Menu choice stated preference tasks to capture demand complementarity in health

Health programs/services are often bundled, allowing for both substitution and complementarity. We adapt Discrete Choice Experiments to capture bundling, with application to a case study of exercise and nutrition; complementarity arises due to the goal of improving health. Our contributions are (1) to present a menu-based choice experiment to explore bundling; (2) to analyse the menu-based data using an extension of the choice set generation model (GenL) to account for correlations between bundles and component singles. A nationally representative sample of 333 Australians chose between a nutrition program only; exercise program only; both nutrition and exercise programs; or their status quo. Overall, we show that by incorporating the menu choice task and introducing the combined alternative, we capture a significant portion of the population seeking both exercise and nutrition components. We estimate a latent class GenL model, and identify two latent classes: Class 1 preferred to choose programs on offer, and Class 2 was more price sensitive and had a stronger preference for staying with their status quo. We show in the post-estimation analysis that heterogeneity in preferences translates into heterogeneity in the way alternatives are bundled, indicating that the combined offering is appealing to specific classes of individuals who prefer bundling. By implementing the menu choice task, researchers and policymakers can effectively identify, cater to and influence the demand for combined exercise and nutrition options, leading to more targeted and impactful interventions in promoting healthier lifestyle choices.

Bidding against the wind: A choice experiment in green energy, green jobs and offshore views in North Carolina, USA

Offshore wind development is in its nascent stages in the United States. Recent research indicates that the visual impacts of offshore wind farms are viewed negatively by the general population. This North Carolina application is the first US-focused discrete choice experiment that explicitly asks respondents to consider the positive local and global benefits from offshore wind development, such as job creation and greenhouse gas emission reductions, simultaneously with their visual impacts. We find significant willingness to pay (WTP) for reducing the visual impacts of offshore wind farms, and that the extent of disamenity varies in the population and with placement along developed tourist towns (as much as $783/year for three years) or preserved coastlines (as much as $451/year for three years). We also find that some preference classes value projects that create permanent jobs and reduce carbon emissions. We use our estimates of preferences for the positive and negative attributes to explore specific wind farm configurations and locations that could achieve positive consensus in a heterogenous population.

Stakeholders' preferences for the design and delivery of virtual care services: A systematic review of discrete choice experiments

This systematic review aimed to synthesise evidence from discrete choice experiments (DCEs) eliciting preferences for virtual models of care, as well as to assess the quality of those DCEs and compare the relative preferences for different stakeholder groups. Articles were included if published between January 2010 and December 2022. Data were synthesised narratively, and attributes were assessed for frequency, significance, and relative importance using a semi-quantitative approach. Overall, 21 studies were included encompassing a wide range of virtual care modalities, with the most common setting being virtual consultations for outpatient management of chronic conditions. A total of 135 attributes were identified and thematically classified into six categories: service delivery, service quality, technical aspects, monetary aspects, health provider characteristics and health consumer characteristics. Attributes related to service delivery were most frequently reported but less highly ranked. Service costs were consistently significant across all studies where they appeared, indicating their importance to the respondents. All studies examining health providers' preferences reported either system performance or professional endorsement attributes to be the most important. Substantial heterogeneity in attribute selection and preference outcomes were observed across studies reporting on health consumers' preferences, suggesting that the consideration of local context is important in the design and delivery of person-centred virtual care services. In general, the experimental design and analysis methods of included studies were clearly reported and justified. An improvement was observed in the quality of DCE design and analysis in recent years, particularly in the attribute development process. Given the continued growth in the use of DCEs within healthcare settings, further research is needed to develop a standardised approach for quantitatively synthesising DCE findings. There is also a need for further research on preferences for virtual care in post-pandemic contexts, where emerging evidence suggests that preferences may differ to those observed in pre-pandemic times.

Monetary values of increasing life expectancy: Sensitivity to shifts of the survival curve

Individuals' monetary values of decreases in mortality risk depend on the magnitude and timing of the risk reduction. We elicited stated preferences among three time paths of risk reduction yielding the same increase in life expectancy (decreasing risk for the next decade, subtracting a constant from or multiplying risk by a constant in all future years) and willingness to pay (WTP) for risk reductions differing in timing and life-expectancy gain. Respondents exhibited heterogeneous preferences over the alternative time paths, with almost 90 percent reporting transitive orderings. WTP is statistically significantly associated with life-expectancy gain (between about 7 and 28 days) and with respondents' stated preferences over the alternative time paths. Estimated value per statistical life year (VSLY) can differ by time path and averages about $500,000, roughly consistent with conventional estimates obtained by dividing estimated value per statistical life by discounted life expectancy.

A systematic review to identify the use of stated preference research in the field of older adult care

In the design of long-term care systems, preferences can serve as an essential indication to better tailor services to the needs, wishes and expectations of its consumers. The aim of this systematic review was to summarize and synthesize available evidence on long-term care preferences that have been elicited by quantitative stated-preference methods. The databases PubMed and Web of Science were searched for the period 2000 to 2020 with an extensive set of search terms. Two independent researchers judged the eligibility of studies. The final number of included studies was 66, conducted in 19 different countries. Studies were systematized according to their content focus as well as the survey method used. Irrespective of the heterogeneity of studies with respect to research focus, study population, sample size and study design, some consistent findings emerged. When presented with a set of long-term care options, the majority of study participants preferred to "age in place" and make use of informal or home-based care. With increasing severity of physical and cognitive impairments, preferences shifted toward the exclusive use of formal care. Next to the severity of care needs, the influence on preferences of a range of other independent variables such as income, family status and education were tested; however, none showed consistent effects across all studies. The inclusion of choice-based elicitation techniques provides an impression of how studies operationalized long-term care and measured preferences. Future research should investigate how preferences might change over time and generations as well as people's willingness and realistic capabilities of providing care.

Assessing the recreational value of small-scale nature-based solutions when planning urban flood adaptation

Nature-based solutions may actively reduce hydro-meteorological risks in urban areas as a part of climate change adaptation. However, the main reason for the increasing uptake of this type of solution is their many benefits for the local inhabitants, including recreational value. Previous studies on recreational value focus on studies of existing nature sites that are often much larger than what is considered as new NBS for flood adaptation studies in urban areas. We thus prioritized studies with smaller areas and nature types suitable for urban flood adaptation and divided them into four common nature types for urban flood adaptation: sustainable urban drainage systems, city parks, nature areas and rivers. We identified 23 primary valuation studies, including both stated and revealed preference studies, and derived two value transfer functions based on meta-regression analysis on existing areas. We investigated trends between values and variables and found that for the purpose of planning of new NBS the size of NBS and population density were determining factors of recreational value. For existing NBS the maximum travelling distance may be included as well. We find that existing state-of-the-art studies overestimate the recreational with more than a factor of 4 for NBS sizes below 5 ha. Our results are valid in a European context for nature-based solutions below 250 ha and can be applied across different NBS types and sizes.

Knowledge gaps and future research needs for assessing the non-market benefits of Nature-Based Solutions and Nature-Based Solution-like strategies

Nature-Based Solutions (NBS) can be defined as solutions based on natural processes that meet societal challenges and simultaneously provide human well-being and biodiversity benefits. These solutions are envisioned to contribute to operationalizing sustainable development strategies, especially in the context of adaptation to climate change (e.g. flood risk reduction). In order to quantify NBS performance, ease their uptake and advocate for them as alternatives to "business-as-usual" infrastructures, a comprehensive, holistic valuation of their multiple benefits (multiple advantages and disadvantages) is needed. This entails quantifying non-market benefits for people and nature in addition to determining the (direct) cost-benefit of the risk-reduction measure. Despite the importance given to the assessment of non-tangible benefits for people and nature in the literature, systematic data collection on these dimensions seems to be missing. This study reviews publications that used stated preference methods to assess non-market human benefits of NBS and NBS-like strategies. Its aim is to highlight any biases or knowledge gaps in this kind of evaluation. Our results show that the valuation of non-tangible benefits of NBS (e.g. increased recreation and well-being, enhanced biodiversity) still suffers from a lack of common framing. Despite some steps being taken on enabling interconnected benefit assessments, unexploited opportunities concerning the integrated assessment of non-market human and nature benefits predominate. Moreover, the research to-date appears based on a case-to-case approach, and thus a shared holistic method does not emerge from the present literature, potentially delaying the uptake of NBS. We argue that future research could minimize missed opportunities by focusing on and systematically applying holistic benefits assessments. Methods based on stated preference surveys may help to ensure holistic approaches are taken, as well as contributing to their replicability and application when upscaling NBS.

How public values for threatened species are affected by conservation strategies

While the imminent extinction of many species is predicted, prevention is expensive, and decision-makers often have to prioritise funding. In democracies, it can be argued that conservation using public funds should be influenced by the values placed on threatened species by the public, and that community views should also affect the conservation management approaches adopted. We conducted on online survey with 2400 respondents from the general Australian public to determine 1) the relative values placed on a diverse set of 12 threatened Australian animal species and 2) whether those values changed with the approach proposed to conserve them. The survey included a contingent valuation and a choice experiment. Three notable findings emerged: 1) respondents were willing to pay $60/year on average for a species (95% confidence interval: $23 to $105) to avoid extinction in the next 20 years based on the contingent valuation, and $29 to $100 based on the choice experiment, 2) respondents were willing to pay to reduce the impact of feral animals on almost all presented threatened species, 3) for few species and respondents, WTP was lower when genetic modification to reduce inbreeding in the remaining population was proposed.

Citizens' preferences on green infrastructure practices and their enhancement in Portland, Oregon

Green infrastructure (GI) has been gaining increasing attention due to its efficiency in controlling and purifying urban stormwater runoff, creating environmental amenities, and biodiversity conservation. Nevertheless, the existing knowledge of people's preferences for GI is not yet sufficient for evidence-based policymaking for enhancing GI. This study analyzes citizens' perceptions of the relative importance of six GI practices and estimates their willingness to pay (WTP) to enhance them. To this end, the study applies two types of stated preference methods (best-worst scaling and contingent valuation) to citizen survey data collected in Portland, Oregon. We found that GI practices that are more likely to lead to private benefits (e.g., rain barrels, urban trees) received relatively higher ratings, whereas the ratings of practices that do not offer such benefits (e.g., bioswales, rain gardens) were relatively lower. However, the diversity of preferences was large, as the relative importance varied widely among respondents. Heterogeneous preferences were also found in terms of citizens' WTP for hypothetical GI enhancement. Our comparison of uniform and variable payment schemes revealed that variable payment outperformed uniform payment because of the significant variation in citizens' WTP. The difference was large when the annual household payment was small.

Willingness-to-pay for cancer treatment and outcome: a systematic review

BACKGROUND

Understanding patient preferences in cancer management is essential for shared decision-making. Patient or societal willingness-to-pay (WTP) for desired outcomes in cancer management represents their preferences and values of these outcomes.

OBJECTIVE

The aim of this systematic review is to critically evaluate how current literature has addressed WTP in relation to cancer treatment and achievement of outcomes.

METHODS

Seven databases were searched from inception until 2 March 2021 to include studies with primary data of WTP values for cancer treatments or achievement of outcomes that were elicited using stated preference methods.

RESULTS

Fifty-four studies were included in this review. All studies were published after year 2000 and more than 90% of the studies were conducted in high-income countries. Sample size of the studies ranged from 35 to 2040, with patient being the most studied population. There was a near even distribution between studies using contingent valuation and discrete choice experiment. Based on the included studies, the highest WTP values were for a quality-adjusted life year (QALY) ($11,498-$589,822), followed by 1-year survival ($3-$198,576), quality of life (QoL) improvement ($5531-$139,499), and pain reduction ($79-$94,662). Current empirical evidence suggested that improvement in QoL and pain reduction had comparable weights to survival in cancer management.

CONCLUSION

This systematic review provides a summary on stated preference studies that elicited patient preferences via WTP and summarised their respective values. Respondents in this review had comparable WTP for 1-year survival and QoL, suggesting that improvement in QoL should be emphasised together with survival in cancer management.

Prescribing antibiotics: Factors driving decision-making in general practice. A discrete choice experiment

BACKGROUND

Antimicrobial resistance is a threat to human health. We need to strive for a rational use of antibiotics to reduce the selection of resistant bacteria. Most antibiotics are prescribed in general practice, but little is known about factors influencing general practitioners' (GPs) decision-making when prescribing antibiotics.

AIM

To 1) assess the importance of factors that influence decisions by GPs to prescribe antibiotics for acute respiratory tract infections (RTIs) and 2) identify segments of GPs influenced differently when deciding to prescribe antibiotics.

METHODS

A questionnaire survey including a discrete choice experiment was conducted. Danish GPs were asked to indicate whether they would prescribe antibiotics in six hypothetical choice sets with six variables: whether the GP is behind schedule, patient's temperature, patient's general condition, lung auscultation findings, C-reactive protein (CRP) level, and whether the patient expects antibiotics. Error component and latent class models were estimated and the probabilities of prescribing in different scenarios were calculated.

RESULTS

The questionnaire was distributed to every Danish GP (n = 3,336); 1,152 (35%) responded. Results showed that GPs were influenced by (in prioritised order): CRP level (Relative importance (RI) 0.54), patient's general condition (RI 0.20), crackles at auscultation (RI 0.15), and fever (RI 0.10). Being behind schedule and patient expectations had no significant impact on antibiotic prescription at the aggregate level. The latent class analysis identified five classes of GPs: generalists, CRP-guided, general condition-guided, reluctant prescribers, and stethoscopy-guided. For all classes, CRP was the most important driver, while GPs were heterogeneously affected by other drivers.

CONCLUSION

The most important factor affecting Danish GPs' decision to prescribe antibiotics at the aggregate level, in subgroups of GPs, and across latent classes was the CRP value. Hence, the use of CRP testing is an important factor to consider in order to promote rational antibiotic use in the battle against antimicrobial resistance.

Potential of on-demand services for urban travel

On-demand mobility services are promising to revolutionise urban travel, but preliminary studies are showing they may actually increase total vehicle miles travelled, worsening road congestion in cities. In this study, we assess the demand for on-demand mobility services in urban areas, using a stated preference survey, to understand the potential impact of introducing on-demand services on the current modal split. The survey was carried out in the Netherlands and offered respondents a choice between bike, car, public transport and on-demand services. 1,063 valid responses are analysed with a multinomial logit and a latent class choice model. By means of the latter, we uncover four distinctive groups of travellers based on the observed choice behaviour. The majority of the sample, the Sharing-ready cyclists (55%), are avid cyclists and do not see on-demand mobility as an alternative for making urban trips. Two classes, Tech-ready individuals (27%) and Flex-ready individuals (9%) would potentially use on-demand services: the former is fairly time-sensitive and would thus use on-demand service if they were sufficiently fast. The latter is highly cost-sensitive, and would therefore use the service primarily if it is cheap. The fourth class, Flex-sceptic individuals (9%) shows very limited potential for using on-demand services.

Debiasing or regularisation? Two interpretations of the concept of 'true preference' in behavioural economics

I reconsider Bleichrodt, Pinto Prades and Wakker's (BPW) 2001 paper about eliciting utility measures from stated preference surveys. That paper pioneers a method that is now widely used in behavioural economics to correct individuals' 'biases' and to recover their 'true preferences'. However, BPW propose this method as way of dealing with inconsistent responses to stated preference surveys, in contrast to more recent applications which aim to help individuals to avoid supposed mistakes in their private choices. I argue that the concepts of true preference and bias are empirically ungrounded, but that BPW's approach can be interpreted as not invoking those concepts. By 'regularising' preferences revealed in actual choice, this approach constructs measures of individual welfare that are broadly aligned with actual preferences and consistent with normative standards of rationality that are appropriate for public decision-making. Public decision-makers' normative judgements are made explicit, rather than being disguised as apparently empirical claims about true preferences.

Acceptability and Preferences of Two Different Community Models of ART Delivery in a High Prevalence Urban Setting in Zambia: Cluster-Randomized Trial, Nested in the HPTN 071 (PopART) Study

Community delivery of Antiretroviral therapy (ART) is a novel innovation to increase sustainable ART coverage for People living with HIV (PLHIV) in resource limited settings. Within a nested cluster-randomised sub-study in two urban communities that participated in the HPTN 071 (PopART) trial in Zambia we investigated individual acceptability and preferences for ART delivery models. Stable PLHIV were enrolled in a cluster-randomized trial of three different models of ART: Facility-based delivery (SoC), Home-based delivery (HBD) and Adherence clubs (AC). Consenting individuals were asked to express their stated preference for ART delivery options. Those assigned to the community models of ART delivery arms could choose ("revealed preference") between the assigned arm and facility-based delivery. In total 2489 (99.6%) eligible individuals consented to the study and 95.6% chose community models of ART delivery rather than facility-based delivery when offered a choice. When asked to state their preference of model of ART delivery, 67.6% did not state a preference of one model over another, 22.8% stated a preference for HBD, 5.0% and 4.6% stated a preference for AC and SoC, respectively. Offering PLHIV choices of community models of ART delivery is feasible and acceptable with majority expressing HBD as their stated preferred option.

Stated Preference Research in Reproductive and Maternal Healthcare Services in Sub-Saharan Africa: A Systematic Review

BACKGROUND AND OBJECTIVE

Understanding the preferred choice of healthcare service attributes for women is important, particularly in sub-Saharan Africa where resources are constrained and improving reproductive and maternal healthcare services is of high importance. The aim of this systematic review was to identify attributes of reproductive and maternal healthcare services in sub-Saharan Africa, and summarise the factors shaping women's preference to access these services.

METHODS

PubMed/MEDLINE, EMBASE, PsycINFO and CINAHL were searched from the inception of each database until March 2021 for published studies reporting stated preferences for maternal and reproductive healthcare services in sub-Saharan Africa. Data were extracted using a predefined extraction sheet, and the quality of reporting of included studies was assessed using PREFS and ISPOR (International Society for Pharmacoeconomics and Outcomes Research) checklists. The Donabedian's model for quality of healthcare was used to categorise attributes into "structure", "process" and "outcome".

RESULTS

A total of 13 studies (12 discrete choice experiments and one best-worst scaling study) were included. Attributes related to the structure of healthcare services (e.g. availability of technical equipment, medications or diagnostic facilities, having good system conditions) are often included within the studies, and are considered the most important by women. Of the three dimensions of quality of healthcare, the outcome dimension was the least frequently studied across studies. All except one study explored women's preferences and the participants were pregnant women, women aged 18-49 years who had recently given birth and women living with human immunodeficiency virus. The included studies came from five sub-Saharan Africa countries of which Ethiopia and South Africa each contributed three studies. All of the included studies reported on the purpose, findings and significance of the study. However, none of the studies reported on the differences between responders vs non-responders. Nine of the 13 studies employed the ISPOR checklist and reported each item including the research question and the methods for identifying and selecting attributes, and provided the findings in sufficient detail and clarity.

CONCLUSIONS

Aligning maternal healthcare service provision with women's preferences may foster client-oriented services and thereby improve service uptake and better patient outcomes.

Quality of care experience in aged care: An Australia-Wide discrete choice experiment to elicit preference weights

The quality of aged care provided to older people is a concern for all countries globally. This study adopts a novel first-stage discrete choice experiment (DCE) and a second-stage quality rating task to empirically estimate the relative importance of six key aged care quality criteria from more than 10,000 Australian general population sample. The six attributes or characteristics (each with five levels) compose the new measure, Quality of Care Experience (QCE) in aged care that includes: 'Respect & Dignity', 'Make Own Decisions', 'Skills & Training (of staff)', 'Health & Wellbeing', 'Social Relationships', and 'Lodging Complaints'. The online survey was conducted between September and October 2019. Preference heterogeneity was evident among respondents. The latent class analysis indicates that those more experienced respondents (i.e. have a better knowledge of Australia's current aged care system or they had a close family member who was receiving aged care services) valued more towards the outcomes of the aged care services whilst the inexperienced respondents valued highly towards the process of the aged care services. A preference weighted scoring algorithm was developed for the QCE measure (on a 0-1 scale whereby 0 = lowest quality and 1 = highest quality) and the corresponding quality thresholds for 'Unacceptable/Poor', 'Satisfactory' and 'High/Very High' quality of care were reported based on the second-stage quality rating questions following each DCE task. The impact of different QCE attributes on the quality ratings was non-linear when considering movements from 'Unacceptable/Poor' to 'Satisfactory', and from 'Satisfactory' to 'High/Very High'. This study provides important insights into the general public's perceptions of the relative importance of key quality of care experience criteria in aged care.

Assessing the impact of management on sea anglers in the UK using choice experiments

Recreational sea angling is a popular activity generating significant socio-economic benefits but can impact on fish stocks. The motivations of recreational sea anglers go beyond catch, with a diverse range of motivations relating to physical health and well-being. Heterogenous motives and the popularity of catch and release practices mean that applying commercial fisheries management goals (maximum sustainable yield) to recreational fisheries could result in reduced participation, increased non-compliance, and a subsequent loss of both market and non-market values generated through recreational angling activities. Hence, assessment of sea angler preferences for management is important for the development of appropriate management strategies. In this study, a choice experiment was conducted to assess sea anglers' preferences for changes in UK sea angling management measures. Stated preferences for catching, keeping, and releasing fish due to bag limits and minimum-landing sizes were assessed. Willingness to pay (WTP) estimates for marginal changes of catching the first sea bass on a trip were between £11 and £31 depending on whether the fish could be kept or released and between £11 and £28 for cod, respectively. WTP was much higher for fish caught and kept than caught and released suggesting that consumption of fish was an important motivation. Minimum size was the most considered choice attribute for respondents, while cost was less commonly considered. The implications of the findings are discussed in the context of future management of recreational fisheries.

An economic valuation technique identified different inpatient care experience as priorities for older Canadians than a traditional approach

OBJECTIVES

To (1) estimate the relative value of older adults' healthcare experiences based on the Canadian Patient Experience Survey for Inpatient Care (CPES-IC) using an economic valuation technique, and (2) compare the results with those of a conventional key-driver analysis of healthcare experiences based on bivariate correlations.

STUDY DESIGN AND SETTING

An online survey of 1,074 Canadians aged 60 and older who had been hospitalized within five years. Participants completed the CPES-IC and a best-worst scaling (BWS) valuation task. BWS data were analyzed using a conditional logit model. These results were compared to a conventional key-driver analysis that estimates importance through Spearman's correlations between experiences and a global rating of overall experience.

RESULTS

The valuation approach found that the three experiences most valued by patients were: that staff seemed informed and up-to-date about their hospital care, doctors explained things in a way that they could understand, and that they got all the information they needed about their care and treatment. Three of the top five most valued experiences from the valuation approach were among the top five in the key driver analysis. However, there were noteworthy differences in rank order.

CONCLUSION

The results of the valuation exercise can inform local and/or system level quality improvement efforts by identifying priorities from an economic evaluation point of view, which are different than those based on a conventional key-driver analysis. Given the degree of uncertainty in estimates both the rank order and confidence intervals should be used to guide decision-making.

Will farmers seek environmental regularization in the Amazon and how? Insights from the Rural Environmental Registry (CAR) questionnaires

The future availability and quality of natural resources essential to life such as ecosystem services and biodiversity depend on the conservation and restoration of native vegetation. The Brazilian Native Vegetation Protection Law (NVPL) requires farmers to conserve a minimum percentage of native vegetation within their properties as Legal Reserves (LR) as well as riparian forests and hilltops as Permanent Preservation Areas (PPAs). To monitor the conservation and facilitate the compliance of these areas, the Rural Environmental Registry (CAR) and the Environmental Regularization Program (PRA) were created. However, so far, little is known about farmers' interest in joining the PRA and the actions they intend to take to correct their past illegal deforestation. This article explores a unique dataset comprising of the individual answers of 97 thousand farmers in the states of Pará and Mato Grosso given to the Brazilian Forest Service in the process of joining at the national rural environmental registry system. We found that the adherence to the PRA is positively correlated with recognition of the LR deficit and the size of the rural property. Also medium and large landowners and crop producers tend to seek compliance by taking actions outside the farm (compensation), while small farmers and squatters are more likely to act inside their own areas (restoration). Understanding farmers' interests and options for LR compliance can contribute for the formulation of more effective implementation strategies for PRA and NVPL.

Consumers and citizens: Identity salience in choice settings focusing on local wind turbines

We explore and illustrate the potential consequences of identity salience on stated choice valuation outcomes. The dual role of individuals as citizens and as consumers is brought to the foreground when considering investments in wind energy. To this end, we use two different settings in a stated choice experiment to elicit household preferences: one based on the decision to buy a home with particular characteristics in the neighbourhood of a wind farm and one based on the decision to support a policy to locate a wind farm in the respondent's municipality. By including a shared set of attributes to describe the wind farm in both settings, we are able to analyse the impact of identity salience on stated preferences. In the home setting, identity salience has no significant effect. In the policy setting, the consumer framing mitigates (when positive) or reinforces (when negative) the identity effect of the setting for the preferences regarding the number of wind turbines, the visibility of the wind turbines and the noise levels associated with the wind park. This finding suggests that it may be easier to shift a respondent's focus from public to private than vice versa. Our results illustrate that valuation exercises triggering a different role at the individual level will likely result in different valuation outcomes. By doing so, we issue a warning to researchers and policy makers to reflect about the objectives and set-up of valuation studies when using them for policy evaluation purposes. If the context of such a study is not adequately taken into account, potentially misleading messages and policy conclusions can emerge.

Patient preferences for osteoarthritis pain and chronic low back pain treatments in the United States: a discrete-choice experiment

OBJECTIVE

To quantify preferences for attributes of potential analgesic treatments for moderate-to-severe pain associated with osteoarthritis (OA) and/or chronic low back pain (CLBP) as relevant to injectable nerve growth factor (NGF)-inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids.

METHODS

We used a discrete-choice experiment (DCE) to elicit preferences for attributes of OA and CLBP pharmaceutical treatments, and a best-worst scaling (BWS) exercise to further characterize the relative importance of treatment-related side-effect risks. The survey was completed online by 602 US residents with self-reported chronic, moderate-to-severe OA pain and/or CLBP who had tried, had contraindications for, or were unwilling to take currently available pharmaceutical therapies. In the DCE, respondents repeatedly chose between two hypothetical treatments defined by six attributes (symptom control; treatment-related risks of (1) severe joint problems, (2) heart attack, and (3) physical dependence; mode/frequency of administration; and cost). In the BWS exercise, respondents evaluated ten side-effect risks. Random-parameters logit models were estimated; conditional relative attribute importance, maximum acceptable risks, and willingness to pay were calculated.

RESULTS

The most important DCE attributes were improving symptom control (scaled conditional relative importance, 10.00) and reducing risk of physical dependence (6.99). The three most important BWS attributes were, in rank order, risks of stroke, physical dependence, and heart attack. Respondents were willing to accept a > 4% treatment-related risk of severe joint problems for even modest symptom improvement.

CONCLUSION

A pharmaceutical treatment with a risk of severe joint problems was viewed as an acceptable alternative to other treatments with comparable efficacy but risks associated with NSAIDs or opioids.

Valuing the Cancer Mortality Risk Reduction from Lowering the Arsenic Maximum Contaminant Level in New Hampshire Municipal Water Supplies

This study uses a 2018 stated preference survey to elicit a willingness to pay (WTP) to reduce the cancer morbidity and mortality risk from arsenic exposure through drinking water. Respondents who use a public water supply are willing to pay $35.43 per month for the risk reduction associated with lowering the maximum allowable level of arsenic in drinking water from 10 to a hypothetical level of 3 ppb; households on private wells are willing to pay $29.19. Respondents from households with children were willing to pay significantly more than respondents from households without children. We derive values of a statistical life (VSL) of $4.61 million and $3.48 million per household member, respectively, in households using municipal or well water. Shortly after the initial release of these findings, New Hampshire became the second state to set a maximum allowable level for arsenic below the national limit of 10 ppb.

What are the determinants of the willingness to share rides in pooled on-demand services?

Simulation studies suggest that pooled on-demand services (also referred to as Demand Responsive Transport, ridesharing, shared ride-hailing or shared ridesourcing services) have the potential to bring large benefits to urban areas while inducing limited time losses for their users. However, in reality, the large majority of users request individual rides (and not pooled rides) in existing on-demand services, leading to increases in motorised vehicle miles travelled. In this study, we investigate to what extent fare discounts, additional travel time, and the (un)willingness to share the ride with (different numbers of) other passengers play a role in the decision of individuals to share rides. To this end, we design a stated preference study targeting Dutch urban individuals. In our research, we (1) disentangle the sharing aspect from related time-cost trade-offs (e.g. detours), (2) investigate preference heterogeneity regarding the studied attributes and identify distinct market segments, and (3) simulate scenarios to understand the impact of the obtained parameters in the breakdown between individual and pooled services. We find that less than one third of respondents have strong preferences against sharing their rides. Also, we find that different market segments vary not only in their values of the willingness to share, but also in how they perceive this willingness to share (per-ride or proportional to the in-vehicle time). Further, the scenario analysis demonstrates that the share of individuals who are willing to share rides depends primarily on the time-cost trade-offs, rather than on the disutility stemming from pooling rides per se.

Valuing inland blue space: A contingent valuation study of two large freshwater lakes

Water bodies, or blue spaces, offer a range of health and well-being benefits. Many of these benefits occur in waterside spaces and do not require direct water contact. For example, non-water based physical activity (e.g. walking and running) and reduced stress as a result of viewing water from a distance. However, research dedicated to understanding the economic impact of changes to freshwater ecosystems predominantly focuses on water-based recreation and water quality. As a result, the economic impacts of changes to waterside space are often overlooked. This study used the contingent valuation method to determine public preference for the protection of lakeside quality, in terms of lake views, path quality and lakeside access, at two large freshwater lakes in Scotland (Loch Lomond and Loch Leven). The aim of the study was to estimate willingness to pay among a sample of adults in Scotland (n = 1056) for the protection of lakeside quality. Results indicate that the majority of respondents are willing to pay for the preservation of lakeside quality at each lake. Based upon the most conservative estimates obtained, mean willingness to pay for the protection of lakeside quality was £12.06 per household per year at Loch Lomond and £8.44 at Loch Leven. These findings provide valuable economic data and suggest that changes to waterside space at destination water bodies have nationally important economic impacts. Greater consideration of the economic impact of changes to lakeside space is recommended in order to develop cost-effective and socially optimal water resource management policies at large freshwater lakes.

Evaluation of penalty and enforcement strategies to combat speeding offences among professional drivers: A Hong Kong stated preference experiment

Speeding has been a great concern around the world due to the occurrence and severity of road crashes. This paper presents an evaluation of the effectiveness of different penalty and camera-based enforcement strategies in curbing speeding offences by professional drivers in Hong Kong. A stated preference survey approach is employed to measure the association between penalty and enforcement strategies and drivers' speed choices. Data suggest that almost all drivers comply with speed limits when they reach a camera housing section of the road. For other road sections, a panel mixed logit model is estimated and applied to understand the effectiveness of penalties and enforcement strategies on driver's speeding behaviors. Driving-offence points (DOPs) are found to be more effective than monetary fines in deterring speeding offences, albeit there is significant heterogeneity in how drivers respond to these strategies. Warning drivers of an upcoming camera-based enforcement section increased speed compliance. Several demographic and employment characteristics, driving history and perception variables also influence drivers' choices of speed compliance. Finally, besides penalty and enforcement strategies, driver education and training programs aimed at addressing aggressiveness/risk-taking traits might help reduce repeated speeding offences among drivers.

Preferences for vaccination program attributes among parents of young infants in Shanghai, China

Compared to many other countries, China offers fewer pediatric vaccines. Future attempts to add mandatory vaccines may run counter to parents' preferences for shot-limiting. The aim of this study was to assess Chinese parents' preferences and willingness-to-pay (WTP) for programmatic attributes of vaccination services. Parents of young infants ≤3 months of age presenting at immunization clinics in Shanghai, China, in 2017 completed a discrete choice experiment (DCE) on vaccination program attributes: waiting time at the clinic, number of shots before 7 months, number of injections per visit, cost per visit, and location of the shot. We estimated preference utilities and WTP using logistic regression. In total, 590 completed the DCE. Caregivers expressed greater utility for less waiting time, fewer office visits, lower cost of vaccines, and fewer injections co-administered. Over the course of their child's first 6 months, parents were willing to pay 113 RMB ($17) to avoid an additional 10 minutes of waiting at each appointment (95% confidence interval [CI]: 213, 929), 474 RMB ($70) to avoid an additional office visit (95% CI: 241, 707), and 703 RMB ($104) to avoid an additional injection at each appointment (95% CI: 337, 1068). As China expands its list of publicly funded vaccines, public health officials will have to counter Chinese parents' strong preferences for limiting the total number of office visits and the number of injections administered at each visit, potentially through the use of combination vaccines.

Attitudinal dataset for mediating the effects of public acceptance on bus reform scheme in a developing country context

This paper presents a comprehensive dataset of how public perceptions and its statistical implication on the behavioral adaptation toward the acceptability of bus reform scheme proposed by the government of Aceh, Indonesia. Studies indicate that public response to such a proposed policy is significantly related to the effectiveness of its implementation. Given the absence of studies from the developing countries context, a stated preference (SP) questionnaire is developed to investigate the public's consciousness concerning bus reform acceptance. A paper-pencil based questionnaire survey performed by direct interview was conducted in late 2017 and early 2018. The questionnaires were distributed with a total of 450 questionnaires valid. The most pertinent inquiries in our questionnaires were designated to attain (i) attitudinal indicators toward the acceptance of bus reform policy, (ii) attitudinal indicators related to perceived appropriateness of the policy, (iii) perceived awareness of problem private-mode in society, (iv) private-mode dependency, (v) inhibition of freedom of movements and (vi) correct and acceptable policy. We implemented a 4-point Likert scale such as 1 to 4 (strongly disagree to strongly agreed) in order to style the questionnaire easy to answer. A valid dataset was analyzed using Confirmatory Factor Analysis (CFA) for revealing how public perception has statistically significant explained the perceived effectiveness of the proposed bus reform policy.

Priorities when deciding on participation in early-phase gene therapy trials for Duchenne muscular dystrophy: a best-worst scaling experiment in caregivers and adult patients

PURPOSE

Several gene therapy trials for Duchenne muscular dystrophy initiated in 2018. Trial decision making is complicated by non-curative, time-limited benefits; the progressive, fatal course; and high unmet needs. Here, caregivers and patients prioritize factors influencing decision making regarding participation in early-phase gene therapy trials.

METHODS

We conducted a best-worst scaling experiment among U.S. caregivers and adults with Duchenne (N = 274). Participants completed 11 choice sets, choosing features they cared about most and least when deciding whether to participate in a hypothetical gene therapy trial. We analyzed the data using sequential conditional logistic regression.

RESULTS

Participants prioritized improved muscle function in trial decision making. Concerns about participation limiting later use of gene transfer and editing were also important, as were improved lung and heart function. Low risk of death fell near the middle. Participants cared least about muscle biopsies and potential for randomization to placebo. Adults with Duchenne and caregivers of non-ambulatory children significantly prioritized improved lung function compared to caregivers of ambulatory children.

CONCLUSION

Our data demonstrate prioritization of anticipated benefits and opportunity costs relative to potential harms and procedures in gene therapy trial decision making. Such data inform protocol development, education and advocacy efforts, and informed consent.

Stubbing out hypothetical bias: improving tobacco market predictions by combining stated and revealed preference data

In health, stated preference data from discrete choice experiments (DCEs) are commonly used to estimate discrete choice models that are then used for forecasting behavioral change, often with the goal of informing policy decisions. Data from DCEs are potentially subject to hypothetical bias. In turn, forecasts may be biased, yielding substandard evidence for policymakers. Bias can enter both through the elasticities as well as through the model constants. Simple correction approaches exist (using revealed preference data) but are seemingly not widely used in health economics. We use DCE data from an experiment on smokers in the US. Real-world data are used to calibrate the scale of utility (in two ways) and the alternative-specific constants (ASCs); several innovations for calibration are proposed. We find that embedding revealed preference data in the model makes a substantial difference to the forecasts; and that how models are calibrated also makes a substantial difference.

No Place Like Home? Disentangling Preferences for HIV Testing Locations and Services Among Men Who Have Sex with Men in China

In China, some health departments and gay community-based organizations have begun to offer home-based HIV testing kits in order to augment test uptake among men who have sex with men (MSM). However, HIV test preferences and motivations for home-testing among MSM in China are not well understood. The HIV testing preferences of 803 MSM throughout China were evaluated using single-item assessment and a discrete choice experiment (DCE). In both the single-item assessment and DCE, participants expressed strong preference for free and anonymous testing by health professionals. Both approaches also indicated that naïve testers most prefer home testing. However, among previous testers, the single-item assessment indicated that "home" was the most preferred testing location (vs. hospital or clinic), while the DCE indicated that "home" was the least preferred testing location after controlling for anonymity. HIV home-testing may have limited appeal to previously tested Chinese MSM if anonymity is not maintained.

Developing an instrument to assess patient preferences for benefits and risks of treating acute myeloid leukemia to promote patient-focused drug development

Objective Acute myeloid leukemia (AML) is a progressive blood cancer with few effective treatment options. As part of a patient-focused drug development (PFDD) initiative led by the Leukemia and Lymphoma Society (LLS), this study sought to use a community-centered approach to develop and pilot an instrument to measure patient preferences for the benefits and risks of treating AML. Methods Instrument development was informed by a literature review, engagement with expert stakeholders (n = 12), engagement with community stakeholders, and pre-testing. A discrete-choice experiment (DCE), in which participants made choices between 16 pairs of hypothetical treatments, was developed with five attributes: event-free survival, complete remission, time in hospital, short-term side-effects, and long-term side-effects. A pilot test was conducted and analyzed using conditional logistic regression. Results are presented using relative attribute importance (RAI) scores. Results Patients with AML and caregivers were engaged in developing (n = 15), pre-testing (n = 13), and pilot testing (n = 26) the instrument. The pilot included patients with AML (n = 18) and caregivers of living or deceased patients with AML (n = 8). Participants had a mean age of 50 years (range =24-81), and were mostly college educated (n = 22), privately insured (n = 21), and employed (n = 13). Based on the DCE, complete remission was identified as the most important attribute (RAI =10), followed by event-free survival (3.7), time in hospital (2.8), long-term side-effects (2.3), and short-term side-effects (2.1). Conclusion The mixed-methods approach to PFDD was welcomed by all stakeholders and there was strong endorsement to implement this DCE as part of a national survey. Key points for decision makers The Leukemia and Lymphoma Society (LLS) initiated an independent effort to promote patient-focused drug development (PFDD). This study presents the development and piloting of a preference study as a first step in this initiative. Results of this pilot study were used to guide a PFDD meeting to discuss the lived experience of patients and caregivers affected by AML. Productive engagement by all patients, caregivers, and stakeholders throughout the process resulted in strong endorsement of the project's approach and recognition of the need to conduct a national study.

Valuing the visual impact of wind farms: A calculus method for synthesizing choice experiments studies

Despite the great potential of mitigating carbon emission, development of wind farms is often opposed by local communities due to the visual impact on landscape. A growing number of studies have applied nonmarket valuation methods like Choice Experiments (CE) to value the visual impact by eliciting respondents' willingness to pay (WTP) or willingness to accept (WTA) for hypothetical wind farms through survey questions. Several meta-analyses have been found in the literature to synthesize results from different valuation studies, but they have various limitations related to the use of the prevailing multivariate meta-regression analysis. In this paper, we propose a new meta-analysis method to establish general functions for the relationships between the estimated WTP or WTA and three wind farm attributes, namely the distance to residential/coastal areas, the number of turbines and turbine height. This method involves establishing WTA or WTP functions for individual studies, fitting the average derivative functions and deriving the general integral functions of WTP or WTA against wind farm attributes. Results indicate that respondents in different studies consistently showed increasing WTP for moving wind farms to greater distances, which can be fitted by non-linear (natural logarithm) functions. However, divergent preferences for the number of turbines and turbine height were found in different studies. We argue that the new analysis method proposed in this paper is an alternative to the mainstream multivariate meta-regression analysis for synthesizing CE studies and the general integral functions of WTP or WTA against wind farm attributes are useful for future spatial modelling and benefit transfer studies. We also suggest that future multivariate meta-analyses should include non-linear components in the regression functions.

Valuing Individuals' Preferences and Health Choices of Physical Exercise

The efficacy of physical exercise for the prevention and treatment of non-specific low back pain (LBP) is well documented, but little is known about how individuals value specific components of physical exercise, such as the type and design or the intensity and frequency of exercise. Other factors that influence individual differences in health choices and adherence are associated with individuals’ attitudes toward and likelihood of performing recommended exercise regimens. Current evidence shows that efficacy is similar among exercise interventions, but their features vary widely. Thus it may be difficult for clinicians to discriminate between available options in clinical practice. Considering the many challenges in determining the form of exercise best suited to the individual patient, this commentary discusses some of the practical methods that could be used to elicit individual preference for recommended health care interventions. Such methods have the advantage of providing more information for health care decision making, particularly with regard to exercise interventions for LBP. This commentary also advocates for the use of patient preference in health care decisions.

Chinese farmers' willingness to accept compensation to practice safe disposal of HPAI infected chicken

Highly Pathogenic Avian Influenza (HPAI) is a high morbidity and mortality zoonotic disease, which threatens poultry and human health. An outbreak of disease in China requires strict slaughter and disposal of all chickens within a three-kilometer radius, incurring large private costs for farmers and encouraging black market transactions. A stated preference survey of 331 farmers across six provinces in China was conducted in 2015, in order to measure the responsiveness of farmers to accept various compensation prices for safely disposing of HPAI infected chicken. Findings suggest that about 25% and 40% of farmers in South and North China respectively would not adopt safe disposal at the current compensation price (10 yuan/bird) offered by the government. However, 80% of farmers would adopt safe disposal if the compensation price increased to 14.1 yuan in South China and 18.9 yuan in North China. The adoption of safe disposal by farmers was positively and significantly influenced by compensation price (p=0.000) and regular contact with epidemic prevention staff (p=0.094). However, adoption was negatively and significantly influenced by net farm income (p=0.100) and chicken production income percentage (p=0.014). Although half of (51%) of farmers were willing to receive zero compensation, a reasonable compensation scheme along with strengthened supervision, may be considered the most effective strategy to encourage safe disposal of HPAI infected chicken and reduce the risks associated with black market transactions.

Control of vegetable pests in Benin - Farmers' preferences for eco-friendly nets as an alternative to insecticides

We investigated if eco-friendly nets (EFNs) are a viable and acceptable alternative to extremely high levels of insecticide use in vegetable production. Using a choice experiment, we found that vegetable producing farmers in Benin preferred all of the characteristics of EFNs except the higher labor requirements. The nets had been distributed in a trial phase for free but in the long run farmers would need to purchase the EFNs. The break-even point for investing in nets was found to vary with the lifespan of EFNs, their purchase price and potential health benefits from avoiding large quantities of insecticides. To break even the nets need to be used for at least two production cycles. To overcome risk-averse farmer's reluctance to adopt EFNs we propose a credit and warranty scheme along with the purchase of the nets. The study's findings can guide the implementation of EFNs in other African countries as part of integrated pest management with global benefits for the environment and human health.

Parents' preferences for seasonal influenza vaccine for their children in Japan

In Japan, trivalent inactivated influenza vaccine is the only approved influenza vaccine. It is typically administrated by hypodermic injection, and children under 13 years of age are recommended to be vaccinated two times during each winter season. Live-attenuated influenza vaccine (LAIV) is administered by a thimerosal-free nasal spray. If LAIV is approved in the future in Japan, parents will have an alternative type of influenza vaccine for their children. This study investigated parents' preference for the type of seasonal influenza vaccine for their children if alternatives are available. The marginal willingness to pay for vaccine benefits was also evaluated. We conducted a discrete choice experiment, a quantitative approach that is often used in healthcare studies, in January 2013. Respondents were recruited from a registered online survey panel, and parents with at least one child under 13 years of age were offered questionnaires. This study showed that for seasonal influenza vaccines for their children, parents are more likely to value safety, including thimerosal-free vaccines and those with a lower risk of adverse events, instead of avoiding the momentary pain from an injection. If LAIV is released in Japan, the fact that it is thimerosal-free could be an advantage. However, for parents to choose LAIV, they would need to accept the slightly higher risk of minor adverse events from LAIV.

What determines providers' stated preference for the treatment of uncomplicated malaria?

As agents for their patients, providers often make treatment decisions on behalf of patients, and their choices can affect health outcomes. However, providers operate within a network of relationships and are agents not only for their patients, but also other health sector actors, such as their employer, the Ministry of Health, and pharmaceutical suppliers. Providers' stated preferences for the treatment of uncomplicated malaria were examined to determine what factors predict their choice of treatment in the absence of information and institutional constraints, such as the stock of medicines or the patient's ability to pay. 518 providers working at non-profit health facilities and for-profit pharmacies and drug stores in Yaoundé and Bamenda in Cameroon and in Enugu State in Nigeria were surveyed between July and December 2009 to elicit the antimalarial they prefer to supply for uncomplicated malaria. Multilevel modelling was used to determine the effect of financial and non-financial incentives on their preference, while controlling for information and institutional constraints, and accounting for the clustering of providers within facilities and geographic areas. 69% of providers stated a preference for artemisinin-combination therapy (ACT), which is the recommended treatment for uncomplicated malaria in Cameroon and Nigeria. A preference for ACT was significantly associated with working at a for-profit facility, reporting that patients prefer ACT, and working at facilities that obtain antimalarials from drug company representatives. Preferences were similar among colleagues within a facility, and among providers working in the same locality. Knowing the government recommends ACT was a significant predictor, though having access to clinical guidelines was not sufficient. Providers are agents serving multiple principals and their preferences over alternative antimalarials were influenced by patients, drug company representatives, and other providers working at the same facility and in the local area. Efforts to disseminate drug policy should target the full range of actors involved in supplying drugs, including providers, employers, suppliers and local communities.

Estimating a WTP-based value of a QALY: the 'chained' approach

A major issue in health economic evaluation is that of the value to place on a quality adjusted life year (QALY), commonly used as a measure of health care effectiveness across Europe. This critical policy issue is reflected in the growing interest across Europe in development of more sound methods to elicit such a value. EuroVaQ was a collaboration of researchers from 9 European countries, the main aim being to develop more robust methods to determine the monetary value of a QALY based on surveys of the general public. The 'chained' approach of deriving a societal willingness-to-pay (WTP) based monetary value of a QALY used the following basic procedure. First, utility values were elicited for health states using the standard gamble (SG) and time trade off (TTO) methods. Second, a monetary value to avoid some risk/duration of that health state was elicited and the implied WTP per QALY estimated. We developed within EuroVaQ an adaptation to the 'chained approach' that attempts to overcome problems documented previously (in particular the tendency to arrive at exceedingly high WTP per QALY values). The survey was administered via Internet panels in each participating country and almost 22,000 responses achieved. Estimates of the value of a QALY varied across question and were, if anything, on the low side with the (trimmed) 'all country' mean WTP per QALY ranging from $18,247 to $34,097. Untrimmed means were considerably higher and medians considerably lower in each case. We conclude that the adaptation to the chained approach described here is a potentially useful technique for estimating WTP per QALY. A number of methodological challenges do still exist, however, and there is scope for further refinement.