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‣ A valuation of patients` willingness-to-pay for insulin delivery in diabetes

GUIMARAES, Camila; MARRA, Carlo A.; COLLEY, Lindsey; GILL, Sabrina; SIMPSON, Scot H.; MENEILLY, Graydon S.; QUEIROZ, Regina H. C.; LYND, Larry D.
Fonte: CAMBRIDGE UNIV PRESS Publicador: CAMBRIDGE UNIV PRESS
Tipo: Artigo de Revista Científica
Português
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Objectives: The aim of this study was to determine the insulin-delivery system and the attributes of insulin therapy that best meet patients` preferences, and to estimate patients` willingness-to-pay (WTP) for them. Methods: This was a cross-sectional discrete choice experiment (DCE) study involving 378 Canadian patients with type 1 or type 2 diabetes. Patients were asked to choose between two hypothetical insulin treatment options made up of different combinations of the attribute levels. Regression coefficients derived using conditional logit models were used to calculate patients` WTP. Stratification of the sample was performed to evaluate WTP by predefined subgroups. Results: A total of 274 patients successfully completed the survey. Overall, patients were willing to pay the most for better blood glucose control followed by weight gain. Surprisingly, route of insulin administration was the least important attribute overall. Segmented models indicated that insulin naive diabetics were willing to pay significantly more for both oral and inhaled short-acting insulin compared with insulin users. Surprisingly, type 1 diabetics were willing to pay $C11.53 for subcutaneous short-acting insulin, while type 2 diabetics were willing to pay $C47.23 to avoid subcutaneous short-acting insulin (p < .05). These findings support the hypothesis of a psychological barrier to initiating insulin therapy...

‣ Avaliação das preferencias dos pacientes por atributos de risco/benefício do tratamento insulínico no diabetes: um modelo de escolha discreta; Patients preferences for risk/benefit attributes of insulin therapy in diabetes: a discrete choice experiment.

Guimarães, Camila
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 22/05/2009 Português
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Utilizou-se um modelo de escolha discreta (MED) para avaliar as preferências e disposição-a-pagar (DAP) dos pacientes por diferentes atributos de risco-benefício do tratamento insulínico, entre eles a via de administração da insulina. Através de uma revisão da literatura, consulta com especialistas, e do desenvolvimento de um estudo qualitativo utilizando as técnicas de entrevistas individuais e grupos focais, os atributos (e níveis) mais importantes do tratamento insulínico foram identificados, sob o ponto de vista dos pacientes. Os atributos incluídos no MED foram: controle da glicemia de jejum, número de episódios de hipoglicemia, ganho de peso, via de administração para as insulinas de ação longa e rápida, e custo do tratamento. Pares de opções de tratamentos insulínicos hipotéticos contendo diferentes níveis dos atributos foram apresentados aos pacientes com DM1 ou DM2, e lhes foi solicitado que, para cada cenário, eles escolhessem a alternativa de sua preferência. Dados demográficos, nível sócio-econômico (NSE) e informações relacionadas ao diabetes também foram coletados. Para a análise dos dados utilizou-se um modelo logit condicional de regressão e modelos segmentados foram posteriormente utilizados para a análise das sub-populações. Um total de 274 questionários foram incluídos na análise final dos dados. A idade média (± DP) dos participantes foi de 56.7 ± 12.98 anos...

‣ What Patients Want From Primary Care Consultations: A Discrete Choice Experiment to Identify Patients’ Priorities

Cheraghi-Sohi, Sudeh; Hole, Arne Risa; Mead, Nicola; McDonald, Ruth; Whalley, Diane; Bower, Peter; Roland, Martin
Fonte: American Academy of Family Physicians Publicador: American Academy of Family Physicians
Tipo: Artigo de Revista Científica
Publicado em /03/2008 Português
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PURPOSE The consultation is fundamental to the delivery of primary care, but different ways of organizing consultations may lead to different patient experiences in terms of access, continuity, technical quality of care, and communication. Patients’ priorities for these different issues need to be understood, but the optimal methods for assessing priorities are unclear. This study used a discrete choice experiment to assess patients’ priorities.

‣ The Effect of Perceived Risks on the Demand for Vaccination: Results from a Discrete Choice Experiment

Sadique, Md Z.; Devlin, Nancy; Edmunds, William J.; Parkin, David
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Publicado em 08/02/2013 Português
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The demand for vaccination against infectious diseases involves a choice between vaccinating and not vaccinating, in which there is a trade-off between the benefits and costs of each option. The aim of this paper is to investigate these trade-offs and to estimate how the perceived prevalence and severity of both the disease against which the vaccine is given and any vaccine associated adverse events (VAAE) might affect demand. A Discrete Choice Experiment (DCE) was used to elicit stated preferences from a representative sample of 369 UK mothers of children below 5 years of age, for three hypothetical vaccines. Cost was included as an attribute, which enabled estimation of the willingness to pay for different vaccines having differing levels of the probability of occurrence and severity of both the infection and VAAE. The results suggest that the severity of the health effects associated with both the diseases and VAAEs exert an important influence on the demand for vaccination, whereas the probability of these events occurring was not a significant predictor. This has important implications for public health policy, which has tended to focus on the probability of these health effects as the main influence on decision making. Our results also suggest that anticipated regrets about the consequences of making the wrong decision also exert an influence on demand.

‣ Rural Clinician Scarcity and Job Preferences of Doctors and Nurses in India: A Discrete Choice Experiment

Rao, Krishna D.; Ryan, Mandy; Shroff, Zubin; Vujicic, Marko; Ramani, Sudha; Berman, Peter
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Publicado em 20/12/2013 Português
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The scarcity of rural doctors has undermined the ability of health systems in low and middle-income countries like India to provide quality services to rural populations. This study examines job preferences of doctors and nurses to inform what works in terms of rural recruitment strategies. Job acceptance of different strategies was compared to identify policy options for increasing the availability of clinical providers in rural areas. In 2010 a Discrete Choice Experiment was conducted in India. The study sample included final year medical and nursing students, and in-service doctors and nurses serving at Primary Health Centers. Eight job attributes were identified and a D-efficient fractional factorial design was used to construct pairs of job choices. Respondent acceptance of job choices was analyzed using multi-level logistic regression. Location mattered; jobs in areas offering urban amenities had a high likelihood of being accepted. Higher salary had small effect on doctor, but large effect on nurse, acceptance of rural jobs. At five times current salary levels, 13% (31%) of medical students (doctors) were willing to accept rural jobs. At half this level, 61% (52%) of nursing students (nurses) accepted a rural job. The strategy of reserving seats for specialist training in exchange for rural service had a large effect on job acceptance among doctors...

‣ Preferences for Working in Rural Clinics among Trainee Health Professionals in Uganda: A Discrete Choice Experiment

Jaskiewicz, Wanda; Wurts, Laura; Kruk, Margaret E; Mgomella, George S; Ntalazi, Francis; Tulenko, Kate; Rockers, Peter C
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
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Background: Health facilities require teams of health workers with complementary skills and responsibilities to efficiently provide quality care. In low-income countries, failure to attract and retain health workers in rural areas reduces population access to health services and undermines facility performance, resulting in poor health outcomes. It is important that governments consider health worker preferences in crafting policies to address attraction and retention in underserved areas. Methods We investigated preferences for job characteristics among final year medical, nursing, pharmacy, and laboratory students at select universities in Uganda. Participants were administered a cadre-specific discrete choice experiment that elicited preferences for attributes of potential job postings they were likely to pursue after graduation. Job attributes included salary, facility quality, housing, length of commitment, manager support, training tuition, and dual practice opportunities. Mixed logit models were used to estimate stated preferences for these attributes. Results: Data were collected from 246 medical students, 132 nursing students, 50 pharmacy students and 57 laboratory students. For all student-groups, choice of job posting was strongly influenced by salary...

‣ Health Worker Preferences for Community-Based Health Insurance Payment Mechanisms: A Discrete Choice Experiment

Robyn, Paul Jacob; Souares, Aurélia; Savadogo, Germain; Bicaba, Brice; Sié, Ali; Sauerborn, Rainer; Baernighausen, Till Winfried
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
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Background: In 2004, a community-based health insurance scheme (CBI) was introduced in Nouna health district, Burkina Faso. Since its inception, coverage has remained low and dropout rates high. One important reason for low coverage and high dropout is that health workers do not support the CBI scheme because they are dissatisfied with the provider payment mechanism of the CBI. Methods: A discrete choice experiment (DCE) was used to examine CBI provider payment attributes that influence health workers’ stated preferences for payment mechanisms. The DCE was conducted among 176 health workers employed at one of the 34 primary care facilities or the district hospital in Nouna health district. Conditional logit models with main effects and interactions terms were used for analysis. Results: Reimbursement of service fees (adjusted odds ratio (aOR) 1.49, p < 0.001) and CBI contributions for medical supplies and equipment (aOR 1.47, p < 0.001) had the strongest effect on whether the health workers chose a given provider payment mechanism. The odds of selecting a payment mechanism decreased significantly if the mechanism included (i) results-based financing (RBF) payments made through the local health management team (instead of directly to the health workers (aOR 0.86...

‣ Differences in preferences for rural job postings between nursing students and practicing nurses: evidence from a discrete choice experiment in Lao People’s Democratic Republic

Rockers, Peter C; Jaskiewicz, Wanda; Kruk, Margaret E; Phathammavong, Outavong; Vangkonevilay, Phouthone; Paphassarang, Chanthakhath; Phachanh, Inpong Thong; Wurts, Laura; Tulenko, Kate
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Português
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Background: A discrete choice experiment was conducted to investigate preferences for job characteristics among nursing students and practicing nurses to determine how these groups vary in their respective preferences and to understand whether differing policies may be appropriate for each group. Methods: Participating students and workers were administered a discrete choice experiment that elicited preferences for attributes of potential job postings. Job attributes included salary, duration of service until promotion to permanent staff, duration of service until qualified for further study and scholarship, housing provision, transportation provision, and performance-based financial rewards. Mixed logit models were fit to the data to estimate stated preferences and willingness to pay for attributes. Finally, an interaction model was fit to formally investigate differences in preferences between nursing students and practicing nurses. Results: Data were collected from 256 nursing students and 249 practicing nurses. For both groups, choice of job posting was strongly influenced by salary and direct promotion to permanent staff. As compared to nursing students, practicing nurses had significantly lower preference for housing allowance and housing provision as well as lower preference for provision of transportation for work and personal use. Conclusions: In the Lao People’s Democratic Republic...

‣ Genomic testing to determine drug response: measuring preferences of the public and patients using Discrete Choice Experiment (DCE)

Najafzadeh, Mehdi; Johnston, Karissa M; Peacock, Stuart J; Connors, Joseph M; Marra, Marco A; Lynd, Larry D; Marra, Carlo A
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Português
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Background: The extent to which a genomic test will be used in practice is affected by factors such as ability of the test to correctly predict response to treatment (i.e. sensitivity and specificity of the test), invasiveness of the testing procedure, test cost, and the probability and severity of side effects associated with treatment. Methods: Using discrete choice experimentation (DCE), we elicited preferences of the public (Sample 1, N = 533 and Sample 2, N = 525) and cancer patients (Sample 3, N = 38) for different attributes of a hypothetical genomic test for guiding cancer treatment. Samples 1 and 3 considered the test/treatment in the context of an aggressive curable cancer (scenario A) while the scenario for sample 2 was based on a non-aggressive incurable cancer (scenario B). Results: In aggressive curable cancer (scenario A), everything else being equal, the odds ratio (OR) of choosing a test with 95% sensitivity was 1.41 (versus a test with 50% sensitivity) and willingness to pay (WTP) was $1331, on average, for this amount of improvement in test sensitivity. In this scenario, the OR of choosing a test with 95% specificity was 1.24 times that of a test with 50% specificity (WTP = $827). In non-aggressive incurable cancer (scenario B)...

‣ Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women

Larson, Elysia; Vail, Daniel; Mbaruku, Godfrey M.; Kimweri, Angela; Freedman, Lynn P.; Kruk, Margaret E.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Português
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Objective: In order to develop patient-centered care we need to know what patients want and how changing socio-demographic factors shape their preferences. Methods: We fielded a structured questionnaire that included a discrete choice experiment to investigate women’s preferences for place of delivery care in four rural districts of Pwani Region, Tanzania. The discrete choice experiment consisted of six attributes: kind treatment by the health worker, health worker medical knowledge, modern equipment and medicines, facility privacy, facility cleanliness, and cost of visit. Each woman received eight choice questions. The influence of potential supply- and demand- side factors on patient preferences was evaluated using mixed logit models. Results: 3,003 women participated in the discrete choice experiment (93% response rate) completing 23,947 choice tasks. The greatest predictor of health facility preference was kind treatment by doctor (β = 1.13, p<0.001), followed by having a doctor with excellent medical knowledge (β = 0.89 p<0.001) and modern medical equipment and drugs (β = 0.66 p<0.001). Preferences for all attributes except kindness and cost were changed with changes to education, primiparity, media exposure and distance to nearest hospital. Conclusions: Care quality...

‣ A comparison of responses to single and repeated discrete choice questions

McNair, Benjamin; Bennett, Jeff; Hensher, David
Fonte: Environmental Management and Development Programme, Crawford School of Economics and Government, The Australian National University; http://www.crawford.anu.edu.au Publicador: Environmental Management and Development Programme, Crawford School of Economics and Government, The Australian National University; http://www.crawford.anu.edu.au
Tipo: Other; Working/Technical Paper Formato: 39 pages
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According to neoclassical economic theory, a stated preference elicitation format comprising a single binary choice between the status quo and one alternative is incentive compatible under certain conditions. Formats typically used in choice experiments comprising a sequence of discrete choice questions do not hold this property. In this paper, the effect on stated preferences of expanding the number of binary choice tasks per respondent from one to four is tested using a split sample treatment in an attribute-based survey relating to the undergrounding of overhead electricity and telecommunications wires. We find evidence to suggest that presenting multiple choice tasks per respondent decreases estimates of expected willingness to pay. Preferences stated in the first of a sequence of choice tasks are not significantly different from those stated in the incentive compatible single binary choice task, but, in subsequent choice tasks, responses are influenced by cost levels observed in past questions. Three behavioural explanations can be advanced – weak strategic misrepresentation, reference point revision and cost-driven value learning. The evidence is contrary to the standard assumption of truthful response with stable preferences.

‣ Modelling heterogeneity in response behaviour towards a sequence of discrete choice questions: a latent class approach

McNair, Benjamin; Hensher, David; Bennett, Jeff
Fonte: Environmental Management and Development Programme, Crawford School of Economics and Government, The Australian National University; http://www.crawford.anu.edu.au Publicador: Environmental Management and Development Programme, Crawford School of Economics and Government, The Australian National University; http://www.crawford.anu.edu.au
Tipo: Other; Working/Technical Paper Formato: 31 pages
Português
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There is a growing body of evidence in the non-market valuation literature suggesting that responses to a sequence of discrete choice questions tend to violate the assumptions typically made by analysts regarding independence of responses and stability of preferences. Heuristics such as value learning and strategic misrepresentation have been offered as explanations for these results. While a few studies have tested these heuristics as competing hypotheses, none have investigated the possibility that each explains the response behaviour of a subgroup of the population. In this paper, we make a contribution towards addressing this research gap by presenting an equality-constrained latent class model designed to estimate the proportion of respondents employing each of the proposed heuristics. We demonstrate the model on binary and multinomial choice data sources and find three distinct types of response behaviour. The results suggest that accounting for heterogeneity in response behaviour may be a better way forward than attempting to identify a single heuristic to explain the behaviour of all respondents.

‣ What sort of follow-up services would Australian breast cancer survivors prefer if we could no longer offer long-term specialist-based care? A discrete choice experiment

Bessen, T.; Chen, G.; Street, J.; Eliott, J.; Karnon, J.; Keefe, D.; Ratcliffe, J.
Fonte: Cancer Research UK Publicador: Cancer Research UK
Tipo: Artigo de Revista Científica
Publicado em //2014 Português
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Background: Early diagnosis and improved treatment outcomes have increased breast cancer survival rates that, in turn, have led to increased numbers of women undergoing follow-up after completion of primary treatment. The current workload growth is unsustainable for breast cancer specialists who also provide care for women newly diagnosed or with a recurrence. Appropriate and acceptable follow-up care is important; yet, currently we know little about patient preferences. The aim of this study was to explore the preferences of Australian breast cancer survivors for alternative modes of delivery of follow-up services. Methods: A self-administered questionnaire (online or paper) was developed. The questionnaire contained a discrete choice experiment (DCE) designed to explore patient preferences with respect to provider, location, frequency and method of delivery of routine follow-up care in years 3, 4 and 5 after diagnosis, as well as the perceived value of ‘drop-in’ clinics providing additional support. Participants were recruited throughout Australia over a 6-month period from May to October 2012. Preference scores and choice probabilities were used to rank the top 10 most preferred follow-up scenarios for respondents. Results: A total of 836 women participated in the study...

‣ Preferences for CT colonography and colonoscopy as diagnostic tests for colorectal cancer: A discrete choice experiment

Howard, K.; Salkeld, G.; Pignone, M.; Hewett, P.; Cheung, P.; Olsen, J.; Clapton, W.; Roberts-Thomson, I.
Fonte: Wiley-Blackwell Publishing, Inc. Publicador: Wiley-Blackwell Publishing, Inc.
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
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OBJECTIVE: Computed tomography colonography (CTC) is an alternative diagnostic test to colonoscopy for colorectal cancer and polyps. The aim of this study was to determine test characteristics important to patients and to examine trade-offs in attributes that patients are willing to accept in the context of the diagnosis of colorectal cancer. METHODS: A discrete choice study was used to assess preferences of patients with clinical indications suspicious of colorectal cancer who experienced both CTC and colonoscopy as part of a diagnostic accuracy study in South Australia. Results were analyzed by using a mixed logit model and presented as odds ratios (ORs) for preferring CTC over colonoscopy. RESULTS: Colonoscopy was preferred over CTC as the need for a second procedure after CTC increased (OR of preferring CTC to colonoscopy = 0.013), as the likelihood of missing cancers or polyps increased (OR of preferring CTC to colonoscopy = 0.62), and as CTC test cost increased (OR of preferring CTC to colonoscopy = 0.65-0.80). CTC would be preferred to colonoscopy if a minimal bowel preparation was available (OR = 1.7). Some patients were prepared to trade off the diagnostic and therapeutic advantage of colonoscopy for a CTC study with a less intensive bowel preparation. Preferences also varied significantly with sociodemographic characteristics. CONCLUSIONS: Despite CTC's often being perceived as a preferred test...

‣ How to Attract Health Workers to Rural Areas? Findings from a Discrete Choice Experiment from India

Rao, Krishna D.; Shroff, Zubin; Ramani, Sudha; Khandpur, Neha; Murthy, Seema; Hazarika, Indrajit; Choksi, Maulik; Ryan, Mandy; Berman, Berman; Vujicic, Marko
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
Português
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India faces significant challenges in attracting qualified health workers to rural areas. In 2010 the authors conducted a Discrete Choice Experiment (DCE) in the Indian states of Uttarakhand and Andhra Pradesh to understand what health departments in India could do to make rural service more attractive for doctors and nurses. Specifically, we wanted to do the following: (a) examine the effect of monetary and nonmonetary job attributes on health worker job choices; and (b) develop incentive 'packages' with a focus on jobs in rural areas. The study sample included medical students, nursing students, in-service doctors and nurses at primary health centers. An initial qualitative study identified eight job attributes health center type, area, health facility infrastructure, staff and workload, salary, guaranteed transfer to city or town after some years of service, professional development, and job in native area. Respondents were required to choose between a series of hypothetical job pairs that were characterized by different attribute-level combinations. Bivariate probit and mixed logit regression was used for the statistical analysis of the choice responses. The findings suggest that the supply of medical graduates for rural jobs remained inelastic in the presence of individual monetary and nonmonetary incentives. In contrast...

‣ Méthode pour l’établissement d’une liste de médicaments remboursables dans le cadre du nouveau programme d’assurance-médicaments en Côte d’Ivoire

Diaby, Vakaramoko
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
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Contexte général La Côte d'Ivoire est un pays de l’Afrique de l’Ouest qui a décidé, depuis 2001, d'étendre la couverture des prestations de santé à toute sa population. En effet, cette réforme du système de santé avait pour but de fournir, à chaque ivoirien, une couverture médicale et pharmaceutique. Toutefois, la mise en œuvre de cette réforme était difficile car, contrairement aux pays développés, les pays en développement ont un secteur « informel » échappant à la législation du travail et occupant une place importante. En conséquence, il a été recommandé qu’il y ait deux caisses d'assurance santé, une pour le secteur formel (fonctionnaires) et l'autre pour le secteur informel. Ces caisses auraient légitimité en ce qui a trait aux décisions de remboursement de médicaments. D’ores-et-déjà, il existe une mutuelle de santé appelée la Mutuelle Générale des Fonctionnaires et Agents de l'État de Côte d'Ivoire (MUGEFCI), chargée de couvrir les frais médicaux et pharmaceutiques des fonctionnaires et agents de l’Etat. Celle-ci connaît, depuis quelques années, des contraintes budgétaires. De plus, le processus actuel de remboursement des médicaments, dans cette organisation, ne prend pas en considération les valeurs implicites liées aux critères d'inscription au formulaire. Pour toutes ces raisons...

‣ Developing Attributes and Attribute-Levels for a Discrete Choice Experiment on Micro Health Insurance in Rural Malawi

Abiiro, Gilbert Abotisem; Leppert, Gerald; Bongololo Mbera, Grace; Robyn, Paul J.; De Allegri, Manuela
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Journal Article; Publications & Research :: Journal Article; Publications & Research
Português
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Discrete choice experiments (DCEs) are attribute-driven experimental techniques used to elicit stakeholders’ preferences to support the design and implementation of policy interventions. The validity of a DCE, therefore, depends on the appropriate specification of the attributes and their levels. There have been recent calls for greater rigor in implementing and reporting on the processes of developing attributes and attribute-levels for discrete choice experiments (DCEs). This paper responds to such calls by carefully reporting a systematic process of developing micro health insurance attributes and attribute-levels for the design of a DCE in rural Malawi.

‣ What determines patient preferences for treating low risk basal cell carcinoma when comparing surgery vs imiquimod?: a discrete choice experiment survey from the SINS trial

Tinelli, Michela; Ozolins, Mara; Bath-Hextall, Fiona; Williams, Hywel C
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em 04/10/2012 Português
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Background The SINS trial (Controlled Clinical Trials ISRCTN48755084; Eudract No. 2004-004506-24) is a randomised controlled trial evaluating long term success of excisional surgery vs. imiquimod 5% cream for low risk nodular and superficial basal cell carcinoma (BCC). The trial included a discrete choice experiment questionnaire to explore patient preferences of a cream versus surgery for the treatment of their skin cancer. Methods The self-completed questionnaire was administered at baseline to 183 participants, measuring patients’ strength of preferences when choosing either alternative ‘surgery’ or ‘imiquimod cream’ instead of a fixed ‘current situation’ option (of surgical excision as standard practice in UK). The treatments were described according to: cost, chance of complete clearance, side effects and appearance. Participants had to choose between various scenarios. Analysis was performed using a mixed logit model, which took into account the impact of previous BCC treatment and sample preference variability. Results The analysis showed that respondents preferred ‘imiquimod cream’ to their ‘current situation’ or ‘surgery’, regardless of previous experience of BCC symptoms and treatment. Respondents were more likely to be worried about their cosmetic outcomes and side effects they might experience over and above their chance of clearance and cost. Those with no experience of surgery (compared with experience) valued more the choice of ‘imiquimod cream’ (£1013 vs £781). All treatment characteristics were significant determinants of treatment choice...

‣ Results from a preliminary study to develop the quality adjustments for quality adjusted life year values for Trinidad and Tobago

Bailey,H
Fonte: West Indian Medical Journal Publicador: West Indian Medical Journal
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2013 Português
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OBJECTIVE: No country can afford to provide all necessary healthcare for its citizens, so prioritization among interventions must feature in all health systems. Resources in health should be allocated among interventions/facilities/patients in such a way as to be in line with the objectives of the health system. To achieve this, resource allocation decisions must be informed by the relative contributions that prospective interventions will make to societal health and to costs. Internationally, the EQ-5D based quality adjusted life year (QALY) now dominates this kind of analysis. This paper reports on a pilot study to develop an EQ-5D-3L value set for Trinidad and Tobago based on a protocol that avoids some of the issues that are associated with other approaches to developing such value sets such as the complex elicitation tasks that respondents must carry out, and the large respondent samples required for collecting multiple valuation subset values using blocked designs. METHODS: An orthogonal discrete choice experiment design was used to elicit a set of choices from a sample of respondents. RESULTS: The choice data were analysed using mixed multinomial logistic regression to produce an internally valid model that predicts well. CONCLUSION: This paper marks an important milestone in the development of health resource allocation in the Caribbean. It sets out the importance of incorporating the impact of health interventions to inform health resource allocation decisions...

‣ Rural practice preferences among medical students in Ghana: a discrete choice experiment

Kruk,Margaret E; Johnson,Jennifer C; Gyakobo,Mawuli; Agyei-Baffour,Peter; Asabir,Kwesi; Kotha,S Rani; Kwansah,Janet; Nakua,Emmanuel; Snow,Rachel C; Dzodzomenyo,Mawuli
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/05/2010 Português
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OBJECTIVE: To determine how specific job attributes influenced fourth year medical students' stated preference for hypothetical rural job postings in Ghana. METHODS: Based on discussions with medical student focus groups and physicians in practice and in the Ministry of Health, we created a discrete choice experiment (DCE) that assessed how students' stated preference for certain rural postings was influenced by various job attributes: a higher salary, free superior housing, an educational allowance for children, improved equipment, supportive management, shorter contracts before study leave and a car. We conducted the DCE among all fourth year medical students in Ghana using a brief structured questionnaire and used mixed logit models to estimate the utility of each job attribute. FINDINGS: Complete data for DCE analysis were available for 302 of 310 (97%) students. All attribute parameter estimates differed significantly from zero and had the expected signs. In the main effects mixed logit model, improved equipment and supportive management were most strongly associated with job preference (β = 1.42; 95% confidence interval, CI: 1.17 to 1.66, and β = 1.17; 95% CI: 0.96 to 1.39, respectively), although shorter contracts and salary bonuses were also associated. Discontinuing the provision of basic housing had a large negative influence (β = -1.59; 95% CI: -1.88 to -1.31). In models including gender interaction terms...