Background
Web-based surveys are increasingly utilized for health valuation studies but may be more prone to lack of engagement and, therefore, poor data validity. The objective of this study was to ...evaluate the effect of imposed engagement (i.e., at least three trade-offs) in the composite time trade-off (cTTO) task.
Methods
The EQ-5D-5L valuation study protocol and study design were adapted for online, unsupervised completion in two arms: base case and engagement. Validity of preferences was assessed using the prevalence of inconsistent valuations and expected patterns of TTO values. Respondent task engagement was measured using time per task. Value sets were generated using linear regression with a random intercept (RILR).
Results
The base case (
n
= 501) and engagement arms (
n
= 504) clustered at different TTO values: base case 0, 1; engagement -0.5, 0.45, 0.6. Mean TTO values were lower for the engagement arm. Engagement respondents did not spend more time per TTO task: base case 63.3 s (SD 77.9 s); engagement 64.7 s (SD 73.3 s);
p
= 0.36. No significant difference was found between arms for prevalence of respondents with at least one inconsistent TTO value: base case 61.1%; engagement 63.5%;
p
= 0.43. Both value sets had significant intercepts far from 1: base case 0.846; engagement 0.783. The relative importance of the EQ-5D dimensions also differed between arms.
Conclusions
Both online arms had poor quality data. A minimum trade-off threshold did not improve engagement nor face validity of the data, indicating that modifications to the number of iterations are insufficient alone to improve data quality/validity of online TTO studies.
To achieve the UNAIDS target of diagnosing 95% of all persons living with HIV, enhanced HIV testing services with greater attractional value need to be developed and implemented. We conducted a ...discrete choice experiment (DCE) to quantify preferences for enhanced HIV testing features across two high-risk populations in the Kilimanjaro Region in northern Tanzania. We designed and fielded a survey with 12 choice tasks to systematically recruited female barworkers and male mountain porters. Key enhanced features included: testing availability on every day of the week, an oral test, integration of a general health check or an examination for sexually transmitted infections (STI) with HIV testing, and provider-assisted confidential partner notification in the event of a positive HIV test result. Across 300 barworkers and 440 porters surveyed, mixed logit analyses of 17,760 choices indicated strong preferences for everyday testing availability, health checks, and STI examinations. Most participants were averse to oral testing and confidential partner notification by providers. Substantial preference heterogeneity was observed within each risk group. Enhancing HIV testing services to include options for everyday testing, general health checks, and STI examinations may increase the appeal of HIV testing offers to high-risk populations.
Trial registration:
ClinicalTrials.gov identifier: NCT02714140.
Schizophrenia is a severe mental illness associated with hallucinations, delusions, apathy, poor social functioning, and impaired cognition. Researchers and funders have been hesitant to focus ...efforts on treatment preferences of patients with schizophrenia because of the perceived cognitive burden that research methods, such as conjoint analysis, place on them.
The objective of this study was to test if patients diagnosed with schizophrenia were able to complete a choice-based conjoint analysis (often referred to as discrete-choice experiments) and to test if meaningful trade-offs were being made.
German outpatients diagnosed with schizophrenia were eligible to participate in this study if they were aged 18-65 years, had received treatment for at least 1 year and were not experiencing acute symptoms. Conjoint analysis tasks were based on six attributes, each with two levels, which were identified via a literature review and focus groups. A psychologist in a professional interview facility presented each respondent with the eight tasks with little explanation. All interviews were recorded, transcribed, and analyzed to verify that respondents understood the tasks. Preferences were assessed using logistic regression, with a correction for clustering.
We found evidence that the 21 patients diagnosed with schizophrenia participating in the study could complete conjoint analysis tasks in a meaningful way. Patients not only related to the scenarios presented in conjoint tasks, but explicitly stated that they used their own preferences to judge which scenarios were better. Statistical analysis confirmed all hypotheses about the attributes (i.e. all attributes had the expected sign). Having a supportive physician, not feeling slowed, and improvements in stressful situations (p < 0.01) were the most important attributes.
We found that patients diagnosed with schizophrenia can complete conjoint analysis tasks, that they base their decisions on their own preferences, and that patients make trade-offs between attributes.
Strokes pose a particular challenge to the health care system. Although stroke-related mortality has declined in recent decades, the absolute number of new strokes (incidence), stroke deaths, and ...survivors of stroke has increased. With the increasing need of neurorehabilitation and the decreasing number of professionals, innovations are needed to ensure adequate care. Digital technologies are increasingly used to meet patients' unfilled needs during their patient journey. Patients must adhere to unfamiliar digital technologies to engage in health interventions. Therefore, the acceptance of the benefits and burdens of digital technologies in health interventions is a key factor in implementing these innovations.
This study aims to describe the development of a discrete choice experiment (DCE) to weigh criteria that impact patient and public acceptance. Secondary study objectives are a benefit-burden assessment (estimation of the maximum acceptable burden of technical features and therapy-related characteristics for the patient or individual, eg, no human contact), overall comparison (assessment of the relative importance of attributes for comparing digital technologies), and adherence (identification of key attributes that influence patient adherence). The exploratory objectives include heterogeneity assessment and subgroup analysis. The methodological aims are to investigate the use of DCE.
To obtain information on the criteria impacting acceptance, a DCE will be conducted including 7 attributes based on formative qualitative research. Patients with stroke (experimental group) and the general population (control group) are surveyed. The final instrument includes 6 best-best choice tasks in partial design. The experimental design is a fractional-factorial efficient Bayesian design (D-error). A conditional logit regression model and mixed logistic regression models will be used for analysis. To consider the heterogeneity of subgroups, a latent class analysis and an analysis of heteroscedasticity will be performed.
The literature review, qualitative preliminary study, survey development, and pretesting were completed. Data collection and analysis will be completed in the last quarter of 2023.
Our results will inform decision makers about patients' and publics' acceptance of digital technologies used in innovative interventions. The patient preference information will improve decisions regarding the development, adoption, and pricing of innovative interventions. The behavioral changes in the choice of digital intervention alternatives are observable and can therefore be statistically analyzed. They can be translated into preferences, which define the value. This study will investigate the influences on the acceptance of digital interventions and thus support decisions and future research.
DERR1-10.2196/46056.
Neuroendocrine tumors (NETs) are rare, slow-growing malignant tumors. So far, there are no data on patient preferences regarding its therapy. This empirical study aimed to elicit patient preferences ...in the drug treatment of NET.
Based on qualitative patient interviews and an analytic hierarchy process, six patient-relevant attributes were analyzed and weighted using a discrete-choice experiment. Patients were recruited with the help of a NET support group. An experimental 3*3 + 6*3 -MNL design was created using NGene. The design consisted of eighty-four choices, divided into seven blocks. Participants were randomly assigned to these blocks. The analysis included random parameter logit and latent class models.
A total of 275 participants (51.6 percent female; mean age, 58.4 years) were included. The preference analysis within the random parameter logit model, taking into account the 95 percent confidence interval, showed predominance for the attribute "overall survival." The attributes "response to treatment" and "stabilization of tumor growth" followed. The side effects "nausea/vomiting" and "diarrhea" were considered of relatively equal importance. Latent class analysis of possible subgroup differences revealed three preference patterns.
Preferences can influence therapeutic decisions. Preference analyses indicated that "overall survival" had the strongest influence, with participants clearly weighing outcome attributes higher than side effect attributes. In conclusion, mono-criterial decisions would not fully reflect patient perspectives.
Patient centricity will initiate a change in healthcare decision-making paradigms. Patient-centered outcomes are a part of the solution to the challenges posed by complex decision problems due to ...multiple clinical and non-clinical outcomes. Multiple decision criteria require that clinical and regulatory decisions be based on the implicit value judgments of experts. Experts are under continuous pressure to ensure decisions are aligned with patient needs and result in positive performance. To fulfill this role and guarantee efficient decisions, experts must be fully informed about patient preferences; however, this assumption might not necessarily reflect reality. Health technology assessment focuses on the measurement of clinical effects, rather than the assessment of the impact of different outcomes on users' perceived value. Further evidence is needed to ensure that expert judgments are congruent with patient preferences. Therefore, patient preferences can be a valuable source of information to inform clinical and regulatory decision-makers.
For optimal solutions in health care, decision makers inevitably must evaluate trade-offs, which call for multiattribute valuation methods. Researchers have proposed using best-worst scaling (BWS) ...methods which seek to extract information from respondents by asking them to identify the best and worst items in each choice set. While a companion paper describes the different types of BWS, application and their advantages and downsides, this contribution expounds their relationships with microeconomic theory, which also have implications for statistical inference. This article devotes to the microeconomic foundations of preference measurement, also addressing issues such as scale invariance and scale heterogeneity. Furthermore the paper discusses the basics of preference measurement using rating, ranking and stated choice data in the light of the findings of the preceding section. Moreover the paper gives an introduction to the use of stated choice data and juxtaposes BWS with the microeconomic foundations.
Abstract Background There has been tremendous progress regarding treatment options for hepatitis C virus (HCV) infection. Several interferon-free regimens are awaiting regulatory approval. These ...innovations promise substantial reductions in the burden of disease and side effects as well as a decrease in treatment duration. Objectives The aim of this quantitaitive study was to elicit patient preferences for attributes of innovative antiviral therapies for hepatitis C. Methods A systematic literature search and 14 semi-structured interviews were performed, resulting in eight patient-relevant characteristics. For the discrete choice experiment, an experimental design (3×3 + 5×6) was generated using Ngene software. The survey was conducted in August 2014 through computer-assisted personal interviews. The data were effects-coded in a random parameter logit estimation. Results Participants were patients with HCV (N = 561; 58.1% men) in different treatment states. The analysis revealed a predominance of the attribute “reaching sustained virological response.” When considering confidence intervals, the results showed three different preference ranks. At first place was “sustained virological response” (level difference LD 3.98), second was “anemia” (LD 1.10), followed by “number of interferon injections” (LD 0.92), “rash” (LD 0.82), “nausea and/or diarrhea” (LD 0.79), and “duration of antiviral therapy” (LD 0.78). The last position was occupied by both “tiredness/fatigue” (LD 0.31) and “headache” (LD 0.34). Conclusions From the patients’ point of view, sustained virological response is the most essential criterion for choosing an HCV therapy. It was ranked at the highest, dominating all side effects and modes of administration. Furthermore, this study proved that patients consider both the probability of occurrence and the severity of treatment-induced side effects. Results clearly point to valuation of probabilities that is separate from that of severity.
Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The objective of this review was to ...obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed.
A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines.
In general, several distinctions can be made: in terms of risk horizons, in terms of risk factors or in terms of the combination of indicators included. Within these, another differentiation by three levels seems reasonable: methods based on mortality risks, methods based on morbidity risks as well as those based on information on (self-reported) health status.
After the final examination of different methods of risk adjustment it was shown that the methodology used to adjust risks varies. The models differ greatly in terms of their included morbidity indicators. The findings of this review can be used in the evaluation of integrated healthcare delivery systems and can be integrated into quality- and patient-oriented reimbursement of care providers in the design of healthcare contracts.
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