

Based on the respondent (N = 231) sample, analysis revealed that of YW aged 18-29 years, most valued having employment benefits along with workplace policies. These values were strongest for women and 18-21-year-olds. Overall, the employment preferences of Canadian YW in the current study align with four of five attributes considered by the International Labour Organization as minimum standards for decent work. These include adequate compensation, adequate access to health care, adequate free time and rest, and organizational values that support one's [own and] family values. More specifically, study findings show that within the cohort there are strong gendered and aged-based preferences for non-monetary over monetary job attributes. These include employment benefits along with equitable, supportive employment policies.

CONCLUSIONS

The findings suggest that health and wellbeing are highly valued by YW and are among key drivers of employment preferences for Canadian YW during and after the pandemic, and therefore call for policies in the workplace that support the health and well-being of YW.

Patient preferences for long-acting HIV treatment: a preference heterogeneity assessment

BACKGROUND

Long-acting antiretroviral therapy (LA-ART) is an emerging alternative to daily oral ART pills that may improve HIV treatment adherence. We studied preference heterogeneity for LA-ART among people with HIV (PWH) in western Washington State and Atlanta, Georgia to determine how preference heterogeneity was related to individual characteristics.

METHODS

We recruited 699 PWH to complete a survey including 17 choice-tasks, each of which included two hypothetical LA-ART alternatives and current daily oral therapy. Each hypothetical alternative was defined by mode (long-acting [LA] oral pills, subcutaneous injections, intramuscular injections, and implants), frequency, treatment location (home, clinic, or pharmacy), injection pain, pre-treatment time undetectable, pre-treatment reaction testing, and late-dose leeway. We fitted a latent class model to the data and investigated associations between class membership and individual characteristics.

RESULTS

Our sample had three classes which were defined by their treatment preferences. Two classes preferred LA-ART over current treatment: the LA-Implant class (29%) and the LA-Oral-or-Injection class (35%). In contrast, the Daily-or-LA-Oral class (36%) preferred current treatment or LA oral pills taken at home. Compared to the third class, participants from the other two were younger, more educated, less adherent to current ART, and less averse to injections. Further, LA-Implant participants were less likely to be virally suppressed and had easier clinic access. LA-Oral-or-Injection participants had a higher prevalence of psychotic disorders.

CONCLUSION

These results provide a deeper understanding of the preference landscape for LA-ART and can aid in the development of interventions better aligned with individual preferences.

Outcome preferences in fidelity-adaptation scenarios across evidence-based parenting programs: A discrete choice experiment

BACKGROUND

Implementing evidence-based parenting programs often involves navigating fidelity-adaptation decisions. While research has explored various aspects of this dilemma, little is known about how practitioners' outcome preferences influence their decisions in real-world scenarios.

METHODS

This study employed a discrete choice experiment (DCE) to investigate the relative importance of five outcomes (Relationship Quality, Satisfaction, Workload Strain, Value Conflict, and Reach) in fidelity-adaptation decisions among 209 practitioners delivering evidence-based parenting programs in Sweden. The DCE presented 25 choice sets across five contextual scenarios, analyzed using Bayesian hierarchical logistic regression.

RESULTS

All five outcomes significantly influenced practitioners' choices, with Relationship Quality emerging as the most impactful (log-odds: 4.56, 95% CI [4.16, 4.91]). Satisfaction and minimizing Value Conflict showed similar importance (log odds: 2.45 and -2.40, respectively), while Workload Strain and Reach had slightly less impact (log odds: -2.10 and 1.96, respectively).

CONCLUSIONS

This study offers a novel perspective on the role of outcome preference in navigating fidelity-adaptation decisions. The strong preference for improving parent-child relationships aligns with core parenting program goals, while consideration of other outcomes reflects practitioners' holistic approach to implementation. These findings can inform the design of interventions and implementation strategies that balance effectiveness with real-world constraints, potentially enhancing parenting programs' adoption, sustainability, and impact.

Incorporating discrete choice experiments into long-term care insurance policy decisions: evidence from China

Background

Rapid population aging has prompted most emerging economies to consider introducing long-term care insurance (LTCI) as part of a comprehensive social health protection scheme. China is also in the process of establishing its own LTCI framework. However, the details of the scheme are still being explored in pilot cities, and a long-term solution has yet to be finalized. This study aims to examine the insurance preferences of potential enrollees, providing insights to inform further adjustments to the existing framework.

Methods

We examine discrete choice experiment (DCE) evidence from LTCI and evaluate several relevant attributes, including the elimination period, maximum monthly benefit, out-of-pocket rate, and annual premium. The study uses a mixed logit model to elicit respondents' preferences and willingness to pay (WTP) for these attributes of LTCI and uses physical health status to assess heterogeneity in responses to insurance choice.

Results

We found that most respondents would consider purchasing LTCI, with respondents most preferring the following attributes: (1) an out-of-pocket rate of 25%, (2) a maximum monthly benefit level of 2000 CNY (about 296 USD), and (3) a three-month elimination period. In addition, among the control variables, marital status, personal self-rated health, and the number of children were significant to varying degrees.

Conclusion

The study can provide a reference for further adjustments to the existing scheme, increasing residents' willingness to participate in insurance and promoting the sustainable development of long-term care insurance.

Caregiver preferences and willingness-to-pay for home care services for older people with dementia: A discrete choice experiment in the Milan metropolitan area

OBJECTIVES

Dementia is a major health and social care challenge in high-income countries where most people are cared for in their own homes. This study aimed to elicit caregiver preferences for alternative bundles of home care services in the Milan metropolitan area.

METHODS

A binary discrete choice experiment was administered to a sample of informal caregivers of people with dementia recruited through a network of non-profit organizations. The experiment included four attributes: 1) number of home care hours per month; 2) type of care; 3) caregiver peer support group organization; 4) monthly family's cost (in euros), each articulated into three levels. A mixed logit model was applied to analyze the responses using Stata.

RESULTS

A total of 93 self-administered questionnaires were collected in January-April 2023. Two-thirds of both caregivers (67.7 %) and care recipients (65.6 %) were female, with a mean age of 59.0 (±12.1) years and 82.2 (±6.5) years, respectively. The experiment showed that increased home care hours, mixed health and social home care, caregiver meetings with professional support and lower monthly costs were mostly valued by caregivers. Some preference heterogeneity was detected in relation to care recipient's characteristics (e.g., age).

CONCLUSIONS

These results are expected to inform policymakers about caregiver priorities in the field of dementia based on the values placed on hypothetical public home care services.

Prediction accuracy of discrete choice experiments in health-related research: a systematic review and meta-analysis

Background

Discrete choice experiments (DCEs) are increasingly used to inform the design of health products and services. It is essential to understand the extent to which DCEs provide reliable predictions outside of experimental settings in real-world decision-making situations. We aimed to compare the prediction accuracy of stated preferences with real-world choices, as modelled from DCE data.

Methods

We searched six databases for health-related studies that used DCE to assess external validity and reported on predicted versus real-world choices, up to July 2024. A generalised linear mixed model was used for a meta-analysis to jointly pool the sensitivity and specificity. Heterogeneity was assessed using the I 2 statistic, and sources of heterogeneity using meta-regression. This study is registered with PROSPERO (CRD42023451545).

Findings

We identified 14 relevant studies, of which 10 were included in the meta-analysis. Most studies were conducted in high-income countries (11/14, 79%) from the European region (9/14, 64%) and analysed using mixed logit models (5/14, 36%). Pooled sensitivity and specificity estimates were 89% (95% CI:77-95, I 2 = 97%) and 52% (95% CI:32-72, I 2 = 95%), respectively. The area under the SROC curve (AUC) was 0.81 (95% CI:0.77-0.84). Our meta-regression found that DCEs for prevention-related choices had higher sensitivity than treatment-related choices. DCEs conducted under clinical settings and analysed using the heteroskedastic multinomial logit model, incorporating systematic preference heterogeneity and random opt-out utility, had higher specificity than non-clinical settings and alternative models.

Interpretation

DCEs are valuable for capturing health-related preferences and possess reasonable external validity to predict health-related behaviours, particularly for opt-in choices. Contextual factors (e.g., type of intervention, study setting, analysis method) influenced the predictive accuracy.

Funding

JJO is supported by an Australian National Health and Medical Research Council Emerging Leadership Investigator Grant (GNT1193955). EBG is supported by the Dutch Research Council (NWO-Talent-Scheme-Vidi-Grant No, 09150171910002). YZ is supported by an Australian Government Research Training Program (RTP) scholarship.

Public Valuations of Managing Compromised Molars: A Discrete Choice Experiment

There is limited evidence to support optimal patient-centered management for compromised first permanent molars (cFPM) in children. Based on an online discrete choice experiment (DCE), this study elicits UK adult general population preferences and calculates willingness to pay (WTP) for pathways to manage cFPM. The DCE was designed with information from semistructured interviews and literature reviews, as well as focus groups with an expert panel of dentists, citizens, and policy makers. A statistically optimal D-efficient design generated 18 choice tasks, split across 2 blocks. Each respondent answered one block of 9 tasks to reduce survey fatigue. Choice tasks varied across 5 attributes: type of treatment, provider of care, who makes the management decision, number of future visits avoided, and cost. An opt-out was included (no treatment). Conditional logit models (fixed effects) were used for data analysis, and marginal WTP for each attribute level was calculated. An overall 430 respondents completed the DCE. Respondents valued children receiving care as compared with not. Restoring a cFPM was valued equally to spontaneous or orthodontic gap closure. In contrast, having a partial gap, prosthetic replacement with a bridge, or a full unit gap was valued less than restoration or full gap closure. General dentists were preferred to dentists with enhanced skills, but there was no evidence of a preference for general dentists over specialists in pediatric dentistry. Respondents preferred to be wholly or partly involved in the decision-making process as opposed to the dentist making the decision alone. Respondents preferred less costly treatments and the avoidance of future dental work. Dental care service providers must consider service user preferences for health and nonhealth outcomes in any service redesign. Furthermore, the results provide marginal WTP estimates that can be used to value dental care services.

Nurses' preferences for working in Uber-style 'Internet plus' nursing services: A discrete choice experiment

BACKGROUND

China's 'Internet Plus' nursing services, which are Uber-style home care services with an 'online application, offline service' approach, have been evolving over the past five years. Registered nurses' preference for these Uber-style Internet Plus nursing services are crucial for improving human resource management and service efficiency, yet research in this area remains scarce.

OBJECTIVE

This study aimed to explore registered nurses' preferences for Uber-style Internet Plus nursing services and provide optimization recommendations from a supply-side perspective.

DESIGN

A cross-sectional study utilising a discrete choice experiment.

SETTING(S)

Two public tertiary hospitals located in Tianjin, China, which have implemented Internet Plus nursing services.

PARTICIPANTS

211 registered nurses who participated in Internet Plus nursing services.

METHODS

The survey was conducted anonymously using an online survey platform. Respondents were presented with choices between two alternatives, based on five key attributes: income, safety and security, patient and family cooperation, commute time, and service type. Mixed logit models estimated the stated preferences for attributes. Relative importance scores, willingness-to-pay estimates, and simulations of service-type uptake rates were calculated. Subgroup analysis and seemingly unrelated regression estimation were performed to examine heterogeneity in preferences.

RESULTS

A total of 3202 choice observations were generated. When sorted by the strength of preference, the five attributes related to registered nurses' choice of Uber-style Internet Plus nursing services, measured by their relative importance scores, are as follows: safety and security (30.89 %), income (27.41 %), patient and family cooperation (18.47 %), service type (11.96 %), and commuting time (11.27 %). Elevating safety and security from low to high levels has the same utility as a 31.81 % increase in monthly income, equivalent to 2586.14 yuan. Subgroup analysis showed that senior nurses place more value on safety and security than junior nurses (β = 1.421 vs.β = 0.725; P = 0.011), and unmarried nurses had a stronger preference for family and caregiver cooperation (β = 1.105 vs.β = 0.314; P = 0.023).

CONCLUSIONS

The strength and heterogeneity of registered nurses' preferences should be highlighted in the dispatch algorithms model of Uber-style Internet Plus nursing services, thereby enhancing the efficiency and humanity of Uber-style Internet Plus nursing services.

TWEETABLE ABSTRACT

Registered nurses prioritise safety and security, acknowledging heterogeneous preferences in Uber-style Internet Plus nursing services.

Balancing choice and socioeconomic realities: analyzing behavioral and economic factors in social oocyte cryopreservation decisions

Purpose

This research investigates the influence of personal income, the likelihood of pregnancy from cryopreserved oocytes, and the risk of infertility, on the decision-making process of women. The study employs the economic stated preference framework alongside the Theory of Planned Behavior in order to comprehend the process of decision-making.

Design/methodology/approach

The data had been collected from women between the ages of 18 and 65 via questionnaire employing conjoint analysis (CA). Through the utilization of this methodology, the factors influencing women's choices concerning oocyte cryopreservation were quantified.

Findings

The study identified crucial factors that impact the determination to cryopreserve oocytes, such as personal financial resources, the likelihood of achieving a successful pregnancy using frozen oocytes, and the potential for infertility. The analysis reveals that a considerable number of participants perceive cryopreservation as a feasible alternative for augmenting their prospects for future procreation.

Research implications

The results validate the patterns and the ways in which personal and socioeconomic elements impact choices regarding fertility. This has the potential to inform forthcoming health policies and educational initiatives that aim to provide more comprehensive support for women's fertility decisions.

Social implications

The research highlights the necessity of policy and societal support for women who are contemplating oocyte cryopreservation. It is recommended that public health policies incorporate provisions for state financing of cryopreservation in order to safeguard reproductive autonomy and alleviate the fertility risk linked to the aging process.

Originality/value

His research is unique in that it employs the Theory of Planned Behavior and an economic stated-preference framework to analyze the dynamics of oocyte cryopreservation decisions. This work enhances the existing body of literature by drawing attention to the socio-economic persona factors that influence choices regarding fertility preservation.

Incentivizing Rural Work Preferences Among Specialist Physicians: Protocol for a Discrete Choice Experiment

BACKGROUND

Retaining specialist physicians in rural parts of India poses a fundamental challenge, which affects the health care system's functionality and provision of standard health care services. There has been an acute shortfall of specialist physicians in the fields of medicine, pediatrics, obstetrics and gynecology, and surgery at rural community health centers. This necessitates urgent policy focus to address the shortages and design effective rural retention strategies. In this study, which uses a discrete choice experiment (DCE), individuals choose from multiple-choice preferences that resemble hypothetical job descriptions.

OBJECTIVE

DCEs are a quantitative approach to assessing several aspects of job selection. This study aims to develop a detailed plan of a DCE method used to determine specialist physicians' job choices. This protocol outlines the DCE method, which uses an exploratory sequential mixed methods research design to understand specialist physicians' preferences and design reward packages that would effectively motivate them to work in underserved regions.

METHODS

The qualitative phase of the study involved identifying job attributes and their corresponding levels for the DCE. We followed a meticulous process, which included reviewing relevant literature, performing qualitative pilot work, conducting in-depth individual interviews, and consulting with medical and health experts. The quantitative phase involved generating a D-efficient orthogonal fractional factorial design using Ngene software to create choice scenarios using the identified job factors and their corresponding levels. The generated choice scenarios were blocked into 6 versions in 6 blocks. The DCE was undertaken among final-year postgraduate medical residents and specialist physicians from several health care facilities in Rajasthan. Various statistical models will be applied to explore the response variability and quantify the trade-offs that participants are willing to make for nonmonetary features as a substitute for adjustments in the monetary attribute.

RESULTS

After the ethics committee's approval of the study, the qualitative data collection phase occurred from September to December 2021, while the quantitative phase took place from May to August 2022. Six attributes and 14 levels were identified and established through qualitative surveys. The experimental design resulted in 36 choice situations, which were grouped into 6 blocks. The preliminary investigation demonstrated that the instrument was valid and reliable. Statistical data analysis has been initiated, and the principal findings are expected to be disseminated in January 2025.

CONCLUSIONS

The protocol provides a systematic framework to assess specialist physicians' preferences regarding working in rural health care centers. This research has the potential to substantially influence the future of rural health care by laying the foundation for understanding specialist physicians' choices, which will help design future incentive schemes, policy interventions, and research.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59621.

Valuing quality of life for economic evaluations in cancer: navigating multiple methods

INTRODUCTION

Utility values offer a quantitative means to evaluate the impact of novel cancer treatments on patients' quality of life (QoL). However, the multiple methods available for valuing QoL present challenges in selecting the most appropriate method across different contexts.

AREAS COVERED

This review provides cancer clinicians and researchers with an overview of methods to value QoL for economic evaluations, including standalone and derived preference-based measures (PBMs) and direct preference elicitation methods. Recent developments are described, including the comparative performance of cancer-specific PBMs versus generic PBMs, measurement of outcomes beyond health-related QoL, and increased use of discrete choice experiments to elicit preferences. Recommendations and considerations are provided to guide the choice of method for cancer research.

EXPERT OPINION

We foresee continued adoption of the QLU-C10D and FACT-8D in cancer clinical trials given the extensive use of the EORTC QLQ-C30 and FACT-G in cancer research. While these cancer-specific PBMs offer the convenience of eliciting utility values without needing a standalone PBM, researchers should consider potential limitations if they intend to substitute them for generic PBMs. As the field advances, there is a greater need for consensus on the approach to selection and integration of various methods in cancer clinical trials.

The DECISION project: DiscrEte Choice experIment Spinal manipulative therapy for lOw back paiN: A study protocol

The smallest worthwhile effect (SWE) is the smallest beneficial effect of an intervention that justifies the costs, risks, and inconveniences. The objective is to establish the SWE of spinal manipulative therapy (SMT) for the treatment of low back pain (LBP), and to gain insight into how different attributes of the treatment are traded among each other when choosing SMT. Part 1. A mixed-methods study will be conducted to establish and prioritize a list of attributes influencing choices for those who consider SMT for the treatment of LBP. Individual interviews and consensus groups with chiropractors, manual therapists, and osteopaths and their patients will be conducted. Interviews and consensus groups will be voice-recorded and transcribed verbatim. Part 2. A Discrete Choice Experiment (DCE) will be conducted among people with LBP who have limited to no experience with SMT. Participants will be recruited through an online independent panel company. The survey will consist of several choice sets with attributes and their levels established from Part 1. The DCE will be preceded by a short survey to understand the clinical aspects (i.e. presentation, history and previous treatment for LBP) as well as socio-demographic characteristics of the participants.

Preferences for attributes of an artificial intelligence-based risk assessment tool for HIV and sexually transmitted infections: a discrete choice experiment

INTRODUCTION

Early detection and treatment of HIV and sexually transmitted infections (STIs) are crucial for effective control. We previously developed MySTIRisk, an artificial intelligence-based risk tool that predicts the risk of HIV and STIs. We examined the attributes that encourage potential users to use it.

METHODS

Between January and March 2024, we sent text message invitations to the Melbourne Sexual Health Centre (MSHC) attendees to participate in an online survey. We also advertised the survey on social media, the clinic's website, and posters in affiliated general practice clinics. This anonymous survey used a discrete choice experiment (DCE) to examine which MySTIRisk attributes would encourage potential users. We analysed the data using random parameters logit (RPL) and latent class analysis (LCA) models.

RESULTS

The median age of 415 participants was 31 years (interquartile range, 26-38 years), with a minority of participants identifying as straight or heterosexual (31.8%, n = 132). The choice to use MySTIRisk was most influenced by two attributes: cost and accuracy, followed by the availability of a pathology request form, level of anonymity, speed of receiving results, and whether the tool was a web or mobile application. LCA revealed two classes: "The Precisionists" (66.0% of respondents), who demanded high accuracy and "The Economists" (34.0% of respondents), who prioritised low cost. Simulations predicted a high uptake (97.7%) for a tool designed with the most preferred attribute levels, contrasting with lower uptake (22.3%) for the least preferred design.

CONCLUSIONS

Participants were more likely to use MySTIRisk if it was free, highly accurate, and could send pathology request forms. Tailoring the tool to distinct user segments could enhance its uptake and effectiveness in promoting early detection and prevention of HIV and STIs.

Preference for community health services in people with chronic diseases: a discrete choice experiment in China

Background

Primary healthcare policies are widely implemented globally. However, many people with chronic diseases find that community-based chronic disease services do not meet their needs. There is a critical need for more evidence on the sustainability and optimization of chronic disease management in Chinese communities, especially from the demand side. Policymakers require detailed data on the needs of chronic disease patients regarding community health services.

Methods

A discrete choice experiment was conducted to measure the preferences of people with chronic diseases. Researchers recruited participants in Sichuan Province, China, and conducted face-to-face surveys. The mixed logit model evaluated participants' preferences for six attributes, estimating willingness to pay and relative importance, and performing subgroup analysis based on the initial model results.

Results

A total of 395 respondents participated in this study. Six attributes included all influenced the preference of people with chronic diseases for community health services. The most valued attribute for people with chronic diseases was drug accessibility (coefficient = 2.761, p < 0.001), followed by appointment referral (coefficient = 2.385, p < 0.001) and traditional Chinese medicine services (coefficient = 1.465, p < 0.001). The results were also borne out by the relative importance of attributes. Meanwhile, people with different types of chronic diseases were also most concerned about drug accessibility. There are differences in the willingness to pay for drug accessibility. Type II respondents had a higher WTP for services with high medicine accessibility (92.93 CNY) compared to Type I (67.05 CNY) and Type III (87.70 CNY) respondents.

Conclusion

This study results highlight the importance of drug accessibility, appointment referral services, and traditional Chinese medicine services in community chronic disease management. These findings provide valuable insights for policymakers to optimize the current management of chronic diseases in Chinese communities.

Integrating parent voices into research at the extremes of prematurity: what are we doing and where should we go?

When a baby is born premature, a landscape of potential problems replaces an imagined future. Outcomes become the measures of success. Researchers are recognizing that we need the direct input of parents to select meaningful outcomes. In this article, we describe how researchers and clinicians in neonatology have historically defined outcomes and the limitations of these methods. We chart the integration of stakeholders-patients and parents-into outcomes selection. 'Parent-important outcomes' are those deemed most important by parents, as the voices of their children. We outline a path toward determining parent-important outcomes in neonatology through mixed methods research. We conclude by suggesting how parent-important outcomes can be integrated into neonatal follow up research and clinical trial design. Ultimately, all researchers of prematurity aim in some way to improve outcomes that parents and patients care about. We hope this article will remind us of this beacon.

Analyzing research trends and developments in osseointegration in patients with extremity amputations: Systematic bibliometric analysis and research recommendations

BACKGROUND

Bone-anchored protheses (BAPs) by means of osseointegrated implants are increasingly being used in amputees with socket-related issues. Clinical advancements are being published by more and more centers worldwide. Although the number of publications and interest in BAP is growing, a systematic evaluation of scholarly output is lacking.

OBJECTIVE

To identify scholarly output, understand research trends and make research recommendations in the clinical field of BAP.

METHODS

Systematic searches in Medline All, Embase, Web of Science Core Collection, Cochrane Library, and Google Scholar were completed in February 2023. The results were deduplicated, screened, and assessed for quality by independent reviewers. Inclusion criteria were as follows: clinical studies and BAP in the extremities. Articles were excluded if they were animal or fundamental studies, nonclinical reports, had a study population less than 10 patients, or BAP was performed in areas other than extremities.

RESULTS

One hundred twelve articles were included and published between 1993 and 2023. An annual growth rate of 10.3% was found and research was published in 62 different journals. Prosthetics and Orthotics International, Clinical Orthopaedics and Related Research and The Bone & Joint Journal were the most prolific journals. Hagberg K, Aschoff HH, and Branemark R were major contributors to BAP research. Collaborations are predominantly among high-income countries. Main research trends were on rehabilitation, questionnaires, complication managements, and implant treatment.

CONCLUSIONS

Research on BAP shows an increasing global trend, highlighting key research areas and authors. A unified global research agenda, stakeholders' collaborations, and consensus are essential for addressing knowledge gaps and development future direction of BAP.

Sources and processes of social influence on health-related choices: A systematic review based on a social-interdependent choice paradigm

BACKGROUND

Most choices in healthcare are not made in social isolation. However, current econometric models treat patients' preferences as the sole determinants of their choices. Through the lens of sociology and medical sociology theories, this paper presents a systematic literature review of identifiable social influences on patients' choices, serving as a first step in developing a social-interdependent choice paradigm.

METHODS

Following the PRISMA guideline and using nine databases, we identified the individual agents or groups involved in health-related choices, the functional content through which social relationships influence patients, and the choice constructs affected by these processes. From 9036 screened articles, we selected 208 to develop an analytical framework connecting social relationships with choice constructs.

RESULTS

Social influences predominantly come from family, friends, specialized physicians, and general practitioners. We decomposed the functional content of social relationships into functions and contents. Dyadic interactions and expert knowledge were prominent functions, followed by social control. Prescriptive and informational contents were prevalent, followed by instrumental and emotional ones. Expert knowledge and social norms aligned with prescriptive and informational signals, while dyadic interactions provide emotional and instrumental signals. Reference points for social norms included friends, coworkers, and patients. Social relationships primarily impact which alternatives are evaluated, followed by alternative evaluation strategies and goal selection. Distinctions between medical domains and dimensions emerged, highlighting how the medical area conditions the social influence process.

CONCLUSION

This systematic review presents a comprehensive framework that elucidates the social influence process in healthcare patient decision-making. By detailing the functional content of social relationships into functions and contents and linking these components to the elements of the choice process, we created a structured approach to understanding how social relationships impact patient choices. This will facilitate the systematic integration of social relationships into econometric models of patient choice.

Patients' Preferences for Sphingosine-1-Phosphate Receptor Modulators in Multiple Sclerosis Based on Clinical Management Considerations: A Choice Experiment

BACKGROUND

Several sphingosine-1-phosphate receptor (S1PR) modulators are available in the US for treating relapsing forms of multiple sclerosis (RMS). Given that these S1PR modulators have similar efficacy and safety, patients may consider the clinical management characteristics of the S1PR modulators when deciding among treatments. However, none of the S1PR modulators is clearly superior in every aspect of clinical management, and for some treatments, clinical management varies based on a patient's comorbid health conditions (e.g., heart conditions [HC]).

OBJECTIVES

This study aimed to determine which S1PR modulator patients with relapsing-remitting multiple sclerosis (RRMS) would prefer based on clinical management considerations, and to estimate how different clinical management considerations might drive these preferences. Preferences were explored separately for patients with and without comorbid HC.

METHODS

A multicriteria decision analysis was conducted on S1PR modulators approved to treat RMS: fingolimod, ozanimod, siponimod, and ponesimod. Clinical management preferences of patients with RRMS were elicited in a discrete choice experiment (DCE) in which participants repeatedly chose between hypothetical S1PR modulator profiles based on their clinical management attributes. Attributes included first-dose observations, genotyping, liver function tests, eye examinations, drug-drug interactions, interactions with antidepressants, interactions with foods high in tyramine, and immune system recovery time. Preferences were estimated separately for patients with HC and without HC (noHC). Marginal utilities were calculated from the DCE data for each attribute and level using a mixed logit model. In the multicriteria decision analysis, partial value scores were created by applying the marginal utilities for each attribute and level to the real-world profiles of S1PR modulators. Partial value scores were summed to determine an overall clinical management value score for each S1PR modulator.

RESULTS

Four hundred patients with RRMS completed the DCE. Ponesimod had the highest overall value score for patients both without (n = 341) and with (n = 59) HC (noHC: 5.1; HC: 4.0), followed by siponimod (noHC: 4.9; HC: 3.3), fingolimod (noHC: 3.4; HC: 2.8), and ozanimod (noHC: 0.9; HC: 0.8). Overall, immune system recovery time contributed the highest partial value scores (noHC: up to 1.9 points; HC: up to 1.2 points), followed by the number of drug-drug interactions (noHC: up to 1.2 points; HC: up to 1.7 points).

CONCLUSIONS

When considering the clinical management of S1PR modulators, the average patient with RRMS is expected to choose a treatment with shorter immune system recovery time and fewer interactions with other drugs. Patients both with and without heart conditions are likely to prefer the clinical management profile of ponesimod over those of siponimod, fingolimod, and ozanimod. This information can help inform recommendations for treating RRMS and facilitate shared decision making between patients and their doctors.

Stated Preferences of At-Risk Populations for the Treatment of Osteoporosis: A Systematic Review

INTRODUCTION

Poor adherence to anti-osteoporosis treatment is a well-recognized problem, partly due to misalignment with patient preferences. In recent years, several quantitative preference studies have been conducted. This study aimed to systematically review stated preference research to provide a comprehensive overview of patient preferences in osteoporosis, in particular on conditional relative attribute importance and preference heterogeneity.

METHODS

This systematic review was conducted in MEDLINE and Embase up to February 29th, 2024. It includes all English-language, peer-reviewed, stated preference articles related to osteoporosis management and treatment in patients with or at risk of osteoporosis. Conditional relative importance of attributes as well as heterogeneity was assessed, and attributes classified into outcome, process, and cost attributes. Quality assessment was performed using a combined checklist of Purpose, Respondents, Explanation, Findings, and Significance (PREFS) and International Society for Pharmacoeconomics and Outcomes Research (ISPOR) items.

RESULTS

Fourteen studies including 4714 participants were evaluated. Attributes were mostly classified as process related (50%) and outcome related (40%), both of which significantly influence patient preferences. In pairwise attribute comparison, efficacy was dominant over cost, administration, and side-effects. Preference heterogeneity was observed in the majority of studies (86%). Quality assessment indicated an overall improvement in study quality over time, with recent studies adhering more closely to established methodological standards.

CONCLUSIONS

The findings highlight the importance of considering patient preferences in the management of osteoporosis, underscoring the need for a patient-centered approach. The readiness of patients to engage in trade-offs between attributes suggests that healthcare providers should ensure treatments are aligned with individual patient preferences to improve adherence and optimize outcomes.

Clinicians' Preferences for Sphingosine-1-Phosphate Receptor Modulators in Multiple Sclerosis Based on Clinical Management Considerations: A Choice Experiment

BACKGROUND

Four sphingosine-1-phosphate receptor (S1PR) modulators are currently available in the USA for treating relapsing forms of multiple sclerosis (MS). These S1PR modulators have similar efficacy. Clinicians may therefore consider other factors, such as clinical management considerations, when distinguishing among treatments. This study estimated which S1PR modulator clinicians would choose on the basis of a treatment's clinical management and quantified how individual aspects of clinical management might drive this choice.

METHODS

A multi-criteria decision analysis (MCDA) was conducted on the basis of clinical management preferences elicited in a discrete choice experiment (DCE) and real-world clinical management profiles of the S1PR modulators currently available to treat relapsing forms of MS (fingolimod, ozanimod, ponesimod, siponimod). The DCE was completed by neurologists in the USA experienced in treating MS and included eight clinical management attributes: first-dose observations, genotyping, liver function tests, eye exams, drug-drug interactions, interactions with antidepressants, interactions with foods high in tyramine, and immune system recovery time. Attribute levels were selected on the basis of S1PR modulator product labels. In the MCDA, partial MCDA scores were created for each attribute and summed to produce an overall MCDA score for each S1PR modulator.

RESULTS

The DCE was completed by 200 neurologists. The overall MCDA score was highest for ponesimod (4.78 points), followed by siponimod (4.10 points), fingolimod (3.61 points), and ozanimod (2.38 points). Having fewer drug-drug interactions contributed most to the overall scores (up to 1.56 points), followed by having no first-dose observations (0.95 points), the shortest immune system recovery time (0.94 points), and not interacting with foods high in tyramine (0.86 points).

CONCLUSION

When considering clinical management convenience, the average US-based neurologist treating MS is likely to choose ponesimod over siponimod, fingolimod, or ozanimod. The strongest driver of preferences was the number of drug-drug interactions. This information can help inform recommendations for the treatment of MS and facilitate shared decision-making between clinicians and patients.

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.

Urban-rural differences in preferences for traditional Chinese medicine services among chronic disease patients: a discrete choice experiment

BACKGROUND

With the increasing prevalence of chronic diseases, the demand for medical services from chronic disease patients has become diversified and personalized. The advantages and role of traditional Chinese medicine in the prevention and treatment of chronic diseases gradually emerging. The preferences and willingness to pay for traditional Chinese medicine services (TCMS) among patients with chronic diseases, as well as any disparities between urban and rural patients, have not been examined in past studies.

OBJECTIVE

This study aimed to investigate the preferences of chronic disease patients for TCMS, explore the value/importance that patients place on different treatment attributes, and evaluate whether there are urban-rural differences in their preferences and willingness to pay for TCMS.

METHODS

A total of 317 patients from Jiangsu Province, China participated in a discrete choice experiment that elicited the preferences for TCMS. The choice questions were constructed by six attributes: out-of-pocket (OOP) cost, institution, medical provider, treatment method, treatment duration, treatment efficacy. Mixed logit models were used to estimate the stated preference and marginal willingness to pay for each attribute.

RESULTS

The choice preferences of chronic disease patients for TCMS in this study were influenced by the four attributes: institution, treatment method, and treatment efficacy, and OOP cost. Improvements in treatment efficacy were the most concerning, followed by being treated in traditional Chinese medicine (TCM) hospital. Patients were willing to pay more to get better treatment outcomes. Compared with primary care institutions, patients were willing to pay more for treatment in TCM hospitals. The preferences for economic attribute (OOP cost) varied between urban and rural areas, and rural patients tended to favor scenarios that imposed a lower economic burden on them.

CONCLUSION

The chronic disease patients' preferences for TCMS were determined mainly by treatment efficacy but also by institution, treatment method and OOP cost. The urban-rural difference in preference identified in this study highlights that effective policy interventions should consider the characteristics of patients' demand in different regions.

What makes patients tick? Vaccine preferences against tick-borne encephalitis in four European countries

BACKGROUND

We explored vaccine motivation and preferences for tick-borne encephalitis (TBE) vaccine attributes among participants in TBE-endemic countries in Europe.

METHODS

An online survey was conducted among the general public in Austria, Germany, Switzerland, and Sweden. Participants were ≥ 18 years old, open to receiving vaccines, and living in, or regularly traveling to, TBE-endemic regions in the aforementioned countries. Participants were asked about their general vaccine knowledge and motivations for vaccination, before rating the importance of TBE vaccine attributes, such as efficacy, safety, dosing schedule, and booster interval. Thereafter, participants were shown three hypothetical TBE vaccine profiles with different combinations of attributes. Assuming equal efficacy and safety, participants were asked to select their preferred profile from 12 screens as part of a discrete-choice conjoint analysis. Utility scores were calculated to show the importance of each attribute. Data are presented for the overall survey group and by age and gender, using t-tests to compare means.

RESULTS

For 73% of participants (n = 1003/1379), self-protection was among the top three reasons to get vaccinated. Disease severity, protection of children or family, and advice or recommendation from a doctor/healthcare professional (HCP) were top three reasons for over half of participants. The majority (58-69%) agreed or strongly agreed that they trust their doctor/HCP on the subject of vaccines, they rely on their doctor/HCP's vaccine knowledge, and they prefer their doctor/HCP to make recommendations on which vaccines they or their families should take. Efficacy and safety were the most important standalone TBE vaccine attributes; however, among TBE vaccine profiles including 3-, 5- and 10-year booster intervals, the 10-year booster interval was the most influential attribute level when choosing a preferred vaccine profile (utility score: 0.58 [standard error: 0.01]). Differences in motivators and preferences were observed between age and gender subgroups.

CONCLUSION

The high level of doctor/HCP reliance highlights the key role doctors/HCPs play in influencing vaccine decision-making. Booster interval was the biggest driver of choice when selecting a hypothetical TBE vaccine profile, with the strongest preference for a 10-year booster interval. These findings could be used to inform TBE vaccination recommendations and in the further development of TBE vaccines.

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.

The Global Impact of Diversifying PrEP Options: Results of an International Discrete Choice Experiment of Existing and Potential PrEP Strategies with Gay and Bisexual Men and Physicians

To improve current and future use of existing (oral, injectable) and potential future (implants, douches) pre-exposure prophylaxis (PrEP) products, we must understand product preferences relative to one another, among gay and bisexual men (GBM), and physicians who prescribe PrEP. We completed an online discrete choice experiment (DCE) with separate groups of GBM and/or physicians from the United States, South Africa, Spain, and Thailand. Participants were presented information on PrEP products, including daily pills, event-driven pills (2-1-1 regimen), injections, subdermal implants (dissolvable, removable), and rectal douches. Next, they completed a choice exercise in which they were shown 10 screens, each presenting 3 of the aforementioned products at a time with 11 attributes for physicians and 10 attributes for GBM. For the attributes that were not constant, one level was shown per screen for each product. Participants selected the product they preferred most and rated their likelihood to select (GBM) or recommend (physicians) that product. Data were modeled using hierarchical Bayes estimation; resulting model coefficients were used to develop attribute importance measures and product preferences. For GBM across all countries, if all aforementioned PrEP products were on the market at the same time, over 90% of GBM would use some form of PrEP; 100% of physicians would recommend at least one of the PrEP products. There were variations in product preference by country. GBM in the United States and Thailand preferred the injection (21.7%, 22.9%, respectively), while the dissolvable implant was preferred in South Africa and Spain (19.9%, 19.8%, respectively). In the United States, South Africa, and Spain (where physician data were available), physicians were most likely to recommend the dissolvable implant (37.2%, 40.6%, 38.3%, respectively).

Preferences of patients and physicians in the United States for relapsed/refractory follicular lymphoma treatments

BACKGROUND

Patients with follicular lymphoma (FL) often relapse or become refractory to treatment (R/R). While the R/R FL treatment landscape evolves, little is known about the priorities of patients and physicians. This discrete-choice experiment (DCE) study assessed patients' and physicians' treatment preferences, and the trade-offs they would be willing to make between efficacy, tolerability, and administration.

METHODS

An online survey was conducted in US-based patients (≥18 years) with R/R FL and FL-treating physicians. The DCE was informed by a targeted literature review, clinical data, expert oncologist input, and pilot interviews. Participants completed eight experimental choice tasks where they chose between two hypothetical treatment profiles defined by six attributes: progression-free survival (PFS), administration/monitoring, risks of laboratory abnormalities requiring intervention, severe infections, diarrhea, and cytokine release syndrome (CRS). Relative attribute importance (RAI) and willingness to trade-off between PFS and other attributes were estimated.

RESULTS

Two-hundred patients (mean age 63.5 years; median three prior lines of therapy) and 151 FL-treating physicians participated. Increasing PFS was most important for both groups, although it was relatively less important to patients than physicians (RAI 35.2% vs. 45.7%). Administration/monitoring was three times more important to patients than physicians (RAI 28.8% vs. 9.5%); patients preferred oral treatment and would be willing to tolerate a significant reduction in PFS for oral administration over weekly intravenous infusions. Avoiding CRS was less important to patients than to physicians (RAI 7.7% vs. 15.8%). Both groups would accept shorter PFS for reduced risks of side effects (especially of laboratory abnormalities for patients and of CRS for physicians).

CONCLUSION

Although PFS was the most important attribute to patients and physicians, both would tolerate lower PFS for reduced side effects. Patients would also accept a substantial reduction in PFS for oral administration. Differences between the preferences/priorities of patients and physicians highlight the importance of shared decision-making.

Preferences of people with diabetes for diabetes care in Germany: a discrete choice experiment

OBJECTIVES

The objective of this study is to elicit health care preferences of people with diabetes and identify classes of people with different preferences.

METHODS

A discrete choice experiment was conducted among people with diabetes in Germany comprising attributes of role division in daily diabetes care planning, type of lifestyle education, support for correct medication intake, consultation frequency, emotional support, and time spent on self-management. A conditional logit model and a latent class model were used to elicit preferences toward diabetes care and analyze preference heterogeneity.

RESULTS

A total of 76 people with diabetes, recruited in two specialized diabetes care centers in Germany (mean age 51.9 years, 37.3% women, 49.1% type 2 diabetes mellitus, 50.9% type 1 diabetes mellitus), completed the discrete choice experiment. The most important attributes were consultation frequency, division in daily diabetes care planning, and correct medication intake. The latent class model detected preference heterogeneity by identifying two latent classes which differ mainly with respect to lifestyle education and medication intake.

CONCLUSION

While the majority of people with diabetes showed preferences in line with current health care provision in Germany, a relevant subgroup wished to strengthen lifestyle education and medication intake support with an aid or website.

Information needs preferences of Chinese colorectal cancer patients receiving chemotherapy: A discrete choice experiment

Objective

The study aims to investigate the information needs and preferences of colorectal cancer (CRC) patients undergoing chemotherapy using a discrete choice experiment (DCE) to optimize and improve the information support strategy for these patients.

Methods

Between May and July 2023, 165 patients with CRC who were receiving chemotherapy at a single hospital in China completed the questionnaire. The survey instruments included a general information questionnaire, a DCE questionnaire, and the Brief Health Literacy Screening Scale. A conditional logit model was used with Stata 16.0 software to analyze patients' preferences.

Results

A total of 159 valid questionnaires were collected, and the questionnaire response rate was 96.4%. All 7 included attributes had an impact on patients' information needs preference (P < 0.05). Among them, information providers, knowledge content, and social support had high relative importance, which were 12.16%, 7.57% and 2.25%, respectively. Patients showed a preference for attending doctors (β = 1.9439, P < 0.05) and primary nurses (β = 1.7985, P < 0.05). Providing knowledge related to disease basis, treatment, and health promotion also had a significant impact (β = 1.6224, P < 0.05).

Conclusions

Healthcare professionals should be the primary information source for patients and improve the accessibility of information by establishing professional information platforms or identifying reliable channels. It is recommended to provide continuous information on treatment and health promotion to CRC patients at various stages of chemotherapy. Attention should be paid to identifying and providing measures to alleviate the economic and psychological burden and to meet the social support needs of patients.