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van Krugten FCW, Jonker MF, Himmler SFW, Hakkaart-van Roijen L, Brouwer WBF. Estimating a Preference-Based Value Set for the Mental Health Quality of Life Questionnaire (MHQoL). Med Decis Making 2024; 44:64-75. [PMID: 37981788 PMCID: PMC10714713 DOI: 10.1177/0272989x231208645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/29/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Health economic evaluations using common health-related quality of life measures may fall short in adequately measuring and valuing the benefits of mental health care interventions. The Mental Health Quality of Life questionnaire (MHQoL) is a standardized, self-administered mental health-related quality of life instrument covering 7 dimensions known to be relevant across and valued highly by people with mental health problems. The aim of this study was to derive a Dutch value set for the MHQoL to facilitate its use in cost-utility analyses. METHODS The value set was estimated using a discrete choice experiment (DCE) with duration that accommodated nonlinear time preferences. The DCE was embedded in a web-based self-complete survey and administered to a representative sample (N = 1,308) of the Dutch adult population. The matched pairwise choice tasks were created using a Bayesian heterogeneous D-efficient design. The overall DCE design comprised 10 different subdesigns, with each subdesign containing 15 matched pairwise choice tasks. Each participant was asked to complete 1 of the subdesigns to which they were randomly assigned. RESULTS The obtained coefficients indicated that "physical health,""mood," and "relationships" were the most important dimensions. All coefficients were in the expected direction and reflected the monotonic structure of the MHQoL, except for level 2 of the dimension "future." The predicted values for the MHQoL ranged from -0.741 for the worst state to 1 for the best state. CONCLUSIONS This study derived a Dutch value set for the recently introduced MHQoL. This value set allows for the generation of an index value for all MHQoL states on a QALY scale and may hence be used in Dutch cost-utility analyses of mental healthcare interventions. HIGHLIGHTS A discrete choice experiment was used to derive a Dutch value set for the MHQoL.This allows the use of the MHQoL in Dutch cost-utility analyses.The dimensions physical health, mood, and relationships were the most important.The utility values range from -0.741 for the worst state to 1 for the best state.
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Affiliation(s)
- Frédérique C. W. van Krugten
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marcel F. Jonker
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Sebastian F. W. Himmler
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner B. F. Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Essers B, Wang P, Stolk E, Jonker MF, Evers S, Joore M, Dirksen C. An investigation of age dependency in Dutch and Chinese values for EQ-5D-Y. Front Psychol 2023; 14:1175402. [PMID: 37860294 PMCID: PMC10583565 DOI: 10.3389/fpsyg.2023.1175402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023] Open
Abstract
Aims The primary aim was to explore the age dependency of health state values derived via trade-offs between health-related quality of life (HRQoL) and life years in a discrete choice experiment (DCE). The secondary aim was to explore if people weigh life years and HRQoL differently for children, adolescents, adults, and older adults. Methods Participants from the general population of the Netherlands and China first completed a series of choice tasks offering choices between two EQ-5D-Y states with a given lifespan. The choice model captured the value of a year in full health, disutility determined by EQ-5D-Y, and a discount rate. Next, they received a slightly different choice task, offering choices between two lives that differed in HRQoL and life expectancy but produced the same number of quality-adjusted life years (QALYs). Participants were randomly assigned to fill out the survey for three or four age frames: a hypothetical person of 10, 15, 40, and 70 years (the last one only applicable to China) to allow the age dependency of the responses to be explored. Results A total of 1,234 Dutch and 1,818 Chinese people administered the survey. Controlling for time preferences, we found that the agreement of health state values for different age frames was generally stronger in the Netherlands than in China. We found no clear pattern of differences in the QALY composition in both samples. The probability distribution over response options varied most when levels for lifespan or severity were at the extremes of the spectrum. Conclusion/discussion The magnitude and direction of age effects on values seemed dimension- and country specific. In the Netherlands, we found a few differences in dimension-specific weights elicited for 10- and 15-year-olds compared to 40-year-olds, but the overall age dependency of values was limited. A stronger age dependency of values was observed in China, where values for 70-year-olds differed strongly from the values for other ages. The appropriateness of using existing values beyond the age range for which they were measured needs to be evaluated in the local context.
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Affiliation(s)
- Brigitte Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
| | - Pei Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, Netherlands
| | - Marcel F. Jonker
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Silvia Evers
- Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
| | - Manuela Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
| | - Carmen Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
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Jonker MF, Donkers B. Interaction Effects in Health State Valuation Studies: An Optimal Scaling Approach. Value Health 2023; 26:554-566. [PMID: 36323377 DOI: 10.1016/j.jval.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 09/28/2022] [Accepted: 10/10/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES This study aimed to introduce a parsimonious modeling approach that enables the estimation of interaction effects in health state valuation studies. METHODS Instead of supplementing a main-effects model with interactions between each and every level, a more parsimonious optimal scaling approach is proposed. This approach is based on the mapping of health state levels onto domain-specific continuous scales. The attractiveness of health states is then determined by the importance-weighted optimal scales (ie, main effects) and the interactions between these domain-specific scales (ie, interaction effects). The number of interaction terms only depends on the number of health domains. Therefore, interactions between dimensions can be included with only a few additional parameters. The proposed models with and without interactions are fitted on 3 valuation data sets from 2 different countries, that is, a Dutch latent-scale discrete choice experiment (DCE) data set with 3699 respondents, an Australian time trade-off data set with 400 respondents, and a Dutch DCE with duration data set with 788 respondents. RESULTS Important interactions between health domains were found in all 3 applications. The results confirm that the accumulation of health problems within health states has a decreasing marginal effect on health state values. A similar effect is obtained when so-called N3 or N5 terms are included in the model specification, but the inclusion of 2-way interactions provides superior model fits. CONCLUSIONS The proposed interaction model is parsimonious, produces estimates that are straightforward to interpret, and accommodates the estimation of interaction effects in health state valuation studies with realistic sample size requirements. Not accounting for interactions is shown to result in biased value sets, particularly in stand-alone DCE with duration studies.
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Affiliation(s)
- 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.
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Jonker MF. The Garbage Class Mixed Logit Model: Accounting for Low-Quality Response Patterns in Discrete Choice Experiments. Value Health 2022; 25:S1098-3015(22)02109-X. [PMID: 36202702 DOI: 10.1016/j.jval.2022.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/15/2022] [Accepted: 07/13/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To introduce the garbage class mixed logit (MIXL) model as a convenient alternative to manually screening and accounting for respondents with low data quality in discrete choice experiments. METHODS Garbage classes are typically used in latent class logit analyses to designate or identify group(s) of respondents with low data quality. Yet, the same concept can be applied to MIXL models as well. RESULTS Based on a reanalysis of 4 discrete choice experiments that were originally analyzed using a standard MIXL model, it is shown that garbage class MIXL models can achieve the same effect as manually screening for (and excluding) respondents with low data quality based on the more commonly used root likelihood test, but with less effort and ambiguity. CONCLUSIONS Including a garbage class in MIXL models removes the influence of respondents with a random choice pattern from the MIXL model estimates, provides an estimate of the number of low-quality respondents in the dataset, and avoids having to manually screen for respondents with low data quality based on internal or statistical validity tests. Although less versatile than the combination of standard MIXL estimates with separate assessments of data quality and sensitivity analyses, the proposed garbage class MIXL model provides an attractive alternative.
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Affiliation(s)
- Marcel F Jonker
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Jonker MF, Roudijk B, Maas M. The Sensitivity and Specificity of Repeated and Dominant Choice Tasks in Discrete Choice Experiments. Value Health 2022; 25:1381-1389. [PMID: 35527163 DOI: 10.1016/j.jval.2022.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/12/2021] [Accepted: 01/17/2022] [Indexed: 05/20/2023]
Abstract
OBJECTIVES This study aimed to identify the most commonly used internal validity tests in the discrete choice experiment (DCE) literature and establish their sensitivity and specificity. METHODS A structured literature review of recent DCE articles (2018-2020Q1) published in the health, marketing, transport economics, and environmental science literature was used to identify commonly used internal validity tests. The 2 most frequently used internal validity tests were incorporated in 4 new data collections. Respondent preferences in each application were summarized using a mixed logit model, which served as the benchmark for the subsequent sensitivity and specificity calculations. The performance of the internal validity tests was also compared with that of the root likelihood (RLH) test, which is a likelihood-based statistical validity test that is commonly used in marketing applications. RESULTS Dominant and repeated choice tasks were most commonly included in health-related DCE designs. Based on 4 applications, their specificity and sensitivity depend on the type of incorrect response pattern to be detected and on design characteristics such as the number of choice options per choice task and the number of internal validity tests as included in the experimental design. In all but one scenario, the performance of the dominant and repeated choice tasks was considerably worse than that of the RLH test. CONCLUSIONS Dominant and repeated choice tasks are unreliable screening tests and costly in terms of statistical power. The RLH test, which is a statistical test that does not require additional choice tasks to be included in the DCE design, provides a more reliable alternative.
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Affiliation(s)
- 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.
| | | | - Merit Maas
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Jonker MF, Norman R. Not all respondents use a multiplicative utility function in choice experiments for health state valuations, which should be reflected in the elicitation format (or statistical analysis). Health Econ 2022; 31:431-439. [PMID: 34841637 PMCID: PMC9298783 DOI: 10.1002/hec.4457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 08/13/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
Discrete choice experiments (DCEs) that include health states and duration are becoming a common method for estimating quality-adjusted life year (QALY) tariffs. These DCEs need to be analyzed under the assumption that respondents treat health and duration multiplicatively. However, in the most commonly used DCE duration format there is no guarantee that respondents actually do so; in fact, respondents can easily simplify the choice tasks by considering health and duration separately. This would result in valid DCE responses but preclude subsequent QALY tariff calculations. Using a Bayesian latent class model and data from two existing valuation studies, our analyses confirm that in both datasets the majority of respondents do not appear to have used a multiplicative utility function. Moreover, a statistical correction for respondents who used an incorrect function changes the range of the QALY weights. Hence our results imply that one can neither assume that respondents use the theoretically required multiplicative utility function nor assume that the type of utility function that respondents use does not affect the estimated QALY weights. As a solution, we advise researchers to use an alternative, more constrained DCE elicitation format that avoids these behavioral problems.
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Affiliation(s)
- Marcel F. Jonker
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamthe Netherlands
- Erasmus Choice Modelling CentreErasmus University RotterdamRotterdamthe Netherlands
- Duke Clinical Research InstituteDuke UniversityDurhamNorth CarolinaUSA
| | - Richard Norman
- School of Public HealthCurtin UniversityPerthWestern AustraliaAustralia
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de Bekker-Grob EW, Donkers B, Veldwijk J, Jonker MF, Buis S, Huisman J, Bindels P. What Factors Influence Non-Participation Most in Colorectal Cancer Screening? A Discrete Choice Experiment. Patient 2020; 14:269-281. [PMID: 33150461 PMCID: PMC7884368 DOI: 10.1007/s40271-020-00477-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
Background and Objective Non-participation in colorectal cancer (CRC) screening needs to be decreased to achieve its full potential as a public health strategy. To facilitate successful implementation of CRC screening towards unscreened individuals, this study aimed to quantify the impact of screening and individual characteristics on non-participation in CRC screening. Methods An online discrete choice experiment partly based on qualitative research was used among 406 representatives of the Dutch general population aged 55–75 years. In the discrete choice experiment, respondents were offered a series of choices between CRC screening scenarios that differed on five characteristics: effectiveness of the faecal immunochemical screening test, risk of a false-negative outcome, test frequency, waiting time for faecal immunochemical screening test results and waiting time for a colonoscopy follow-up test. The discrete choice experiment data were analysed in a systematic manner using random-utility-maximisation choice processes with scale and/or preference heterogeneity (based on 15 individual characteristics) and/or random intercepts. Results Screening characteristics proved to influence non-participation in CRC screening (21.7–28.0% non-participation rate), but an individual’s characteristics had an even higher impact on CRC screening non-participation (8.4–75.5% non-participation rate); particularly the individual’s attitude towards CRC screening followed by whether the individual had participated in a cancer screening programme before, the decision style of the individual and the educational level of the individual. Our findings provided a high degree of confidence in the internal–external validity. Conclusions This study showed that although screening characteristics proved to influence non-participation in CRC screening, a respondent’s characteristics had a much higher impact on CRC screening non-participation. Policy makers and physicians can use our study insights to improve and tailor their communication plans regarding (CRC) screening for unscreened individuals.
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Affiliation(s)
- Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, The Netherlands.
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University, Rotterdam, The Netherlands
| | - Jorien Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, The Netherlands
| | - Marcel F Jonker
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, The Netherlands
| | - Sylvia Buis
- General Practice, Gezondheidscentrum Ommoord, Rotterdam, The Netherlands
| | - Jan Huisman
- General Practice, Het Doktershuis, Ridderkerk, The Netherlands
| | - Patrick Bindels
- Department of General Practice, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Jonker MF, Donkers B, Goossens LMA, Hoefman RJ, Jabbarian LJ, de Bekker-Grob EW, Versteegh MM, Harty G, Wong SL. Summarizing Patient Preferences for the Competitive Landscape of Multiple Sclerosis Treatment Options. Med Decis Making 2020; 40:198-211. [PMID: 32065023 DOI: 10.1177/0272989x19897944] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective. Quantitatively summarize patient preferences for European licensed relapsing-remitting multiple sclerosis (RRMS) disease-modifying treatment (DMT) options. Methods. To identify and summarize the most important RRMS DMT characteristics, a literature review, exploratory physician interviews, patient focus groups, and confirmatory physician interviews were conducted in Germany, the United Kingdom, and the Netherlands. A discrete choice experiment (DCE) was developed and executed to measure patient preferences for the most important DMT characteristics. The resulting DCE data (n=799 and n=363 respondents in the United Kingdom and Germany, respectively) were analyzed using Bayesian mixed logit models. The estimated individual-level patient preferences were subsequently summarized using 3 additional analyses: the quality of the choice data was assessed using individual-level R2 estimates, individual-level preferences for the available DMTs were aggregated into DMT-specific preference shares, and a principal component analysis was performed to explain the patients' choice process. Results. DMT usage differed between RRMS patients in Germany and the United Kingdom but aggregate patient preferences were similar. Across countries, 42% of all patients preferred oral medications, 38% infusions, 16% injections, and 4% no DMT. The most often preferred DMT was natalizumab (26%) and oral DMT cladribine tablets (22%). The least often preferred were mitoxantrone and the beta-interferon injections (1%-3%). Patient preferences were strongly correlated with patients' MS disease duration and DMT experience, and differences in patient preferences could be summarized using 8 principle components that together explain 99% of the variation in patients' DMT preferences. Conclusion. This study summarizes patient preferences for the included DMTs, facilitates shared decision making along the dimensions that are relevant to RRMS patients, and introduces methods in the medical DCE literature that are ideally suited to summarize the impact of DMT introductions in preexisting treatment landscapes.
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Affiliation(s)
- Marcel F Jonker
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Lucas M A Goossens
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Renske J Hoefman
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Lea J Jabbarian
- Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - 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
| | - Matthijs M Versteegh
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Mandrik O, Yaumenenka A, Herrero R, Jonker MF. Population preferences for breast cancer screening policies: Discrete choice experiment in Belarus. PLoS One 2019; 14:e0224667. [PMID: 31675357 PMCID: PMC6824571 DOI: 10.1371/journal.pone.0224667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/18/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Reaching an acceptable participation rate in screening programs is challenging. With the objective of supporting the Belarus government to implement mammography screening as a single intervention, we analyse the main determinants of breast cancer screening participation. METHODS We developed a discrete choice experiment using a mixed research approach, comprising a literature review, in-depth interviews with key informants (n = 23), "think aloud" pilots (n = 10) and quantitative measurement of stated preferences for a representative sample of Belarus women (n = 428, 89% response rate). The choice data were analysed using a latent class logit model with four classes selected based on statistical (consistent Akaike information criterion) and interpretational considerations. RESULTS Women in the sample were representative of all six geographic regions, mainly urban (81%), and high-education (31%) characteristics. Preferences of women in all four classes were primarily influenced by the perceived reliability of the test (sensitivity and screening method) and costs. Travel and waiting time were important components in the decision for 34% of women. Most women in Belarus preferred mammography screening to the existing clinical breast examination (90%). However, if the national screening program is restricted in capacity, this proportion of women will drop to 55%. Women in all four classes preferred combined screening (mammography with clinical breast examination) to single mammography. While this preference was stronger if lower test sensitivity was assumed, 28% of women consistently gave more importance to combined screening than to test sensitivity. CONCLUSION Women in Belarus were favourable to mammography screening. Population should be informed that there are no benefits of combined screening compared to single mammography. The results of this study are directly relevant to policy makers and help them targeting the screening population.
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Affiliation(s)
- Olena Mandrik
- Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- The University of Sheffield, School of Health and Related Research (ScHARR), Health Economic and Decision Science (HEDS), Sheffield, the United Kingdom
| | - Alesya Yaumenenka
- N.N. Alexandrov National Cancer Center of Belarus, Cancer control department, N.N. Alexandrov National Cancer Centre of Belarus, Liasny, Belarus
| | - Rolando Herrero
- Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - Marcel F. Jonker
- Duke Clinical Research Institute, Duke University, Durham, United States of America
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Jonker MF, Bliemer MCJ. On the Optimization of Bayesian D-Efficient Discrete Choice Experiment Designs for the Estimation of QALY Tariffs That Are Corrected for Nonlinear Time Preferences. Value Health 2019; 22:1162-1169. [PMID: 31563259 DOI: 10.1016/j.jval.2019.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 04/10/2019] [Accepted: 05/06/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES This article explains how to optimize Bayesian D-efficient discrete choice experiment (DCE) designs for the estimation of quality-adjusted life year (QALY) tariffs that are unconfounded by respondents' time preferences. METHODS The calculation of Bayesian D-errors is explained for DCE designs that allow for the disentanglement of respondents' time and health-state preferences. Time preferences are modelled via an exponential, hyperbolic, or power discount function and the performance of the proposed DCE designs is compared with that of several conventional DCE designs that do not take nonlinear time preferences into account. RESULTS Based on the achieved D-error, asymptotic standard error, and estimated sample size to obtain statistically significant estimates of the discount rate parameters, the proposed designs outperform the conventional DCE designs. CONCLUSIONS We recommend that applied researchers use appropriately optimized DCE designs for the estimation of QALY tariffs that are corrected for time preferences. The TPC-QALY software package that accompanies this article makes the recommended designs easily accessible for health-state valuation researchers.
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Affiliation(s)
- Marcel F Jonker
- Duke Clinical Research Institute, Duke University, Durham, NC, USA; Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Michiel C J Bliemer
- Institute of Transport and Logistics, University of Sydney Business School, Sydney, Australia
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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 Health 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Goossens LMA, Jonker MF, Rutten-van Mölken MPMH, Boland MRS, Slok AHM, Salomé PL, van Schayck OCP, In 't Veen JCCM, Stolk EA, Donkers B. The Fold-in, Fold-out Design for DCE Choice Tasks: Application to Burden of Disease. Med Decis Making 2019; 39:450-460. [PMID: 31142198 PMCID: PMC6613173 DOI: 10.1177/0272989x19849461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background In discrete-choice experiments (DCEs), choice alternatives are described by attributes. The importance of each attribute can be quantified by analyzing respondents’ choices. Estimates are valid only if alternatives are defined comprehensively, but choice tasks can become too difficult for respondents if too many attributes are included. Several solutions for this dilemma have been proposed, but these have practical or theoretical drawbacks and cannot be applied in all settings. The objective of the current article is to demonstrate an alternative solution, the fold-in, fold-out approach (FiFo). We use a motivating example, the ABC Index for burden of disease in chronic obstructive pulmonary disease (COPD). Methods Under FiFo, all attributes are part of all choice sets, but they are grouped into domains. These are either folded in (all attributes have the same level) or folded out (levels may differ). FiFo was applied to the valuation of the ABC Index, which included 15 attributes. The data were analyzed in Bayesian mixed logit regression, with additional parameters to account for increased complexity in folded-out questionnaires and potential differences in weight due to the folding status of domains. As a comparison, a model without the additional parameters was estimated. Results Folding out domains led to increased choice complexity for respondents. It also gave domains more weight than when it was folded in. The more complex regression model had a better fit to the data than the simpler model. Not accounting for choice complexity in the models resulted in a substantially different ABC Index. Conclusion Using a combination of folded-in and folded-out attributes is a feasible approach for conducting DCEs with many attributes.
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Affiliation(s)
- Lucas M A Goossens
- Erasmus School of Health Policy and Management & Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands.,Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Marcel F Jonker
- Erasmus School of Health Policy and Management & Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands.,Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Maureen P M H Rutten-van Mölken
- Erasmus School of Health Policy and Management & Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands.,Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Melinde R S Boland
- Erasmus School of Health Policy and Management & Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands.,Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Annerika H M Slok
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - Onno C P van Schayck
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - Elly A Stolk
- Erasmus School of Health Policy and Management & Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands.,Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands.,EuroQol Foundation, Rotterdam, the Netherlands
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands.,Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
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13
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Jonker MF, Donkers B, de Bekker‐Grob E, Stolk EA. Attribute level overlap (and color coding) can reduce task complexity, improve choice consistency, and decrease the dropout rate in discrete choice experiments. Health Econ 2019; 28:350-363. [PMID: 30565338 PMCID: PMC6590347 DOI: 10.1002/hec.3846] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/05/2018] [Accepted: 10/19/2018] [Indexed: 05/14/2023]
Abstract
A randomized controlled discrete choice experiment (DCE) with 3,320 participating respondents was used to investigate the individual and combined impact of level overlap and color coding on task complexity, choice consistency, survey satisfaction scores, and dropout rates. The systematic differences between the study arms allowed for a direct comparison of dropout rates and cognitive debriefing scores and accommodated the quantitative comparison of respondents' choice consistency using a heteroskedastic mixed logit model. Our results indicate that the introduction of level overlap made it significantly easier for respondents to identify the differences and choose between the choice options. As a stand-alone design strategy, attribute level overlap reduced the dropout rate by 30%, increased the level of choice consistency by 30%, and avoided learning effects in the initial choice tasks of the DCE. The combination of level overlap and color coding was even more effective: It reduced the dropout rate by 40% to 50% and increased the level of choice consistency by more than 60%. Hence, we can recommend attribute level overlap, with color coding to amplify its impact, as a standard design strategy in DCEs.
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Affiliation(s)
- Marcel F. Jonker
- Erasmus Choice Modelling CentreErasmus UniversityRotterdamThe Netherlands
- Duke Clinical Research InstituteDuke UniversityDurhamNorth Carolina
- Erasmus School of Health Policy and ManagementErasmus UniversityRotterdamThe Netherlands
| | - Bas Donkers
- Erasmus Choice Modelling CentreErasmus UniversityRotterdamThe Netherlands
- Erasmus School of EconomicsErasmus UniversityRotterdamThe Netherlands
| | - Esther de Bekker‐Grob
- Erasmus Choice Modelling CentreErasmus UniversityRotterdamThe Netherlands
- Erasmus School of Health Policy and ManagementErasmus UniversityRotterdamThe Netherlands
| | - Elly A. Stolk
- Erasmus Choice Modelling CentreErasmus UniversityRotterdamThe Netherlands
- EuroQol Research FoundationRotterdamThe Netherlands
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14
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Lim S, Jonker MF, Oppe M, Donkers B, Stolk E. Severity-Stratified Discrete Choice Experiment Designs for Health State Evaluations. Pharmacoeconomics 2018; 36:1377-1389. [PMID: 30030818 PMCID: PMC6182499 DOI: 10.1007/s40273-018-0694-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Discrete choice experiments (DCEs) are increasingly used for health state valuations. However, the values derived from initial DCE studies vary widely. We hypothesize that these findings indicate the presence of unknown sources of bias that must be recognized and minimized. Against this background, we studied whether values derived from a DCE are sensitive to how well the DCE design spans the severity range. METHODS We constructed an experiment involving three variants of DCE tasks for health state valuation: standard DCE, DCE-death, and DCE-duration. For each type of DCE, an experimental design was generated under two different conditions, enabling a comparison of health state values derived from current best practice Bayesian efficient DCE designs with values derived from 'severity-stratified' designs that control for coverage of the severity range in health state selection. About 3000 respondents participated in the study and were randomly assigned to one of the six study arms. RESULTS Imposing the severity-stratified restriction had a large effect on health states sampled for the DCE-duration approach. The unstratified efficient design returned a skewed distribution of selected health states, and this introduced bias. The choice probability of bad health states was underestimated, and time trade-offs to avoid bad states were overestimated, resulting in too low values. Imposing the same restriction had limited effect in the DCE-death approach and standard DCE. CONCLUSION Variation in DCE-derived values can be partially explained by differences in how well selected health states spanned the severity range. Imposing a 'severity stratification' on DCE-duration designs is a validity requirement.
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Affiliation(s)
- Sesil Lim
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus School of Economics, 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
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Mark Oppe
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Elly Stolk
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- EuroQol Research Foundation, Rotterdam, The Netherlands
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15
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Jonker MF, Donkers B, de Bekker-Grob EW, Stolk EA. Advocating a Paradigm Shift in Health-State Valuations: The Estimation of Time-Preference Corrected QALY Tariffs. Value Health 2018; 21:993-1001. [PMID: 30098678 DOI: 10.1016/j.jval.2018.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 01/16/2018] [Accepted: 01/21/2018] [Indexed: 05/15/2023]
Abstract
BACKGROUND Despite evidence of nonproportional trade-offs in time trade-off exercises and the explicit incorporation of exponential discounting in health technology assessment calculations, quality-adjusted life-year (QALY) tariffs are currently still established under the assumption of linear time preferences. OBJECTIVES The aim of this study was to introduce a general method of accommodating for nonlinear time preferences in discrete choice experiment (DCE) duration studies and to evaluate its impact on estimated QALY tariffs. METHODS A parsimonious utility function is proposed that accommodates any discounting function and preserves linear time preferences as a special case. Based on an efficient DCE design and 1775 respondents from a nationally representative scientific household panel, preferences and QALY tariffs for the Dutch SF-6D were estimated while accommodating for nonlinear time preferences via exponential and hyperbolic discounting functions. RESULTS When the discount rate was estimated directly, we found strong evidence of nonlinear time preferences (with an exponential and hyperbolic discount rate of 5.7% and 16.5%, respectively). When the discount rate was estimated as a function of health state severity, we found that years lived in better health states are discounted minus years lived in impaired health states. Finally, the best statistical fit was obtained when using a hyperbolic discount function, which resulted in smaller QALY decrements and fewer health states classified as worse than immediate death. CONCLUSIONS Our results highlight the relevance and even necessity of a paradigm shift in health valuation studies in favor of time-preference corrected QALY tariffs, with potentially important implications for health technology assessment calculations and regulatory decisions.
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Affiliation(s)
- Marcel F Jonker
- Duke Clinical Research Institute, Duke University, Durham, NC, USA; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, The Netherlands
| | - Esther W de Bekker-Grob
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands
| | - Elly A Stolk
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, The Netherlands; EuroQol Research Foundation, Rotterdam, The Netherlands
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Jonker MF, Donkers B, de Bekker-Grob EW, Stolk EA. Effect of Level Overlap and Color Coding on Attribute Non-Attendance in Discrete Choice Experiments. Value Health 2018; 21:767-771. [PMID: 30005748 DOI: 10.1016/j.jval.2017.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/08/2017] [Accepted: 10/10/2017] [Indexed: 05/07/2023]
Abstract
OBJECTIVE The aim of this study was to test the hypothesis that level overlap and color coding can mitigate or even preclude the occurrence of attribute nonattendance in discrete choice experiments. METHODS A randomized controlled experiment with five experimental study arms was designed to investigate the independent and combined impact of level overlap and color coding on respondents' attribute nonattendance. The systematic differences between the study arms allowed for a direct comparison of observed dropout rates and estimates of the average number of attributes attended to by respondents, which were obtained by using augmented mixed logit models that explicitly incorporated attribute non-attendance. RESULTS In the base-case study arm without level overlap or color coding, the observed dropout rate was 14%, and respondents attended, on average, only two out of five attributes. The independent introduction of both level overlap and color coding reduced the dropout rate to 10% and increased attribute attendance to three attributes. The combination of level overlap and color coding, however, was most effective: it reduced the dropout rate to 8% and improved attribute attendance to four out of five attributes. The latter essentially removes the need to explicitly accommodate for attribute non-attendance when analyzing the choice data. CONCLUSIONS On the basis of the presented results, the use of level overlap and color coding are recommendable strategies to reduce the dropout rate and improve attribute attendance in discrete choice experiments.
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Affiliation(s)
- Marcel F Jonker
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, The Netherlands
| | - Esther W de Bekker-Grob
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands; Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Elly A Stolk
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, The Netherlands; EuroQol Research Foundation, Rotterdam, The Netherlands
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Goossens LMA, Rutten-van Mölken MPMH, Boland MRS, Donkers B, Jonker MF, Slok AHM, Salomé PL, van Schayck OCP, In 't Veen JCCM, Stolk EA. ABC Index: quantifying experienced burden of COPD in a discrete choice experiment and predicting costs. BMJ Open 2017; 7:e017831. [PMID: 29282261 PMCID: PMC5770840 DOI: 10.1136/bmjopen-2017-017831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The Assessment of Burden of COPD (ABC) tool supports shared decision making between patient and caregiver. It includes a coloured balloon diagram to visualise patients' scores on burden indicators. We aim to determine the importance of each indicator from a patient perspective, in order to calculate a weighted index score and investigate whether that score is predictive of costs. DESIGN Discrete choice experiment. SETTING AND PARTICIPANTS Primary care and secondary care in the Netherlands. 282 patients with chronic obstructive pulmonary disease (COPD) and 252 members of the general public participated. METHODS Respondents received 14 choice questions and indicated which of two health states was more severe. Health states were described in terms of specific symptoms, limitations in physical, daily and social activities, mental problems, fatigue and exacerbations, most of which had three levels of severity. Weights for each item-level combination were derived from a Bayesian mixed logit model. Weights were rescaled to construct an index score from 0 (best) to 100 (worst). Regression models were used to find a classification of this index score in mild, moderate and severe that was discriminative in terms of healthcare costs. RESULTS Fatigue, limitations in moderate physical activities, number of exacerbations, dyspnoea at rest and fear of breathing getting worse contributed most to the burden of disease. Patients assigned less weight to dyspnoea during exercise, listlessness and limitations with regard to strenuous activities. Respondents from the general public mostly agreed. Mild, moderate and severe burden of disease were defined as scores <20, 20-39 and ≥40. This categorisation was most predictive of healthcare utilisation and annual costs: €1368, €2510 and €9885, respectively. CONCLUSIONS The ABC Index is a new index score for the burden of COPD, which is based on patients' preferences. The classification of the index score into mild, moderate and severe is predictive of future healthcare costs. TRIAL REGISTRATION NUMBER NTR3788; Post-results.
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Grants
- Almirall BV, Utrecht, The Netherlands
- the Innovation Fund Dutch Health Insurers, Zeist, The Netherlands
- GlaxoSmithKline BV, Zeist, The Netherlands
- Chiesi Pharmaceuticals BV, Rijswijk, The Netherlands
- Novartis BV, Arnhem, The Netherlands
- AstraZeneca BV, Zoetermeer, The Netherlands
- Picasso for COPD, Alkmaar, The Netherlands
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Affiliation(s)
- Lucas M A Goossens
- Erasmus School of Health Policy and Management & Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maureen P M H Rutten-van Mölken
- Erasmus School of Health Policy and Management & Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Melinde R S Boland
- Erasmus School of Health Policy and Management & Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marcel F Jonker
- Erasmus School of Health Policy and Management & Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Annerika H M Slok
- CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | | | - Onno C P van Schayck
- CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | | | - Elly A Stolk
- Erasmus School of Health Policy and Management & Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- EuroQol Foundation, Rotterdam, The Netherlands
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18
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Jonker MF, Attema AE, Donkers B, Stolk EA, Versteegh MM. Are Health State Valuations from the General Public Biased? A Test of Health State Reference Dependency Using Self-assessed Health and an Efficient Discrete Choice Experiment. Health Econ 2017; 26:1534-1547. [PMID: 27790801 DOI: 10.1002/hec.3445] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/03/2016] [Accepted: 09/19/2016] [Indexed: 05/20/2023]
Abstract
Health state valuations of patients and non-patients are not the same, whereas health state values obtained from general population samples are a weighted average of both. The latter constitutes an often-overlooked source of bias. This study investigates the resulting bias and tests for the impact of reference dependency on health state valuations using an efficient discrete choice experiment administered to a Dutch nationally representative sample of 788 respondents. A Bayesian discrete choice experiment design consisting of eight sets of 24 (matched pairwise) choice tasks was developed, with each set providing full identification of the included parameters. Mixed logit models were used to estimate health state preferences with respondents' own health included as an additional predictor. Our results indicate that respondents with impaired health worse than or equal to the health state levels under evaluation have approximately 30% smaller health state decrements. This confirms that reference dependency can be observed in general population samples and affirms the relevance of prospect theory in health state valuations. At the same time, the limited number of respondents with severe health impairments does not appear to bias social tariffs as obtained from general population samples. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Marcel F Jonker
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Arthur E Attema
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Bas Donkers
- Department of Business Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Elly A Stolk
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Matthijs M Versteegh
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Jonker MF, D'Ippolito E, Eikemo TA, Congdon PD, Nante N, Mackenbach JP, Kamphuis CBM. The effect of regional politics on regional life expectancy in Italy (1980-2010). Scand J Public Health 2017; 45:121-131. [PMID: 28152652 DOI: 10.1177/1403494816686266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The evidence on the association between politics and health is scarce considering the importance of this topic for population health. Studies that investigated the effect of different political regimes on health outcomes show inconsistent results. METHODS Bayesian time-series cross-section analyses are used to examine the overall impact of regional politics on variations in Italian regional life expectancy (LE) at birth during the period 1980-2010. Our analyses control for trends in and unobserved determinants of regional LE, correct for temporal as well as spatial autocorrelation, and employ a flexible specification for the timing of the political effects. RESULTS In the period from 1980 to 1995, we find no evidence that the communist, left-oriented coalitions and Christian Democratic, centre-oriented coalitions have had an effect on regional LE. In the period from 1995 onwards, after a major reconfiguration of Italy's political regimes and a major healthcare reform, we again find no evidence that the Centre-Left and Centre-Right coalitions have had a significant impact on regional LE. CONCLUSION The presented results provide no support for the notion that different regional political regimes in Italy have had a differential effect on regional LE, even though Italian regions have had considerable and increasing autonomy over healthcare and health-related policies and expenditures.
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Affiliation(s)
- Marcel F Jonker
- 1 Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.,2 Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Edoardo D'Ippolito
- 3 Department of Public Health, Health Services Research Laboratory, University of Siena, Italy
| | - Terje A Eikemo
- 1 Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.,4 Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Peter D Congdon
- 5 School of Geography, Queen Mary University of London, London, UK
| | - Nicola Nante
- 3 Department of Public Health, Health Services Research Laboratory, University of Siena, Italy
| | - Johan P Mackenbach
- 1 Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Carlijn B M Kamphuis
- 1 Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Abstract
Discrete-choice experiments (DCEs) have become a commonly used instrument in health economics and patient-preference analysis, addressing a wide range of policy questions. An important question when setting up a DCE is the size of the sample needed to answer the research question of interest. Although theory exists as to the calculation of sample size requirements for stated choice data, it does not address the issue of minimum sample size requirements in terms of the statistical power of hypothesis tests on the estimated coefficients. The purpose of this paper is threefold: (1) to provide insight into whether and how researchers have dealt with sample size calculations for healthcare-related DCE studies; (2) to introduce and explain the required sample size for parameter estimates in DCEs; and (3) to provide a step-by-step guide for the calculation of the minimum sample size requirements for DCEs in health care.
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Affiliation(s)
- Esther W de Bekker-Grob
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Bas Donkers
- Department of Business Economics, Erasmus University, Rotterdam, The Netherlands
| | - Marcel F Jonker
- Department of Health Economics, Policy and Law, Erasmus University, Rotterdam, The Netherlands
| | - Elly A Stolk
- Department of Health Economics, Policy and Law, Erasmus University, Rotterdam, The Netherlands
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Willers SM, Jonker MF, Klok L, Keuken MP, Odink J, van den Elshout S, Sabel CE, Mackenbach JP, Burdorf A. High resolution exposure modelling of heat and air pollution and the impact on mortality. Environ Int 2016; 89-90:102-109. [PMID: 26826367 DOI: 10.1016/j.envint.2016.01.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Elevated temperature and air pollution have been associated with increased mortality. Exposure to heat and air pollution, as well as the density of vulnerable groups varies within cities. The objective was to investigate the extent of neighbourhood differences in mortality risk due to heat and air pollution in a city with a temperate maritime climate. METHODS A case-crossover design was used to study associations between heat, air pollution and mortality. Different thermal indicators and air pollutants (PM10, NO2, O3) were reconstructed at high spatial resolution to improve exposure classification. Daily exposures were linked to individual mortality cases over a 15year period. RESULTS Significant interaction between maximum air temperature (Tamax) and PM10 was observed. During "summer smog" days (Tamax>25°C and PM10>50μg/m(3)), the mortality risk at lag 2 was 7% higher compared to the reference (Tamax 15°C and PM10 15μg/m(3)). Persons above age 85 living alone were at highest risk. CONCLUSION We found significant synergistic effects of high temperatures and air pollution on mortality. Single living elderly were the most vulnerable group. Due to spatial differences in temperature and air pollution, mortality risks varied substantially between neighbourhoods, with a difference up to 7%.
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Affiliation(s)
- Saskia M Willers
- Air Quality Department, DCMR Environmental Protection Agency Rijnmond, P.O. Box 843, 3100 AV Schiedam, The Netherlands; Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Marcel F Jonker
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Lisette Klok
- Netherlands Organisation for Applied Scientific Research TNO, Princetonlaan 6, 3584 CB Utrecht, The Netherlands.
| | - Menno P Keuken
- Netherlands Organisation for Applied Scientific Research TNO, Princetonlaan 6, 3584 CB Utrecht, The Netherlands.
| | - Jennie Odink
- Municipal Public Health Service Rotterdam-Rijnmond, Postbus 70032, 3000 LP Rotterdam, The Netherlands.
| | - Sef van den Elshout
- Air Quality Department, DCMR Environmental Protection Agency Rijnmond, P.O. Box 843, 3100 AV Schiedam, The Netherlands.
| | - Clive E Sabel
- School of Geographical Sciences, University of Bristol, University Rd, Bristol BS8 1SS, UK.
| | - Johan P Mackenbach
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Alex Burdorf
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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Jonker MF, van Lenthe FJ, Donkers B, Mackenbach JP, Burdorf A. The effect of urban green on small-area (healthy) life expectancy. J Epidemiol Community Health 2014; 68:999-1002. [DOI: 10.1136/jech-2014-203847] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jonker MF, Congdon PD, van Lenthe FJ, Donkers B, Burdorf A, Mackenbach JP. Small-area health comparisons using health-adjusted life expectancies: A Bayesian random-effects approach. Health Place 2013; 23:70-8. [DOI: 10.1016/j.healthplace.2013.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 03/05/2013] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
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Jonker MF, van Lenthe FJ, Donkers B, Congdon PD, Burdorf A, Mackenbach JP. The impact of nursing homes on small-area life expectancies. Health Place 2013; 19:25-32. [DOI: 10.1016/j.healthplace.2012.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 09/26/2012] [Accepted: 09/30/2012] [Indexed: 11/26/2022]
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Jonker MF, van Lenthe FJ, Congdon PD, Donkers B, Burdorf A, Mackenbach JP. Comparison of Bayesian random-effects and traditional life expectancy estimations in small-area applications. Am J Epidemiol 2012; 176:929-37. [PMID: 23136165 DOI: 10.1093/aje/kws152] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There are several measures that summarize the mortality experience of a population. Of these measures, life expectancies are generally preferred based on their simpler interpretation and direct age standardization, which makes them directly comparable between different populations. However, traditional life expectancy estimations are highly inaccurate for smaller populations and consequently are seldom used in small-area applications. In this paper, the authors compare the relative performance of traditional life expectancy estimation with a Bayesian random-effects approach that uses correlations (i.e., borrows strength) between different age groups, geographic areas, and sexes to improve the small-area life expectancy estimations. In the presented Monte Carlo simulations, the Bayesian random-effects approach outperforms the traditional approach in terms of bias, root mean square error, and coverage of the 95% confidence intervals. Moreover, the Bayesian random-effects approach is found to be usable for populations as small as 2,000 person-years at risk, which is considerably smaller than the minimum of 5,000 person-years at risk recommended for the traditional approach. As such, the proposed Bayesian random-effects approach is well-suited for estimation of life expectancies in small areas.
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Affiliation(s)
- Marcel F Jonker
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
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