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Ozdemir S, Gonzalez JM, Bansal P, Huynh VA, Sng BL, Finkelstein E. Getting it right with discrete choice experiments: Are we hot or cold? Soc Sci Med 2024; 348:116850. [PMID: 38608481 DOI: 10.1016/j.socscimed.2024.116850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/26/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Abstract
Discrete Choice Experiments (DCEs) are widely employed survey-based methods to assess preferences for healthcare services and products. While they offer an experimental way to represent health-related decisions, the stylized representation of scenarios in DCEs may overlook contextual factors that could influence decision-making. The aim of this paper was to evaluate the predictive validity of preferences elicited through a DCE in decisions likely influenced by a hot-cold empathy gap, and compare it to another commonly used method, a direct-elicitation question. We focused on preferences for pain-relief modalities, especially for an epidural during childbirth - a context where direct-elicitation questions have shown a preference for or intention to have a natural birth (representing the "cold" state), yet individuals often opt for an epidural during labor (representing the "hot" state). Leveraging a unique dataset collected from 248 individuals, we incorporated both the stated preferences collected through a survey administered upon hospital admission for childbirth and the actual pain-relief modality usage data documented in medical records. The DCE allowed for the evaluation of scenarios outside of those expected by respondents to simulate decision-making during childbirth. When we compared the predicted epidural use with the actual epidural use during labor, we observed a choice concordance of 71-60%, depending on the model specification. The concordance rate between the predicted and actual choices increased to 77-76% when accounting for the initial use of other ineffective modalities. In contrast, the direct-elicitation choices, relying solely on respondents' baseline expectations, yielded a lower concordance rate of 58% with actual epidural use. These findings highlight the flexibility of the DCE method in simulating complex decision contexts, including those involving hot-cold empathy gaps. The DCE proves valuable in assessing nuanced preferences, providing a more accurate representation of the decision-making processes in healthcare scenarios.
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Affiliation(s)
- Semra Ozdemir
- Department of Population Health Sciences, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Prateek Bansal
- Department of Civil and Environmental Engineering, National University of Singapore, Singapore
| | - Vinh Anh Huynh
- Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Eric Finkelstein
- Department of Population Health Sciences, Duke University, Durham, NC, USA; Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Thai T, Lancsar E, Spinks J, Freeman C, Chen G. Understanding Australian pharmacy degree holders' job preferences through the lens of motivation-hygiene theory. Soc Sci Med 2024; 348:116832. [PMID: 38569288 DOI: 10.1016/j.socscimed.2024.116832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/27/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
Increasing the contribution of pharmacists to primary care has been long discussed, particularly in the context of health workforce shortages and the push to better integrate all providers across primary care. This study examines the employment preferences of Australian pharmacy degree holders (PDHs) elicited through a discrete choice experiment (DCE), to better understand the drivers of current labour force choices. A labelled DCE was developed incorporating the six employment sectors: hospital pharmacy, community pharmacy, primary healthcare settings, pharmaceutical industry, government/academia, and non-pharmacy-related sector. Each alternative was described by five attributes using Herzberg's Two Factor Theory as a conceptual framework. They include motivators - role and career opportunities, and hygiene factors-flexible work schedule, geographic location, and salary. Unforced choice data were analysed using conditional logit and mixed logit models. Based on a sample of 678 PDHs in Australia, our findings indicated pharmaceutical industry is the least preferred sector, followed by non-pharmacy-related sector. Motivators in the form of role and career opportunities are the most important attributes in hospital pharmacy while hygiene factors - geographic location and salary significantly drive the choice of community pharmacy and primary care settings. We provided evidence of a willingness to adopt expanded roles in community pharmacy. This unique interpretation of the key drivers of employment preference in light of motivators and hygiene factors provides policy makers with important information when designing policies to attract and retain PDHs across employment sectors.
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Affiliation(s)
- Thao Thai
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Emily Lancsar
- Department of Health Services Research & Policy, Research School of Population Health, College of Health & Medicine, The Australian National University, 63A Eggleston Road, Acton ACT, 2601, Australia
| | - Jean Spinks
- Centre for the Business and Economics of Health, Lev 5, Bld 14, The University of Queensland, St Lucia Campus, Brisbane, QLD, 4072, Australia
| | - Christopher Freeman
- The University of Queensland, School of Pharmacy, Brisbane, QLD, Australia; The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia; Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Level 5, Building H, Caulfield Campus, 900 Dandenong Road, Caulfield East, VIC, 3145, Australia
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Aschmann HE, Musinguzi A, Kadota JL, Namale C, Kakeeto J, Nakimuli J, Akello L, Welishe F, Nakitende A, Berger C, Dowdy DW, Cattamanchi A, Semitala FC, Kerkhoff AD. Preferences of people living with HIV for features of tuberculosis preventive treatment regimens - a discrete choice experiment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.13.23295043. [PMID: 37745521 PMCID: PMC10516058 DOI: 10.1101/2023.09.13.23295043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Tuberculosis (TB) preventive treatment (TPT) is recommended for people living with HIV (PLHIV) in high TB burden settings. While 6 months of daily isoniazid remains widely used, shorter regimens are now available. However, little is known about preferences of PLHIV for key features of TPT regimens. Methods We conducted a discrete choice experiment among adult PLHIV engaged in care at an urban HIV clinic in Kampala, Uganda. In nine random choice tasks, participants chose between two hypothetical TPT regimens with different features (pills per dose, frequency, duration, need for adjusted antiretroviral therapy [ART] dosage and side effects). We analyzed preferences using hierarchical Bayesian estimation, latent class analysis, and willingness-to-trade simulations. Results Of 400 PLHIV, 392 (median age 44, 72% female, 91% TPT-experienced) had high quality choice task responses. Pills per dose was the most important attribute (relative importance 32.4%, 95% confidence interval [CI] 31.6 - 33.2), followed by frequency (20.5% [95% CI 19.7 - 21.3]), duration (19.5% [95% CI 18.6 - 20.5]), and need for ART dosage adjustment (18.2% [95% CI 17.2 - 19.2]). Latent class analysis identified three preference groups: one prioritized less frequent, weekly dosing (N=222; 57%); another was averse to ART dosage adjustment (N=107; 27%); and the last prioritized short and tolerable regimens (N=63; 16%). All groups highly valued fewer pills per dose. Participants were willing to accept a regimen of 2.8 months' additional duration [95% CI: 2.4 - 3.2] to reduce pills per dose from five to one, 3.6 [95% CI 2.4 - 4.8] months for weekly rather than daily dosing, and 2.2 [95% CI 1.3 - 3.0] months to avoid ART dosage adjustment. Conclusions To align with preferences of PLHIV, decision-makers should prioritize the development and implementation of TPT regimens with fewer pills, less frequent dosing, and no need for ART dosage adjustment, rather than focus primarily on duration of treatment.
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Affiliation(s)
- Hélène E Aschmann
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA USA
| | | | - Jillian L Kadota
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA USA
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA USA
| | - Catherine Namale
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
| | - Juliet Kakeeto
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
| | - Jane Nakimuli
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Lydia Akello
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Fred Welishe
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Anne Nakitende
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Christopher Berger
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA USA
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA USA
| | - David W Dowdy
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Adithya Cattamanchi
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA USA
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA USA
| | - Fred C Semitala
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - Andrew D Kerkhoff
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA USA
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA USA
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Huls SPI, de Bekker-Grob EW. Can healthcare choice be predicted using stated preference data? The role of model complexity in a discrete choice experiment about colorectal cancer screening. Soc Sci Med 2022; 315:115530. [PMID: 36434890 DOI: 10.1016/j.socscimed.2022.115530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/17/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The validity of discrete choice experiments (DCEs) is crucial to its usage in healthcare decision-making, but there is only a limited number of health contexts in which external validity is demonstrated. This study aims to assess the internal and external validity of the DCE in the context of colorectal cancer (CRC) screening, and gather insights into the discrepancy between stated and revealed preferences. METHODS Stated and revealed preferences were elicited on an individual level from Dutch residents eligible for CRC screening in a DCE and a field experiment, respectively (N = 568). To identify the determinants of CRC screening participation and their relative importance, five random utility maximisation models that varied in complexity were used. We assessed the accuracy with which the models based on stated preferences predict individual-level screening choice in a holdout task (internal validity) and in the actual screening choice (external validity). Insights into the discrepancy between stated and revealed preferences were gathered by comparing groups of respondents. RESULTS Our findings show high internal and external validity. Choices could be accurately predicted for 95% of the respondents in the holdout task, and 90% in the actual screening choice. When scale and preference heterogeneity were taken into account model fit improved; individual-level prediction accuracy slightly increased for the holdout task but not for the actual screening choice. Respondents for whom stated preferences matched revealed preferences were generally in better health and found the GP's support for their screening decision more important. DISCUSSION Evidence was found that revealed preferences can be predicted accurately on an individual level. Incorporating heterogeneity improved internal validity but not external validity. Differences between stated and revealed preferences can be attributed to respondents' health and the support of their GP. We suggest researchers to continue investigating the internal and external validity of discrete choice experiments, and the role of model complexity.
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Affiliation(s)
- Samare P I Huls
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, the Netherlands.
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, the Netherlands
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Johnston BM, Daveson B, Normand C, Ryan K, Smith M, McQuillan R, Higginson I, Selman L, Tobin K. Preferences of Older People With a Life-Limiting Illness: A Discrete Choice Experiment. J Pain Symptom Manage 2022; 64:137-145. [PMID: 35490993 DOI: 10.1016/j.jpainsymman.2022.04.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
CONTEXT There is limited evidence about which elements and characteristics of palliative care service provision improve the experiences of older people living with life-limiting illness. OBJECTIVES To evaluate older patients' (≥65 years) preferences for elements of services and supports and to explore relationships between patient characteristics and the patterns of preferences. METHODS A cross-sectional survey undertaken in Ireland and England using a Discrete Choice Experiment with people accessing specialist palliative care services. A random-effects probit model was used to estimate patient preferences. RESULTS Of the 77 patients were interviewed, 51 participated in the Discrete Choice Experiment component of the interview (response rate = 66%). Participants prioritized support that minimized unpaid caregiver burden (P < 0.001). They also preferred ease of access to services including out-of-hours access (P < 0.001) and free care at home (P < 0.001). Quality of life was prioritized over quantity of life (<0.001). CONCLUSION People living with a life-limiting illness value care that focuses on quality of life, ensures barrier-free access to services and provides sufficient support for relatives. In the context of limited resources and growing demand for care, this study provides evidence about the service elements palliative care delivery models should prioritize and evaluate.
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Affiliation(s)
- Bridget M Johnston
- Centre of Health Policy and Management (B.M.J., C.N., M.S.), School of Medicine, Trinity College Dublin, Ireland.
| | - Barbara Daveson
- Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK
| | - Charles Normand
- Centre of Health Policy and Management (B.M.J., C.N., M.S.), School of Medicine, Trinity College Dublin, Ireland; Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK
| | - Karen Ryan
- Mater Misericordiae University Hospital (K.R.), Dublin, Ireland
| | - Melinda Smith
- Centre of Health Policy and Management (B.M.J., C.N., M.S.), School of Medicine, Trinity College Dublin, Ireland
| | | | - Irene Higginson
- Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK; King's College Hospital NHS Foundation Trust (I.H.), London, UK
| | - Lucy Selman
- Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK; Population Health Sciences, Bristol Medical School (L.S.), University of Bristol, Bristol UK
| | - Katy Tobin
- Global Brain Health Institute (K.T.), School of Medicine, Trinity College Dublin, Dublin, Ireland
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Thrasher JF, Islam F, Arillo-Santillán E, Rodriguez-Bolaños R, de Miera Juarez BS, Hardin JW, Barrientos-Gutierrez I. Strategies to enhance the effects of pictorial warnings for cigarettes: results from a discrete choice experiment. Addiction 2022; 117:1095-1104. [PMID: 34697845 PMCID: PMC8904287 DOI: 10.1111/add.15725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022]
Abstract
AIMS To measure the effects of changing attributes of pictorial health warning labels (HWLs) on cigarette packs in a country that has already implemented pictorial HWLs. MEASURES For each choice set, participants were presented with two cigarette packs and asked the following three questions: (1) 'If only these two cigarette packs were available, which would you buy?'; (2) 'Each of these two packs has warnings on the front and back about the health effects of smoking. Which of these warnings best informs you about the dangers from smoking?'; and (3) 'Which warning most makes you think about quitting smoking?'. As recommended for best practices in discrete choice experiments, each of these questions was followed by an 'opt-out' question for participants to indicate whether they really believed there was a difference between the options presented (i.e. 'Would you really choose one of them?'; 'Do you really think that either of these warnings informs you about dangers from smoking?'; or 'Do you really think that either of these warnings would make you think about quitting smoking?', respectively). Each choice set could be viewed for as long as the participant wished. For each choice question (i.e. willingness to buy, informative, motivating to quit), the pack chosen was coded as 1 and the other pack as 0, with both packs being given a value of 0 if the participant 'opted out'. DESIGN A within-subject discrete choice experiment that involved systematic manipulation of pictorial HWL size [75 versus 30% (current policy)]; inclusion of imagery on the back of the pack [versus none (current policy)]; and color formatting [black on yellow versus yellow on black (current policy)]. SETTING Mexico, on-line panel. PARTICIPANTS Adult smokers (n = 705). MEASUREMENTS For each choice set, participants selected one pack as having the most informative HWL about smoking harms, the one that makes them think the most about quitting and the one they were most willing to buy. We assessed the independent and interactive effects of HWL attributes on choices. FINDINGS Larger HWL size on the pack front (75 versus 30%) and inclusion of a pictorial image on the pack back were both independently associated with lower willingness to buy a pack [b = -0.228, standard error (SE) = 0.023 and -0.089, SE = 0.016, respectively] and greater perception of an HWL as informative (b = 0.214, SE = 0.022, and 0.191, SE = 0.017, respectively) and motivating to quit (b = 0.251, SE = 0.023 and 0.194, SE = 0.017, respectively). HWL with black text and yellow background were perceived as less informative (b = -0.037, SE = 0.016) and less motivating to quit (b = -0.032, SE = 0.015) compared with yellow text on a black background. CONCLUSIONS Among adult Mexican smokers, pictorial health warning labels on cigarette packages that are larger or cover both sides of the pack appear more effective at lowering purchase intentions and increasing risk perceptions and motivation to quit than smaller health warning labels or health warning labels with imagery only on the pack front.
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Affiliation(s)
- James F. Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Farahnaz Islam
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Edna Arillo-Santillán
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rosibel Rodriguez-Bolaños
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - James W. Hardin
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Little KM, Flomen L, Hanif H, Anderson SM, Thurman AR, Clark MR, Doncel GF. HIV Pre-exposure Prophylaxis Implant Stated Preferences and Priorities: Results of a Discrete Choice Experiment Among Women and Adolescent Girls in Gauteng Province, South Africa. AIDS Behav 2022; 26:3099-3109. [PMID: 35360893 PMCID: PMC9371991 DOI: 10.1007/s10461-022-03658-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 12/14/2022]
Abstract
For adolescent girls (AG) and young women (YW), adherence barriers may limit the effectiveness of daily oral HIV pre-exposure prophylaxis (PrEP). Due to its low-burden and long-lasting product attributes, PrEP implants could remove some of the critical adherence barriers of oral PrEP products for individuals at risk of HIV. To explore stated preferences for a long-acting PrEP implant, we conducted a quantitative survey and discrete choice experiment with AG (ages 15-17), YW (18-34), and female sex workers (FSW; ≥ 18) in Gauteng Province, South Africa. We completed 600 quantitative surveys across the three subgroups of women. Respondents stated preference for an implant that provided longer HIV protection (24 months versus 6 months) and required a single insertion. They stated that they preferred a biodegradable implant that could be removed within 1 month of insertion. Respondents had no preference for a particular insertion location. Overall, 78% of respondents said they would be likely (33%) or very likely (45%) to use a PrEP implant were one available, with the majority (82%) stating preference for a product that would provide dual protection against HIV and unintended pregnancies. To reduce their risk of HIV, AG, YW, and FSW in our survey reported a strong willingness to use long-acting, highly-effective, dissolvable PrEP implants.
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Affiliation(s)
- Kristen M Little
- HIV/TB Department, Population Services International (PSI), Washington, DC, USA
| | - Lola Flomen
- Strategy & Insights Department, PSI, 1120 19th Street NW, Suite 600, Washington, DC, 20036, USA.
| | - Homaira Hanif
- CONRAD, Eastern Virginia Medical School, Norfolk, VA, USA
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McPhedran R, Gold N, Bemand C, Weston D, Rosen R, Scott R, Chadborn T, Amlôt R, Mawby M, Toombs B. Location, location, location: a discrete choice experiment to inform COVID-19 vaccination programme delivery in the UK. BMC Public Health 2022; 22:431. [PMID: 35246082 PMCID: PMC8894545 DOI: 10.1186/s12889-022-12823-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large-scale vaccination is fundamental to combatting COVID-19. In March 2021, the UK's vaccination programme had delivered vaccines to large proportions of older and more vulnerable population groups; however, there was concern that uptake would be lower among young people. This research was designed to elicit the preferences of 18-29-year-olds regarding key delivery characteristics and assess the influence of these on intentions to get vaccinated, to inform planning for this cohort. METHODS From 25 March to 2 April 2021, an online sample of 2012 UK adults aged 18-29 years participated in a Discrete Choice Experiment. Participants made six choices, each involving two SMS invitations to book a vaccination appointment and an opt-out. Invitations had four attributes (1 × 5 levels, 3 × 3 levels): delivery mode, appointment timing, proximity, and sender. These were systematically varied according to a d-optimal design. Responses were analysed using a mixed logit model. RESULTS The main effects logit model revealed a large alternative-specific constant (β = 1.385, SE = 0.067, p < 0.001), indicating a strong preference for 'opting in' to appointment invitations. Pharmacies were dispreferred to the local vaccination centre (β = - 0.256, SE = 0.072, p < 0.001), appointments in locations that were 30-45 min travel time from one's premises were dispreferred to locations that were less than 15 min away (β = - 0.408, SE = 0.054, p < 0.001), and, compared to invitations from the NHS, SMSs forwarded by 'a friend' were dispreferred (β = - 0.615, SE = 0.056, p < 0.001) but invitations from the General Practitioner were preferred (β = 0.105, SE = 0.048, p = 0.028). CONCLUSIONS The results indicated that the existing configuration of the UK's vaccination programme was well-placed to deliver vaccines to 18-29-year-olds; however, some adjustments might enhance acceptance. Local pharmacies were not preferred; long travel times were a disincentive but close proximity (0-15 min from one's premises) was not necessary; and either the 'NHS' or 'Your GP' would serve as adequate invitation sources. This research informed COVID-19 policy in the UK, and contributes to a wider body of Discrete Choice Experiment evidence on citizens' preferences, requirements and predicted behaviours regarding COVID-19.
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Affiliation(s)
- Robert McPhedran
- Kantar Public UK Behavioural Practice, 4 Millbank, Westminster, London, SW1P 3JA, UK.
| | - Natalie Gold
- Kantar Public UK Behavioural Practice, 4 Millbank, Westminster, London, SW1P 3JA, UK.,Public Health England Behavioural Insights, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK.,Centre for Philosophy of Natural and Social Science, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Charlotte Bemand
- Solent NHS Trust, NHS England, Highpoint Venue, Bursledon Rd, Southampton, Hampshire, SO19 8BR, UK
| | - Dale Weston
- Behavioural Science and Insights Unit, UK Health Security Agency, Porton Down, Salisbury, Wilts, SP4 0JG, UK
| | - Rachel Rosen
- Economics and Strategic Analysis Team, NHS England and NHS Improvement, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Robert Scott
- Economics and Strategic Analysis Team, NHS England and NHS Improvement, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Tim Chadborn
- Public Health England Behavioural Insights, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Richard Amlôt
- Behavioural Science and Insights Unit, UK Health Security Agency, Porton Down, Salisbury, Wilts, SP4 0JG, UK
| | - Max Mawby
- Kantar Public UK Behavioural Practice, 4 Millbank, Westminster, London, SW1P 3JA, UK
| | - Ben Toombs
- Kantar Public UK Behavioural Practice, 4 Millbank, Westminster, London, SW1P 3JA, UK
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You W, Yuan Y, Boyle KJ, Michaud TL, Parmeter C, Seidel RW, Estabrooks PA. Examining Ways to Improve Weight Control Programs' Population Reach and Representativeness: A Discrete Choice Experiment of Financial Incentives. PHARMACOECONOMICS - OPEN 2022; 6:193-210. [PMID: 34757584 PMCID: PMC8864042 DOI: 10.1007/s41669-021-00310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Both theoretical and empirical evidence supports the potential of modest financial incentives to increase the reach of evidence-based weight control programs. However, few studies exist that examine the best incentive design for achieving the highest reach and representativeness at the lowest cost and whether or not incentive designs may be valued differentially by subgroups that experience obesity-related health disparities. METHODS A discrete choice experiment was conducted (n = 1232 participants; over 90% of them were overweight/obese) to collect stated preference towards different financial incentive attributes, including reward amount, program location, reward contingency, and payment form and frequency. Mixed logit and conditional logit models were used to determine overall and subgroup preference ranking of attributes. Using the National Health and Nutrition Examination Survey data sample weights and the estimated models, we predicted US nationally representative participation rates by subgroups and examined the effect of offering more than one incentive design. External validity was checked by using a completed cluster randomized control trial. RESULTS There were significant subgroup differences in preference toward incentive attributes. There was also a sizable negative response to larger incentive amounts among African Americans, suggesting that higher amounts would reduce participation from this population. We also find that offering participants a menu of incentive designs to choose from would increase reach more than offering higher reward amounts. CONCLUSIONS We confirmed the existence of preference heterogeneity and the importance of subgroup-targeted incentive designs in any evidence-based weight control program to maximize population reach and reduce health disparities.
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Affiliation(s)
- Wen You
- Department of Public Health Science, School of Medicine, University of Virginia, University of Virginia Cancer Center, Charlottesville, VA USA
| | | | - Kevin J. Boyle
- Department of Agricultural and Applied Economics, Willis Blackwood Real Estate, Virginia Tech, Blacksburg, VA USA
| | - Tzeyu L. Michaud
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE USA
| | - Chris Parmeter
- Department of Economics, University of Miami, Miami, FL USA
| | - Richard W. Seidel
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA USA
| | - Paul A. Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE USA
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Monzón J, Islam F, Mus S, Thrasher JF, Barnoya J. Effects of tobacco product type and characteristics on appeal and perceived harm: Results from a discrete choice experiment among Guatemalan adolescents. Prev Med 2021; 148:106590. [PMID: 33930431 PMCID: PMC8645268 DOI: 10.1016/j.ypmed.2021.106590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/16/2021] [Accepted: 04/25/2021] [Indexed: 11/29/2022]
Abstract
Guatemala is one of the few countries where both heated tobacco products (HTPs) and electronic cigarettes (e-cigarettes) remain unregulated. We used a discrete choice experiment (DCE) administered to 2038 high school students to assess how tobacco product attributes influence their appeal among Guatemalan adolescents. Participants were randomly assigned to evaluate 4 of 32 contrasting sets, each containing 3 packs (1 of each product type). Experimental manipulations included: product type, brand, nicotine content and flavor. Participants then indicated which product they were most and least interested in trying and would be most and least harmful to their health. Conditional logistic regression models were used to assess the impact of product characteristics on choice. Product type accounted for almost 90% of variation in choices. Respondents were less interested in trying HTPs (B = -0.93; p < 0.001) and viewed them as more harmful (B = 2.77; p < 0.001) compared to cigarettes. They were more interested in trying e-cigarettes (B = 1.22; p < 0.001), which were also perceived as less harmful (B = -1.47; p < 0.001) compared to cigarettes. Products without nicotine were of more interest for trying (B = 0.14; p < 0.001) and perceived as more harmful (B = 0.20; p < 0.001) than those with. Students were more interested in trying a flavor compared to regular tobacco and among the flavors, berry was the highest rated one (B = 0.28; p < 0.001). Finally, in this country with weak tobacco control, e-cigarettes appear to be more appealing and perceived as less harmful than HTPs and cigarettes. Packaging and flavoring regulations are urgently needed on these products as they are a marketing strategy targeting adolescents.
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Affiliation(s)
- Jose Monzón
- Instituto de Investigación en Ciencias de la Salud (IECIS), Rafael Landívar University, Guatemala City, Guatemala
| | - Farahnaz Islam
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sophia Mus
- Instituto de Investigación en Ciencias de la Salud (IECIS), Rafael Landívar University, Guatemala City, Guatemala
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Joaquin Barnoya
- Instituto de Investigación en Ciencias de la Salud (IECIS), Rafael Landívar University, Guatemala City, Guatemala; Unidad de Cirugía Cardiovascular de Guatemala (UNICAR), Guatemala City, Guatemala.
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Carroll FE, Al-Janabi H, Rooshenas L, Owen-Smith A, Hollinghurst S, Hay AD. Parents' preferences for nursery care when children are unwell: a discrete choice experiment. J Public Health (Oxf) 2021; 42:161-168. [PMID: 30576558 DOI: 10.1093/pubmed/fdy215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/25/2018] [Accepted: 11/27/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pre-school children's daycare is associated with increased incidence of respiratory and diarrhoeal illnesses. While the incidence might be reduced if all unwell children were kept at home, parental employment pressures make this difficult when children are marginally unwell. METHODS A discrete choice experiment (DCE) was conducted to identify what aspects of daycare policy and provision would affect parents' decisions to keep marginally unwell children home. Prior qualitative research informed parameter choice. The DCE was accompanied by a best-worst scaling task examining preferences for four modifiable aspects of care: swapping unused daycare sessions, reimbursing unused sessions, daycare paracetamol policy and presence of a 'quiet room'. RESULTS Paracetamol guidelines and the presence of a quiet room had the strongest predicted influence on parents' decision-making. Conditional on assumptions about the set-up of the daycare, introducing a 'no paracetamol' policy would result in a fall from 62 to 25% in mean predicted probabilities of a parent sending a marginally unwell child to nursery, while introducing a quiet room would increase the mean probability from 34 to 53%. CONCLUSIONS Daycare policy, particularly the use of paracetamol prior to attendance, could impact parents' decisions to send unwell children to daycare, potentially influencing the transmission of children's infectious illness.
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Affiliation(s)
- Fran E Carroll
- Royal College of Obstetricians and Gynaecologists and Honorary Research Fellow, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Leila Rooshenas
- Bristol Medical School, Population Health Sciences, Bristol, UK
| | | | - Sandra Hollinghurst
- Centre of Academic Primary Care, NIHR School for Primary Care Research, Bristol Medical School, Population Health Sciences, Bristol, UK
| | - Alastair D Hay
- Centre of Academic Primary Care, NIHR School for Primary Care Research, Bristol Medical School, Population Health Sciences, Bristol, UK
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Barrientos-Gutierrez I, Islam F, Cho YJ, Salloum RG, Louviere J, Arillo-Santillán E, Reynales-Shigematsu LM, Barnoya J, Saenz de Miera Juarez B, Hardin J, Thrasher JF. Assessing cigarette packaging and labelling policy effects on early adolescents: results from a discrete choice experiment. Tob Control 2020; 30:tobaccocontrol-2019-055463. [PMID: 32665358 PMCID: PMC7855531 DOI: 10.1136/tobaccocontrol-2019-055463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Cigarette packaging is a primary channel for tobacco advertising, particularly in countries where traditional channels are restricted. The current study evaluated the independent and interactive effects of cigarette packaging and health warning label (HWL) characteristics on perceived appeal of cigarette brands for early adolescents in Mexico. METHODS A discrete choice experiment (DCE) was conducted with early adolescents, aged 12-14 years (n=4251). The DCE involved a 3×25 design with six attributes: brand (Marlboro, Pall Mall, Camel), tobacco flavour (regular, menthol), flavour capsule (none, 1 or 2 capsules), presence of descriptive terms, branding (vs plain packaging), HWL size (30%, 75%) and HWL content (emphysema vs mouth cancer). Participants viewed eight sets of three cigarette packs and selected a pack in each set that: (1) is most/least attractive, (2) they are most/least interested in trying or (3) is most/least harmful, with a no difference option. RESULTS Participants perceived packs as less attractive, less interesting to try and more harmful if they had plain packaging or had larger HWLs, with the effect being most pronounced when plain packaging is combined with larger HWLs. For attractiveness, plain packaging had the biggest influence on choice (43%), followed by HWL size (19%). Interest in trying was most influenced by brand name (34%), followed by plain packaging (29%). Perceived harm was most influenced by brand name (30%), followed by HWL size (29%). CONCLUSION Increasing the size of HWLs and implementing plain packaging appear to reduce the appeal of cigarettes to early adolescents. Countries should adopt these policies to minimise the impact of tobacco marketing.
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Affiliation(s)
| | - Farahnaz Islam
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Yoo Jin Cho
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | | | - Jordan Louviere
- School of Marketing, University of South Australia, Adelaide, South Australia, Australia
| | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Joaquin Barnoya
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Mississippi, USA
| | | | - James Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - James F Thrasher
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA
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Norman R, Moorin R, Maxwell S, Robinson S, Brims F. Public Attitudes on Lung Cancer Screening and Radiation Risk: A Best-Worst Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:495-505. [PMID: 32327167 DOI: 10.1016/j.jval.2019.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/30/2019] [Accepted: 11/23/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To measure Australian population preferences for lung cancer screening and to explore whether these preferences are related to respondent characteristics and lung cancer risk. METHODS An online ranking task was administered to a sample of 521 Australians between the ages of 50 and 80 with a history of cigarette smoking. Choice sets contained 2 alternative lungs screens and an opt-out, and respondents were asked to rank the 3 options. Both conditional logit and mixed logit analyses were conducted exploring both the forced choice between the 2 screens and identifying the types of respondent most likely to opt out of any screening. For this, respondent 6-year lung cancer risk was estimated and used as a covariate. RESULTS Respondents valued tests that involved breath or blood tests in addition to computerized tomography (CT), locations that were close to home, receiving results quickly, and minimizing radiation from the CT scan. Willingness to pay differed between relatively higher and lower risk individuals; higher risk individuals placed greater emphasis on convenience, result timeliness, and radiation. Respondent characteristics that predicted opting out of any screening included being male, fewer years of smoking, and not having a previous cancer diagnosis. Lung cancer risk did not influence the likelihood of opting out. CONCLUSIONS Uptake of lung cancer screening is likely to be changeable if different modalities of screening are provided, with effects likely differing across population subgroups.
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Affiliation(s)
- Richard Norman
- School of Public Health, Curtin University, Perth, Australia.
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Australia; School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Suzy Maxwell
- School of Public Health, Curtin University, Perth, Australia
| | | | - Fraser Brims
- Curtin Medical School, Curtin University, Perth, Australia
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A Hierarchical Bayes Approach to Modeling Heterogeneity in Discrete Choice Experiments: An Application to Public Preferences for Prenatal Screening. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 13:211-223. [DOI: 10.1007/s40271-019-00402-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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de Bekker-Grob EW, Swait JD, Kassahun HT, Bliemer MCJ, Jonker MF, Veldwijk J, Cong K, Rose JM, Donkers B. Are Healthcare Choices Predictable? The Impact of Discrete Choice Experiment Designs and Models. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1050-1062. [PMID: 31511182 DOI: 10.1016/j.jval.2019.04.1924] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Lack of evidence about the external validity of discrete choice experiments (DCEs) is one of the barriers that inhibit greater use of DCEs in healthcare decision making. OBJECTIVES To determine whether the number of alternatives in a DCE choice task should reflect the actual decision context, and how complex the choice model needs to be to be able to predict real-world healthcare choices. METHODS Six DCEs were used, which varied in (1) medical condition (involving choices for influenza vaccination or colorectal cancer screening) and (2) the number of alternatives per choice task. For each medical condition, 1200 respondents were randomized to one of the DCE formats. The data were analyzed in a systematic way using random-utility-maximization choice processes. RESULTS Irrespective of the number of alternatives per choice task, the choice for influenza vaccination and colorectal cancer screening was correctly predicted by DCE at an aggregate level, if scale and preference heterogeneity were taken into account. At an individual level, 3 alternatives per choice task and the use of a heteroskedastic error component model plus observed preference heterogeneity seemed to be most promising (correctly predicting >93% of choices). CONCLUSIONS Our study shows that DCEs are able to predict choices-mimicking real-world decisions-if at least scale and preference heterogeneity are taken into account. Patient characteristics (eg, numeracy, decision-making style, and general attitude for and experience with the health intervention) seem to play a crucial role. Further research is needed to determine whether this result remains in other contexts.
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Affiliation(s)
- Esther W de Bekker-Grob
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Joffre D Swait
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | - Marcel F Jonker
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jorien Veldwijk
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Karen Cong
- Australian Rivers Institute, Griffith University, Brisbane, Queensland, Australia
| | - John M Rose
- Business School, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Business Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Falahee M, Finckh A, Raza K, Harrison M. Preferences of Patients and At-risk Individuals for Preventive Approaches to Rheumatoid Arthritis. Clin Ther 2019; 41:1346-1354. [PMID: 31196645 DOI: 10.1016/j.clinthera.2019.04.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/22/2019] [Accepted: 04/10/2019] [Indexed: 02/07/2023]
Abstract
Effective treatments for rheumatoid arthritis (RA) are available and can lead to remission for some patients, but most patients remain on potentially toxic and expensive medications in the long term. Interest is increasingly turning to the disease phases preceding the development of RA that represent opportunities for preventive interventions. At-risk target populations include individuals with genetic and environmental risk factors, those who have developed systemic autoimmunity, and those who have developed clinically suspect symptoms (eg, arthralgias without synovitis, or an early arthritis). Ongoing prospective studies will inform the development of increasingly accurate predictive tools to identify individuals at risk of developing RA. Furthermore, a range of preventive approaches has been suggested, including lifestyle modification (eg, smoking cessation) and pharmacologic interventions (eg, hydroxychloroquine, methotrexate, abatacept, rituximab) that are currently the subject of randomized controlled trials. As prediction and prevention of RA evolve, it is increasingly likely that individuals at risk (including asymptomatic individuals) may be faced with complex decisions about whether to accept assessment of their risk status or to take a preventive intervention associated with risk of serious adverse events and uncertain benefit. Acceptance of preventive medication in other contexts can be low. For example, <25% of women at high risk of breast cancer are willing to take preventive hormonal treatments. Actual uptake is lower still. Patients' beliefs and preferences predict treatment uptake and adherence. Before the dream of preventing RA can become reality, health care providers need to understand the perspectives of individuals in the target population and to identify barriers and facilitators for this approach. This commentary reviews what is currently known about the perspectives of patients and individuals at risk about predictive and preventive approaches for RA and identifies gaps to be addressed to inform the development of efficient preventive strategies.
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Affiliation(s)
- Marie Falahee
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - Axel Finckh
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Karim Raza
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence, MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research, NIHR Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
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Grosse SD, Pike J, Soelaeman R, Tilford JM. Quantifying Family Spillover Effects in Economic Evaluations: Measurement and Valuation of Informal Care Time. PHARMACOECONOMICS 2019; 37:461-473. [PMID: 30953263 PMCID: PMC6529092 DOI: 10.1007/s40273-019-00782-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Spillover effects on the welfare of family members may refer to caregiver health effects, informal care time costs, or both. This review focuses on methods that have been used to measure and value informal care time and makes suggestions for their appropriate use in cost-of-illness and cost-effectiveness analyses. It highlights the importance of methods to value informal care time that are independent of caregiver health effects in order to minimize double counting of spillover effects. Although the concept of including caregiver time costs in economic evaluations is not new, relatively few societal perspective cost-effectiveness analyses have included informal care, with the exception of dementia. This is due in part to challenges in measuring and valuing time costs. Analysts can collect information on time spent in informal care or can assess its impact in displacing other time use, notably time in paid employment. A key challenge is to ensure appropriate comparison groups that do not require informal care to be able to correctly estimate attributable informal care time or foregone market work. To value informal care time, analysts can use estimates of hourly earnings in either opportunity cost or replacement cost approaches. Researchers have used widely varying estimates of hourly earnings. Alternatively, stated-preference methods (i.e. contingent valuation, conjoint analysis) can be used to value the effect of informal care on utility, but this can entail double counting with health effects. Lack of consensus and standardization of methods makes it difficult to compare estimates of informal care costs.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS E-87, Atlanta, GA, 30341, USA.
| | - Jamison Pike
- Immunization Services Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rieza Soelaeman
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS E-87, Atlanta, GA, 30341, USA
| | - J Mick Tilford
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Quaife M, Terris-Prestholt F, Di Tanna GL, Vickerman P. How well do discrete choice experiments predict health choices? A systematic review and meta-analysis of external validity. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:1053-1066. [PMID: 29380229 DOI: 10.1007/s10198-018-0954-6] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/08/2018] [Indexed: 05/12/2023]
Abstract
Discrete choice experiments (DCEs) are economic tools that elicit the stated preferences of respondents. Because of their increasing importance in informing the design of health products and services, it is critical to understand the extent to which DCEs give reliable predictions outside of the experimental context. We systematically reviewed the literature of published DCE studies comparing predictions to choices made in reality; we extracted individual-level data to estimate a bivariate mixed-effects model of pooled sensitivity and specificity. Eight studies met the inclusion criteria, and six of these gave sufficient data for inclusion in a meta-analysis. Pooled sensitivity and specificity estimates were 88% (95% CI 81, 92%) and 34% (95% CI 23, 46%), respectively, and the area under the SROC curve (AUC) was 0.60 (95% CI 0.55, 0.64). Results indicate that DCEs can produce reasonable predictions of health-related behaviors. There is a great need for future research on the external validity of DCEs, particularly empirical studies assessing predicted and revealed preferences of a representative sample of participants.
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Affiliation(s)
- Matthew Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Gian Luca Di Tanna
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Discrete Choice Experiments on The Acceptability of Monetary-Based Health Treatments: A Replication and Extension to Deposit Contracts. PSYCHOLOGICAL RECORD 2018. [DOI: 10.1007/s40732-018-0296-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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