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Senanayake S, Kularatna S, Crawford-Williams F, Brain D, Allen M, Hettiarachchi RM, Hart NH, Koczwara B, Ee C, Chan RJ. Cancer survivor preferences for breast cancer follow-up care: a discrete choice experiment. J Cancer Surviv 2024:10.1007/s11764-024-01629-9. [PMID: 38871994 DOI: 10.1007/s11764-024-01629-9] [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: 10/16/2023] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To identify the key attributes of breast cancer follow-up care models preferred by cancer survivors in Australia. METHODS A discrete choice experiment (DCE) was conducted to elicit preferences for attributes of breast cancer follow-up care. Respondents were presented with two hypothetical scenarios, known as choice sets, and asked to select a preference. Respondents were individuals living in Australia who were diagnosed with breast cancer within the past five years prior to survey completion and were recruited through the Breast Cancer Network of Australia and other community or consumer networks. Latent class modelling (LCM) approach under a random utility framework was used for the analysis. RESULTS 123 breast cancer survivors completed the DCE survey. LCA revealed two latent classes, those with older age and lower quality of life (class 1) and younger women with higher quality of life (class 2). Class 2 preferred a care team comprising specialists, nurses and GPs and emphasised the importance of shared survivorship care plans. Class 1 remained neutral regarding the team's composition but was notably concerned about the out-of-pocket costs per consultation, a finding not seen in Class 2. CONCLUSIONS Age and quality of life status are associated with patient preference for types and attributes of breast cancer follow-up care. The health system can work towards enhancing flexibility of follow-up care delivery, ultimately achieving person-centred care. IMPLICATIONS FOR CANCER SURVIVORS Efforts need to be made by policymakers to ensure consumer preferences are taken into consideration to implement tailored person-centred follow-up care pathways.
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Affiliation(s)
- Sameera Senanayake
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), 60 Musk Avenue, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia.
- Duke-NUS Medical School, Health Services and Systems Research, Singapore, Singapore.
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), 60 Musk Avenue, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Duke-NUS Medical School, Health Services and Systems Research, Singapore, Singapore
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - David Brain
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), 60 Musk Avenue, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Michelle Allen
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), 60 Musk Avenue, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Ruvini M Hettiarachchi
- Centre for the Business and Economics of Health (CBEH), University of Queensland, Brisbane, QLD, Australia
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Faculty of Health, Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Sydney, NSW, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Bogda Koczwara
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Adelaide, SA, Australia
| | - Carolyn Ee
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Geng J, Li R, Wang X, Xu R, Liu J, Jiang H, Wang G, Hesketh T. Eliciting Older Cancer Patients' Preferences for Follow-Up Care to Inform a Primary Healthcare Follow-Up Model in China: A Discrete Choice Experiment. THE PATIENT 2024:10.1007/s40271-024-00697-4. [PMID: 38702574 DOI: 10.1007/s40271-024-00697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND OBJECTIVES Increasing longevity and advances in treatment have increased the cancer burden in the elderly, resulting in complex follow-up care needs; however, in China, little is known about the follow-up care preferences of these patients. This study quantified older cancer patients' preferences for follow-up care and examined the trade-offs they are willing to make to accept an alternative follow-up model. METHODS A discrete choice experiment was conducted among inpatients aged over 60 years with breast, prostate, or colorectal cancer, at two large tertiary hospitals in Nantong, China. Preference weights for follow-up care were estimated using mixed logit analysis. Subgroup analysis and latent class analysis were used to explore preference heterogeneity. RESULTS Complete results were obtained from 422 patients (144 with breast cancer, 133 with prostate cancer, 145 with colorectal cancer), with a mean age of 70.81 years. Older cancer patients stated a preference for follow-up by specialists over primary healthcare (PHC) providers ( β = -1.18, 95% confidence interval -1.40 to -0.97). The provider of follow-up care services was the most valued attribute among patients with breast cancer (relative importance [RI] 37.17%), while remote contact services were prioritized by patients with prostate (RI 43.50%) and colorectal cancer (RI 33.01%). The uptake rate of an alternative care model integrating PHC increased compared with the baseline setting when patients were provided with preferred services (continuity of care, individualized care plans, and remote contact services). CONCLUSION To encourage older cancer patients to use PHC-integrated follow-up care, alternative follow-up care models need to be based on patients' preferences before introducing them as a routine option.
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Affiliation(s)
- Jiawei Geng
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Ran Li
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Insititute of Global Health, University College London, London, UK
| | - Xinyu Wang
- School of Public Health, Nantong University, Nantong, China
| | - Rongfang Xu
- Department of Nursing, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Jibin Liu
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Haiyan Jiang
- Department of Health Management, Affiliated Hospital of Nantong University, Nantong, China
| | - Gaoren Wang
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China.
| | - Therese Hesketh
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China.
- Insititute of Global Health, University College London, London, UK.
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Li L, Fu L, Li H, Liu T, Sun J. Emerging trends and patterns in healthcare-seeking behavior: A systematic review. Medicine (Baltimore) 2024; 103:e37272. [PMID: 38394511 DOI: 10.1097/md.0000000000037272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES The study of healthcare-seeking behavior is essential for optimizing resource allocation and improving healthcare services. Its complexity and diversity have made it a prominent research area. Understanding factors influencing healthcare-seeking decisions allows targeted interventions and policy development to address barriers and ensure equitable access to quality healthcare for diverse populations. Such research plays a vital role in enhancing healthcare outcomes and overall population health. METHODS The study utilized a systematic quantitative literature review approach, employing the Web of Science (WOS) Core Collection and PubMed databases as data sources. Additionally, bibliometric tools such as CiteSpace and VOSviewer were employed for analysis and visualization of the literature. RESULTS A comprehensive statistical analysis and visualization were performed on the annual publication volume, publication countries, journals, keywords, and keyword co-occurrence patterns up until 2023. Through this analysis, a framework was established, identifying the determinants and fundamental elements of healthcare-seeking behavior. These findings contribute to the advancement of research in this field and inform future studies and interventions aimed at improving healthcare-seeking behavior. CONCLUSIONS Based on the aforementioned literature review and framework, several conclusions were drawn. The determinants that facilitate healthcare-seeking behavior include improving health education awareness, enhancing healthcare resources, reducing costs, and ensuring system soundness. Additionally, providing social environment support was found to be crucial. Furthermore, the fundamental elements of healthcare-seeking behavior were identified as healthcare demand, healthcare choices, and the process of diagnosis and treatment. These findings provide valuable insights for developing interventions and policies to promote optimal healthcare-seeking behavior.
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Affiliation(s)
- Limin Li
- School of Health Care Management, Anhui Medical University, Hefei, China
| | - Li Fu
- School of Health Care Management, Anhui Medical University, Hefei, China
| | - Hui Li
- School of Health Care Management, Anhui Medical University, Hefei, China
| | - Tong Liu
- School of Health Care Management, Anhui Medical University, Hefei, China
| | - Jiangjie Sun
- School of Health Care Management, Anhui Medical University, Hefei, China
- School of Management, Hefei University of Technology, Hefei, China
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Jolliffe L, Christie LJ, Fearn N, Nohrenberg M, Liu R, Williams JF, Parsons MW, Pearce AM. A systematic review of discrete choice experiments in stroke rehabilitation. Top Stroke Rehabil 2024:1-12. [PMID: 38372124 DOI: 10.1080/10749357.2024.2312641] [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: 10/01/2023] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Existing research qualitatively explores consumer preferences for stroke rehabilitation interventions. However, it remains unclear which intervention characteristics are most important to consumers, and how these preferences may influence uptake and participation. Discrete choice experiments (DCE) provide a unique way to quantitatively measure preferences for health and health care. This study aims to explore how DCEs have been used in stroke rehabilitation and to identify reported consumer preferences for rehabilitation interventions. MATERIAL AND METHODS A systematic review of published stroke rehabilitation DCEs was completed (PROSPERO registration: CRD42021282578). Six databases (including CINAHL, MEDLINE, EconLIT) were searched from January 2000-March 2023. Data extracted included topic area, sample size, aim, attributes, design process, and preference outcomes. Descriptive and thematic analyses were conducted, and two methodological checklists applied to review quality. RESULTS Of 2,446 studies screened, five were eligible. Studies focused on exercise preference (n = 3), the structure and delivery of community services (n = 1), and self-management programs (n = 1). All had small sample sizes (range 50-146) and were of moderate quality (average score of 77%). Results indicated people have strong preferences for one-to-one therapy (over group-based), light-moderate intensity of exercise, and delivery by qualified therapists (over volunteers). CONCLUSIONS Few DCEs have been conducted in stroke rehabilitation, suggesting consumer preferences could be more rigorously explored. Included studies were narrow in the scope of attributes included, limiting their application to practice and policy. Further research is needed to assess the impact of differing service delivery models on uptake and participation.
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Affiliation(s)
- Laura Jolliffe
- Department of Occupational Therapy, Peninsula Health, Melbourne, Australia
- Department of Occupational Therapy, Monash University, Melbourne, Australia
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
| | - Lauren J Christie
- Allied Health Research Unit, St Vincent's Health Network Sydney, Darlinghurst, Australia
- Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Nicola Fearn
- Allied Health Research Unit, St Vincent's Health Network Sydney, Darlinghurst, Australia
| | - Michael Nohrenberg
- School of Public Health, The University of Sydney, Camperdown, Australia
| | - Rasia Liu
- School of Public Health, The University of Sydney, Camperdown, Australia
| | - Julie F Williams
- Walter McGrath Library, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Mark W Parsons
- Department of Neurology, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, Australia
- School of Medicine and Health, UNSW, Sydney, Australia
- Sydney Brain Centre, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Alison M Pearce
- School of Public Health, The University of Sydney, Camperdown, Australia
- The Daffodil Centre, a joint venture between Cancer Council NSW and the University of Sydney, The University of Sydney, Sydney, Australia
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Venchiarutti RL, Sharman AR, Dawson T, Elliott MS, Clark JR, Palme CE. Patient-reported experiences and satisfaction with head and neck surgery outreach clinics in regional New South Wales, Australia: A cross-sectional survey. J Eval Clin Pract 2023; 29:1302-1313. [PMID: 37608573 DOI: 10.1111/jep.13918] [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: 05/01/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
RATIONALE Head and neck surgery services are increasingly being centralised in Australia. Outreach models can overcome burdens of travel that patients in regional and rural areas experience when attending routine appointments, by providing services closer to home. AIM To explore patient-reported experiences and satisfaction with regional outreach services for head and neck surgery in Australia. METHODS Patients who attended two regional outreach clinics in New South Wales (NSW), Australia, were surveyed over a 6-month period. Patients completed the Outpatient Cancer Clinics Survey (2020 version) that explored perceptions and experiences of the clinic. Patients with cancer were asked to complete the Edmonton Symptom Assessment System and the Communication and Attitudinal Self-Efficacy scale. Descriptive statistics and analysis of data was performed, and results were compared to the NSW statewide Outpatient Cancer Clinics Survey (2020). Content analysis of free text responses was performed. RESULTS Some 128 patients responded (56% response rate; mean age 67.2 years, 46.1% female). Compared to the 2020 NSW survey, a higher proportion of patients in our cohort responded positively to 14 of the 26 questions, with the greatest differences observed for questions regarding waiting area comfort (+12.1%, p = 0.008), being informed about different treatment options (+9.5%, p = 0.04), and issues relating to parking (+9.5%, p = 0.03). A lower proportion of our sample responded positively to the question about whether health professionals knew enough about their medical history (-19.3%, p < 0.001). Respondents appreciated having a local clinic that helped them avoid travel to major cities and associated expenses and highlighted benefits of expert consultation and timeliness of investigations. However, cost of appointments and level of reimbursements remain barriers for some patients. CONCLUSIONS Patients had a high level of satisfaction with regional outreach clinics for head and neck surgery across most domains, indicating patients highly value this service.
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Affiliation(s)
- Rebecca L Venchiarutti
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Ashleigh R Sharman
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Tania Dawson
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Michael S Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
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Liu R, Li Q, Li Y, Wei W, Ma S, Wang J, Zhang N. Public Preference Heterogeneity and Predicted Uptake Rate of Upper Gastrointestinal Cancer Screening Programs in Rural China: Discrete Choice Experiments and Latent Class Analysis. JMIR Public Health Surveill 2023; 9:e42898. [PMID: 37428530 PMCID: PMC10366669 DOI: 10.2196/42898] [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: 09/23/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Rapid increases in the morbidity and mortality of patients with upper gastrointestinal cancer (UGC) in high-incidence countries in Asia have raised public health concerns. Screening can effectively reduce the incidence and mortality of patients with UGC, but the low population uptake rate seriously affects the screening effect. OBJECTIVE We aimed to determine the characteristics that influence residents' preference heterogeneity for a UGC-screening program and the extent to which these characteristics predict residents' uptake rates. METHODS A discrete choice experiment was conducted in 1000 residents aged 40-69 years who were randomly selected from 3 counties (Feicheng, Linqu, and Dongchangfu) in Shandong Province, China. Each respondent was repeatedly asked to choose from 9 discrete choice questions of 2 hypothetical screening programs comprising 5 attributes: screening interval, screening technique, regular follow-up for precancerous lesions, mortality reduction, and out-of-pocket costs. The latent class logit model was used to estimate residents' preference heterogeneity for each attribute level, their willingness to pay, and the expected uptake rates. RESULTS Of the 1000 residents invited, 926 (92.6%) were included in the final analyses. The mean age was 57.32 (SD 7.22) years. The best model contained 4 classes of respondents (Akaike information criterion=7140.989, Bayesian information criterion=7485.373) defined by different preferences for the 5 attributes. In the 4-class model, out of 926 residents, 88 (9.5%) were assigned to class 1, named as the negative latent type; 216 (3.3%) were assigned to class 2, named as the positive integrated type; 434 (46.9%) were assigned to class 3, named as the positive comfortable type; and 188 (20.3%) were assigned to class 4, named as the neutral quality type. For these 4 latent classes, "out-of-pocket cost" is the most preferred attribute in negative latent type and positive integrated type residents (45.04% vs 66.04% importance weights), whereas "screening technique" is the most preferred factor in positive comfortable type residents (62.56% importance weight) and "screening interval" is the most valued attribute in neutral quality type residents (47.05% importance weight). Besides, residents in different classes had common preference for painless endoscopy, and their willingness to pay were CNY ¥385.369 (US $59.747), CNY ¥93.44 (US $14.486), CNY ¥1946.48 (US $301.810), and CNY ¥3566.60 (US $552.961), respectively. Residents' participation rate could increase by more than 89% (except for the 60.98% in class 2) if the optimal UGC screening option with free, follow-up for precancerous lesions, 45% mortality reduction, screening every year, and painless endoscopy was implemented. CONCLUSIONS Public preference heterogeneity for UGC screening does exist. Most residents have a positive attitude toward UGC screening, but their preferences vary in selected attributes and levels, except for painless endoscopy. Policy makers should consider these heterogeneities to formulate UGC-screening programs that incorporate the public's needs and preferences to improve participation rates.
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Affiliation(s)
- Ruyue Liu
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- School of Public Health, Weifang Medical University, Weifang, China
| | - Qiuxia Li
- School of Public Health, Weifang Medical University, Weifang, China
| | - Yifan Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Wenjian Wei
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Siqi Ma
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jialin Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Nan Zhang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Kularatna S, Allen M, Hettiarachchi RM, Crawford-Williams F, Senanayake S, Brain D, Hart NH, Koczwara B, Ee C, Chan RJ. Cancer Survivor Preferences for Models of Breast Cancer Follow-Up Care: Selecting Attributes for Inclusion in a Discrete Choice Experiment. THE PATIENT 2023:10.1007/s40271-023-00631-0. [PMID: 37213062 DOI: 10.1007/s40271-023-00631-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND AND OBJECTIVE It is critical to evaluate cancer survivors' preferences when developing follow-up care models to better address the needs of cancer survivors. This study was conducted to understand the key attributes of breast cancer follow-up care for use in a future discrete choice experiment (DCE) survey. METHODS Key attributes of breast cancer follow-up care models were generated using a multi-stage, mixed-methods approach. Focus group discussions were conducted with cancer survivors and clinicians to generate a range of attributes of current and ideal follow-up care. These attributes were then prioritised using an online survey with survivors and healthcare providers. The DCE attributes and levels were finalised via an expert panel discussion based on the outcomes of the previous stages. RESULTS Four focus groups were held, two with breast cancer survivors (n = 7) and two with clinicians (n = 8). Focus groups generated sixteen attributes deemed important for breast cancer follow-up care models. The prioritisation exercise was conducted with 20 participants (14 breast cancer survivors and 6 clinicians). Finally, the expert panel selected five attributes for a future DCE survey tool to elicit cancer survivors' preferences on breast cancer follow-up care. The final attributes included: the care team, allied health and supportive care, survivorship care planning, travel for appointments, and out-of-pocket costs. CONCLUSIONS Attributes identified can be used in future DCE studies to elicit cancer survivors' preferences for breast cancer follow-up care. This strengthens the design and implementation of follow-up care programs that best suit the needs and expectations of breast cancer survivors.
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Affiliation(s)
- Sanjeewa Kularatna
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Michelle Allen
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Ruvini M Hettiarachchi
- Centre for the Business and Economics of Health, The University of Queensland, QLD, Brisbane, Australia
| | - Fiona Crawford-Williams
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia.
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - David Brain
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Nicolas H Hart
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia
| | - Bogda Koczwara
- College of Medicine and Public Health and Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Carolyn Ee
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Ben-Aharon O, Iskrov G, Sagy I, Greenberg D. Willingness to pay for cancer prevention, screening, diagnosis, and treatment: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:281-295. [PMID: 36635646 DOI: 10.1080/14737167.2023.2167713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Willingness to pay (WTP) studies examine the maximum amount of money an individual is willing to pay for a specified health intervention, and can be used to inform coverage and reimbursement decisions. Our objectives were to assess how people value cancer-related interventions, identify differences in the methodologies used, and review the trends in studies' publication. AREAS COVERED We extracted PubMed and EconLit articles published in 1997-2020 that reported WTP for cancer-related interventions, characterized the methodological differences and summarized each intervention's mean and median WTP values. We reviewed 1,331 abstracts and identified 103 relevant WTP studies, of which 37 (36%) focused on treatment followed by screening (26), prevention (21), diagnosis (7) and other interventions (12). The methods used to determine WTP values were primarily discrete-choice questions (n = 54, 52%), bidding games (15), payment cards (12) and open-ended questions (12). We found a wide variation in WTP reported values ranged from below $100 to over $20,000. EXPERT OPINION The WTP literature on oncology interventions has grown rapidly. There is considerable heterogeneity with respect to the type of interventions and diseases assessed, the respondents' characteristics, and the study methodologies. This points to the need to establish international guidelines for best practices in this field.
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Affiliation(s)
- Omer Ben-Aharon
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Georgi Iskrov
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Bulgaria
| | - Iftach Sagy
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.,Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
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Chen N, Bai J, Nicholas S, Maitland E, Tan J, Wang J. Preferences for private health insurance in China: A discrete choice experiment. Front Public Health 2022; 10:985582. [PMID: 36148354 PMCID: PMC9486459 DOI: 10.3389/fpubh.2022.985582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/08/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction There is limited evidence on the sustainability and optimal design of China's private health insurance market, especially from the demand-side. With the increasing medical cost burden on both patients and the social security system, policy makers need data on potential clients' demand for private health insurance. Methods A discrete choice experiment was conducted to explore potential clients' preferences for a type of government-involved private supplementary health insurance, Huimin Insurance, in China. A mixed logit model was used to evaluated participants' preferences for six attributes. Willingness to pay, subgroup analysis and interaction effects were estimated based on the initial model. Results Among the 947 participants, 883 (93.2%) were aged 18 to 59 years and 578 (61.0%) were female. Participants had a strong preference for government involvement, extensive benefit packages, high reimbursement ratio and compensation for pre-existing conditions. With respect to the attribute of deductible, participants were indifferent between the level of CNY15,000 and CNY18,000 but had strong and significant preference for the level of CNY15,000 than CNY20,000. The premium was significantly correlated with a decline in the utility of PHI. Conclusions All attributes had a significant impact on participants' preference for Huimin Insurance. Providing a reference point for the development of private health insurance in China, our results inform the optimal design of PHI, especially Huimin Insurance's products.
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Affiliation(s)
- Nuo Chen
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China
| | - Jing Bai
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia,Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, United Kingdom
| | - Jialong Tan
- School of Public Health, Wuhan University, Wuhan, China,*Correspondence: Jialong Tan
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China,Center for Health Economics and Management at the School of Economics and Management, Wuhan University, Wuhan, China,Jian Wang
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10
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Leng A, Maitland E, Wang S, Nicholas S, Lan K, Wang J. Preferences for End-of-Life Care Among Patients With Terminal Cancer in China. JAMA Netw Open 2022; 5:e228788. [PMID: 35467732 PMCID: PMC9039770 DOI: 10.1001/jamanetworkopen.2022.8788] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE In China, little is known about end-of-life (EOL) care preferences of patients with terminal cancer. Understanding these patients' treatment preferences is needed to improve patient-centered health care, better inform surrogates and medical staff about patient preferences, and enhance the quality of EOL care. OBJECTIVE To examine preferences for EOL care among patients with terminal cancer in China. DESIGN, SETTING, AND PARTICIPANTS In this survey study, patients older than 50 years who had terminal cancer were randomly selected from medical records at a single hospital in China. Data on patients' EOL care preferences were collected by discrete choice experiment (DCE) from August to November 2018 and were analyzed from October 2020 to March 2021. MAIN OUTCOMES AND MEASURES The main outcome was patient preferences in EOL care, derived using a mixed logit model. Each DCE scenario described 6 attributes: hospitalization days, life extension, quality of life, adverse treatment events, place-of-death preference, and out-of-pocket costs. The marginal willingness to pay (WTP) in US dollars was estimated from regression coefficients. RESULTS Of 188 patients selected for the survey, 183 participated (97.3%). Among the respondents, the mean [SD] age was 61 [8.4] years, and 128 (69.8%) were male. Patients' preferences for moderate increase in survival time, better quality of life, death at home, and lower out-of-pocket costs were significantly associated with their choices between treatment models. Extending life by 10 months (vs 4 months: β, 1.63; 95% CI, 0.81-2.44) and a better quality of life (very good vs poor: β, 1.79; 95% CI, 0.96-2.62) were the most important attributes to patients. The uptake rate for a treatment scenario increased by 61.6% when the quality of life improved from poor to very good, and when life extension increased from 4 months to 10, the uptake rate increased by 57.2%. The uptake increased by 12.5% when the place of death changed from hospital to home. However, it decreased by 31.4% when the costs increased to $21 174. The study found a WTP of $38 854 (95% CI, $19 468-$95 096) to improve quality of life from a poor to a very good level, substantially higher than the WTP for a life extension of 6 months ($35 308; 95% CI, $17 745-$80 279) or 1 year ($27 572; 95% CI, $16 389-$58 027) compared with the baseline scenario of a 4-month extension. Patients were willing to pay $8860 (95% CI, $621-$26 474) to die at home rather than in a hospital. CONCLUSIONS AND RELEVANCE The findings suggest that in addition to extending life moderately for patients with terminal cancer, improving quality of life during EOL care and supporting home deaths may deserve greater attention. The findings also suggest that physicians and surrogates should ask about patients' care preferences and better inform them of their choices to improve EOL care outcomes.
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Affiliation(s)
- Anli Leng
- School of Political Science and Public Administration, Shandong University, Qingdao, China
- Center for Health Preferences Research, Shandong University, Jinan, China
| | | | - Siyuan Wang
- Faculty of Business and Economics, University of Melbourne, North Melbourne, Victoria, Australia
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Australian Technology Park, Sydney, New South Wales, Australia
- Newcastle Business School, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kuixu Lan
- Publicity Department, The Affiliated Hospital of Qingdao University, Shinan District, Qingdao, China
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China
- Center for Health Economics and Management at the School of Economics and Management, Wuhan University, Wuhan, China
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11
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Yu X, Bao H, Shi J, Yuan X, Qian L, Feng Z, Geng J. Preferences for healthcare services among hypertension patients in China: a discrete choice experiment. BMJ Open 2021; 11:e053270. [PMID: 34876431 PMCID: PMC8655589 DOI: 10.1136/bmjopen-2021-053270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Our study aimed to support evidence-informed policy-making on patient-centred care by investigating preferences for healthcare services among hypertension patients. DESIGN We identified six attributes of healthcare services for a discrete choice experiment (DCE), and applied Bayesian-efficient design with blocking techniques to generate choice sets. After conducting the DCE, we used a mixed logit regression model to investigate patients' preferences for each attribute and analysed the heterogeneities in preferences. Estimates of willingness to pay were derived from regression coefficients. SETTING The DCE was conducted in Jiangsu province and Shanghai municipality in China. PARTICIPANTS Patients aged 18 years or older with a history of hypertension for at least 2 years and who took medications regularly were recruited. RESULTS Patients highly valued healthcare services that produced good treatment effects (β=4.502, p<0.001), followed by travel time to healthcare facilities within 1 hour (β=1.285, p<0.001), and the effective physician-patient communication (β=0.771, p<0.001). Continuity of care and minimal waiting time were also positive predictors (p<0.001). However, the out-of-pocket cost was a negative predictor of patients' choice (β=-0.168, p<0.001). Older adults, patients with good health-related quality of life, had comorbidities, and who were likely to visit secondary and tertiary hospitals cared more about favourable effects (p<0.05). Patients were willing to pay ¥2489 (95% CI ¥2013 to ¥2965) as long as the clinical benefits gained were substantial. CONCLUSIONS Our findings highlight the importance of effective, convenient, efficient, coordinated and patient-centred care for chronic diseases like hypertension. Policy-makers and healthcare providers are suggested to work on aligning the service provision with patients' preferences.
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Affiliation(s)
- Xiaolan Yu
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
| | - Haini Bao
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
| | - Jianwei Shi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyu Yuan
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Liangliang Qian
- Department of Family Health Services, Pujiang Community Health Service Center, Shanghai, China
| | - Zhe Feng
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
| | - Jinsong Geng
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
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12
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Fenton GD, Cazaly MHM, Rolland SL, Vernazza CR. Eliciting Preferences for Adult Orthodontic Treatment: A Discrete Choice Experiment. JDR Clin Trans Res 2021; 7:118-126. [PMID: 33955299 DOI: 10.1177/23800844211012670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION There has been little research to explore how adults financially value private orthodontic treatment and whether they have preferences for different attributes of treatment. This study used a discrete choice experiment and aimed to determine whether the recognized skill level of the dental professional and the type of orthodontic appliance influence the values that the public places on private adult orthodontic treatment. METHODS In total, 206 adult patients or the parents/guardians of children attending general dental practices in the northeast of England were recruited to complete a discrete choice experiment. Three attributes were included: the type of dental professional providing treatment, the type of orthodontic appliance, and cost. Also collected were demographic and orthodontic history characteristics. Results were analyzed with conditional logistic regression and elicited marginal willingness to pay (MWTP). RESULTS Participants value the training and expertise of the dental professional providing private orthodontic treatment greater than the type of orthodontic appliance. MWTP for orthodontic treatment increased in conjunction with the recognized skill level of the dental professional. Participants were willing to pay more for aesthetic appliances over a fixed metal appliance. CONCLUSIONS Participants value the training and expertise of the dental professional providing private adult orthodontic treatment greater than the type of orthodontic appliance. These preferences concur with other discrete choice experiments undertaken in medical specialties that included attributes focusing on the qualification, skill, or expertise of the health care professional. MWTP for orthodontic treatment increased in conjunction with the recognized skill level of the dental professional. Participants were willing to pay more for aesthetic appliances than metal fixed appliances. The cost of orthodontics is significant, and adults appreciate the importance of having options and making choices.Knowledge Transfer Statement: The results of this study suggest that patients are willing to pay more for orthodontic services provided by clinicians with higher levels of formal training. In a competitive market where the public appears to prefer the provider over treatment modality, there is an incentive for clinicians to optimize their knowledge and skills to deliver the high-quality orthodontic treatment that patients are demanding. Orthodontic clinicians should be mindful of the demand for the different adult orthodontic appliances and tailor their skill sets accordingly.
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Affiliation(s)
- G D Fenton
- Orthodontic Department, Newcastle Dental Hospital, Newcastle upon Tyne, UK
| | - M H M Cazaly
- Orthodontic Department, Newcastle Dental Hospital, Newcastle upon Tyne, UK
| | - S L Rolland
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - C R Vernazza
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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13
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Nason GJ, Wood LA, Huddart RA, Albers P, Rendon RA, Einhorn LH, Nichols CR, Kollmannsberger C, Anson-Cartwright L, Sweet J, Warde P, Jewett MA, Chung P, Bedard PL, Hansen AR, Hamilton RJ. A Canadian approach to the regionalization of testis cancer: A review. Can Urol Assoc J 2020; 14:346-351. [PMID: 32432537 PMCID: PMC7716843 DOI: 10.5489/cuaj.6268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
At the Canadian Testis Cancer Workshop, the rationale and feasibility of regionalization of testis cancer care were discussed. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician's assistants, residents and fellows, and nurses, as well as patients and patient advocacy groups.This review summarizes the discussion and recommendations of one of the central topics of the workshop - the centralization of testis cancer in Canada. It was acknowledged that non-guideline-concordant care in testis cancer occurs frequently, in the range of 18-30%. The National Health Service in the U.K. stipulates various testis cancer care modalities be delivered through supra-regional network. All cases are reviewed at a multidisciplinary team meeting and aspects of care can be delivered locally through the network. In Germany, no such network exists, but an insurance-supported online second opinion network was developed that currently achieves expert case review in over 30% of cases. There are clear benefits to regionalization in terms of survival, treatment morbidity, and cost. There was agreement at the workshop that a structured pathway for diagnosis and treatment of testis cancer patients is required.Regionalization may be challenging in Canada because of geography; independent administration of healthcare by each province; physicians fearing loss of autonomy and revenue; patient unwillingness to travel long distances from home; and the inability of the larger centers to handle the ensuing increase in volume. We feel the first step is to identify the key performance indicators and quality metrics to track the quality of care received. After identifying these metrics, implementation of a "networks of excellence" model, similar to that seen in sarcoma care in Ontario, could be effective, coupled with increased use of health technology, such as virtual clinics and telemedicine.
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Affiliation(s)
- Gregory J. Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lori A. Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Robert A. Huddart
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Peter Albers
- Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
| | | | - Lawrence H. Einhorn
- Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Craig R. Nichols
- Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, WA, United States
| | - Christian Kollmannsberger
- British Columbia Cancer Agency Vancouver Cancer Center, University of British Columbia, Vancouver, BC, Canada
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael A.S. Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Philippe L. Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Aaron R. Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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14
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Sukpanich R, Sanglestsawai S, Seib CD, Gosnell JE, Shen WT, Roman SA, Sosa JA, Duh QY, Suh I. The Influence of Cosmetic Concerns on Patient Preferences for Approaches to Thyroid Lobectomy: A Discrete Choice Experiment. Thyroid 2020; 30:1306-1313. [PMID: 32204688 DOI: 10.1089/thy.2019.0821] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Newer transoral thyroidectomy techniques that aim to avoid scars in the neck and maximize cosmetic outcomes have become more prevalent. We conducted a discrete choice experiment (DCE) to evaluate the influence of cosmetic concerns and other factors on patients' decision-making processes when choosing among different thyroidectomy approaches. Methods: A questionnaire was developed to identify key attributes driving patient preferences around thyroidectomy approaches using mixed analyses of patient focus groups, expert opinion, and literature review. These attributes included (i) risk of recurrent laryngeal nerve (RLN) injury, (ii) risk of mental nerve injury, (iii) travel distance for surgery, (iv) out-of-pocket cost, and (v) incision site. Using fractional factorial design, discrete choice sets consisting of randomly generated hypothetical scenarios across all attributes were created. A face-to-face DCE survey was administered to patients being evaluated in clinic for thyroid lobectomy for noncancerous thyroid disease. Participants chose among scenarios constructed from the choice sets of attributes. Analyses were conducted using a mixed logit model, and the trade-offs between different attributes that patients were willing to accept were quantified. Results: The DCE was completed by 109 participants (86 [79%] women; mean age 51.3 ± 3.0 years). Overall, the risk of having RLN and/or mental nerve injury, travel distance, and cost were the most influential attributes. Participants aged ≤60 years significantly preferred an approach without a neck incision and were willing to accept an additional $2332 USD in out-of-pocket cost, 693 miles of travel distance, 0.6% increased risk of RLN injury, and 2.2% risk of mental nerve injury. Patients aged >60 years significantly preferred a conventional neck incision and were willing to pay an additional $3401 out-of-pocket and travel 1011 miles to avoid a scarless approach. Conclusions: The risk of nerve injury, travel distance, and cost were the most important drivers for patients choosing among surgical approaches for thyroidectomy. Cosmetic considerations also influenced patient choices, but in opposing ways depending on patient age.
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Affiliation(s)
- Rupporn Sukpanich
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
- Department of General Surgery, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
| | - Santi Sanglestsawai
- Department of Agricultural and Resource Economics, Kasetsart University, Bangkok, Thailand
| | - Carolyn D Seib
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Jessica E Gosnell
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Wen T Shen
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Sanziana A Roman
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Julie A Sosa
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Quan-Yang Duh
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Insoo Suh
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
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15
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Mott DJ, Chami N, Tervonen T. Reporting Quality of Marginal Rates of Substitution in Discrete Choice Experiments That Elicit Patient Preferences. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:979-984. [PMID: 32828225 DOI: 10.1016/j.jval.2020.04.1831] [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: 01/20/2020] [Revised: 03/27/2020] [Accepted: 04/19/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Discrete choice experiments (DCEs) are commonly used to elicit patient preferences as marginal rates of substitution (MRSs) between treatment or health service attributes. Because these studies are increasing in importance, it is vital that uncertainty around MRS estimates is reported. OBJECTIVE To review recently published DCE studies that elicit patient preferences in relation to MRS reporting and to explore the accuracy of using other reported information to estimate the uncertainty of the MRSs. METHODS A systematic literature review of DCEs conducted with patients between 2014 and July 2019 was performed. The number of studies reporting coefficients, MRSs, standard errors (SEs), and confidence intervals was recorded. If all information was reported, studies were included in an analysis to determine the impact of estimating the SEs of MRSs using coefficients and assuming zero covariance, to determine the impact of this assumption. RESULTS Two hundred and thirty-two patient DCEs were identified in the review; 34.1% (n = 79) reported 1 or more MRS and, of these, only 62.0% (n = 49) provided an estimate of the uncertainty. Of these studies, 16 contained enough information for inclusion in the analysis, providing 116 datapoints. Actual SEs were smaller than estimated SEs in 75.0% of cases (n = 87), and estimated SEs were within 25% of the actual SE in 59.5% of cases (n = 69). CONCLUSION Uncertainty of MRS estimates is unreported in a substantial proportion of recently published DCE studies. Estimating the SE of a MRS by solely using the SEs of the utility coefficients is likely to lead to biased estimates of the precision of patient trade-offs.
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Affiliation(s)
- David J Mott
- Office of Health Economics, London, England, UK.
| | - Nour Chami
- City, University of London, London, England, UK; Evidera, London, England, UK
| | - Tommi Tervonen
- Evidera, London, England, UK; Department of Epidemiology, University of Groningen, Groningen, The Netherlands
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16
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Dhanda DS, Veenstra DL, Regier DA, Basu A, Carlson JJ. Payer Preferences and Willingness to Pay for Genomic Precision Medicine: A Discrete Choice Experiment. J Manag Care Spec Pharm 2020; 26:529-537. [PMID: 32223606 PMCID: PMC10390910 DOI: 10.18553/jmcp.2020.26.4.529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although precision medicine using genetic information offers significant promise, its uptake and eventual clinical and economic impacts are uncertain. Health care payers will play an important role in evaluating evidence and costs to develop coverage and reimbursement policies. OBJECTIVE To elicit U.S. health care payer preference for genomic precision medicine to better understand trade-offs among clinical benefits, uncertainty, and cost. METHODS Using key informant interviewer discussions (N = 6 payers), we identified 6 key attributes of genetic tests important to payers: type of information the test provides (screening vs. treatment prediction), probability that the member has an informative genetic marker, expert agreement on changing medical care based on the marker, quality-of-life gains, life expectancy gains (with statistical uncertainty), and cost to the plan. We designed a stated preference discrete choice experiment using these attributes and administered a web survey to a sample of U.S. health care payers. We used effects coding and analyzed the data using an error component mixed logit modeling approach. RESULTS The survey response rate was 58% (150 participants completed the survey). Approximately 53% of respondents had previous experience evaluating genetic tests for reimbursement, and 85% had more than 5 years of health care decision-making experience. Payers valued improvements in quality of life the most (marginal willingness to pay [mWTP] of $1,513-$6,076), followed by medical expert agreement on the treatment change (mWTP of $2,881-$3,489). Payers placed a relatively lower value for genetic tests with lower marker probability (mWTP of $2,776 for highest marker probability to $423 for lowest marker probability). Payers mWTP was lowest for resolving uncertainty in quality of life (mWTP of $1,513-$2,031) and life expectancy gains ($536-$1,537). CONCLUSIONS Payers exhibited a strong preference for genetic tests that improved quality of life, had high expert agreement on changing medical care, and increased life expectancy. These findings suggest that payers will need evidence of clinical utility to support coverage and reimbursement of genomic precision medicine. DISCLOSURES This study was supported by a grant from the NIH Common Fund and NIA (1U01AG047109-01) via the Personalized Medicine Economics Research (PriMER) project. Unrelated to this study, Veenstra reports consulting fees from Bayer and Halozyme; Basu reports consulting fees from Salutis Consulting; and Reiger reports consulting fees from Roche. Carlson reports grants from Institute for Clinical and Economic Review, during the conduct of this study, and consulting fees from Bayer, Adaptive Biotechnologies, Allergan, Galderma, and Vifor Pharma, unrelated to this study.
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Affiliation(s)
- Devender S. Dhanda
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle
| | - David L. Veenstra
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle
| | - Dean A. Regier
- School of Population and Public Health, University of British Columbia, and Canadian Centre for Applied Research in Cancer Control (ARCC), BC Cancer, Vancouver, BC, Canada
| | - Anirban Basu
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle
| | - Josh J. Carlson
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle
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17
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Soekhai V, de Bekker-Grob EW, Ellis AR, Vass CM. Discrete Choice Experiments in Health Economics: Past, Present and Future. PHARMACOECONOMICS 2019; 37:201-226. [PMID: 30392040 PMCID: PMC6386055 DOI: 10.1007/s40273-018-0734-2] [Citation(s) in RCA: 375] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Discrete choice experiments (DCEs) are increasingly advocated as a way to quantify preferences for health. However, increasing support does not necessarily result in increasing quality. Although specific reviews have been conducted in certain contexts, there exists no recent description of the general state of the science of health-related DCEs. The aim of this paper was to update prior reviews (1990-2012), to identify all health-related DCEs and to provide a description of trends, current practice and future challenges. METHODS A systematic literature review was conducted to identify health-related empirical DCEs published between 2013 and 2017. The search strategy and data extraction replicated prior reviews to allow the reporting of trends, although additional extraction fields were incorporated. RESULTS Of the 7877 abstracts generated, 301 studies met the inclusion criteria and underwent data extraction. In general, the total number of DCEs per year continued to increase, with broader areas of application and increased geographic scope. Studies reported using more sophisticated designs (e.g. D-efficient) with associated software (e.g. Ngene). The trend towards using more sophisticated econometric models also continued. However, many studies presented sophisticated methods with insufficient detail. Qualitative research methods continued to be a popular approach for identifying attributes and levels. CONCLUSIONS The use of empirical DCEs in health economics continues to grow. However, inadequate reporting of methodological details inhibits quality assessment. This may reduce decision-makers' confidence in results and their ability to act on the findings. How and when to integrate health-related DCE outcomes into decision-making remains an important area for future research.
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Affiliation(s)
- Vikas Soekhai
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | - Esther W. de Bekker-Grob
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
| | - Alan R. Ellis
- Department of Social Work, North Carolina State University, Raleigh, NC USA
| | - Caroline M. Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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18
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Naunheim MR, Rathi VK, Naunheim ML, Alkire BC, Lam AC, Song PC, Shrime MG. What Do Patients Want from Otolaryngologists? A Discrete Choice Experiment. Otolaryngol Head Neck Surg 2017; 157:618-624. [PMID: 28675119 DOI: 10.1177/0194599817717662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Patient preferences are crucial for the delivery of patient-centered care. Discrete choice experiments (DCEs) are an emerging quantitative methodology used for understanding these preferences. In this study, we employed DCE techniques to understand the preferences of patients presenting for an ear, nose, and throat clinic visit. Study Design DCE. Setting Decision science laboratory. Methods A DCE survey of 5 attributes-wait time, physician experience, physician personality, utilization of visit time, and cost/copayment-was constructed with structured qualitative interviews with patients. The DCE was administered to participants from the general population, who chose among hypothetical scenarios that varied across these attributes. A conditional logit model was used to determine relative attribute importance, with a separate logit model for determining subject effects. Results A total of 161 participants were included. Cost/copayment had the greatest impact on decision making (importance, 32.2%), followed by wait time and physician experience (26.5% and 24.7%, respectively). Physician personality mattered least (4.7%), although all attributes were significantly correlated to decision making. Participants preferred doctors who spent more time performing physical examination than listening or explaining. Participants were willing to pay $52 extra to avoid a 4-week delay in appointment time; $87 extra for a physician with 10 years of experience (vs 0 years); and $9 extra for a caring, friendly, and compassionate doctor (vs formal, efficient, and business-like). Conclusion DCEs allow for powerful economic analyses that may help physicians understand patient preferences. Our model showed that cost is an important factor to patients and that patients are willing to pay extra for timely appointments, experience, and thorough physical examination.
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Affiliation(s)
- Matthew R Naunheim
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Vinay K Rathi
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret L Naunheim
- 3 Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Blake C Alkire
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen C Lam
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Phillip C Song
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark G Shrime
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.,4 Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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