What Matters Most to Patients and Rheumatologists? A Discrete Choice Experiment in Rheumatoid Arthritis

Introduction: To determine patient and rheumatologist preferences for rheumatoid arthritis (RA) treatment attributes in Spain and to evaluate their attitude towards shared decision-making (SDM). Methods: Observational, descriptive, exploratory and cross-sectional study based on a discrete choice experiment (DCE). To identify the attributes and their levels, a literature review and two focus groups (patients [P] = 5; rheumatologists [R] = 4) were undertaken. Seven attributes with 2–4 levels were presented in eight scenarios. Attribute utility and relative importance (RI) were assessed using a conditional logit model. Patient preferences for SDM were assessed using an ad hoc questionnaire. Results: Ninety rheumatologists [52.2% women; mean years of experience 18.1 (SD: 9.0); seeing an average of 24.4 RA patients/week (SD: 15.3)] and 137 RA patients [mean age: 47.5 years (SD: 10.7); 84.0% women; mean time since diagnosis of RA: 14.2 years (SD: 11.8) and time in treatment: 13.2 years (SD: 11.2), mean HAQ score 1.2 (SD: 0.7)] participated in the study. In terms of RI, rheumatologists and RA patients viewed: time with optimal QoL: R: 23.41%/P: 35.05%; substantial symptom improvement: R: 13.15%/P: 3.62%; time to onset of treatment action: R: 16.24%/P: 13.56%; severe adverse events: R: 10.89%/P: 11.20%; mild adverse events: R: 4.16%/P: 0.91%; mode of administration: R: 25.23%/P: 25.00%; and added cost: R: 6.93%/P: 10.66%. Nearly 73% of RA patients were involved in treatment decision-making to a greater or lesser extent; however, 27.4% did not participate at all. Conclusion: Both for rheumatologists and patients, the top three decision-making drivers are time with optimal quality, treatment mode of administration and time to onset of action, although in different ranking order. Patients were willing to be more involved in the treatment decision-making process

Should I stay or should I go? Exploring the job preferences of allied health professionals working with people with disability in rural Australia

Introduction: The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services. Objective: This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists – “therapists”) living in a rural area of Australia and working with people with disability, place on different job characteristics and how these may affect their retention. Methods: A cross-sectional survey was conducted using an online questionnaire distributed to AHPs working with people with disability in a rural area of Australia over a 3-month period. Information was sought about various aspects of the AHPs’ current job, and their workforce preferences were explored using a best–worst scaling discrete choice experiment (BWSDCE). Conditional logistic and latent class regression models were used to determine AHPs’ relative preferences for six different job attributes. Results: One hundred ninety-nine AHPs completed the survey; response rate was 51 %. Of those, 165 completed the BWSDCE task. For this group of AHPs, “high autonomy of practice” is the most valued attribute level, followed by “travel BWSDCE arrangements: one or less nights away per month”, “travel arrangements: two or three nights away per month” and “adequate access to professional development”. On the other hand, the least valued attribute levels were “travel arrangements: four or more nights per month”, “limited autonomy of practice” and “minimal access to professional development”. Except for “some job flexibility”, all other attributes had a statistical influence on AHPs’ job preference. Preferences differed according to age, marital status and having dependent children. Conclusions: This study allowed the identification of factors that contribute to AHPs’ employment decisions about staying and working in a rural area. This information can improve job designs in rural areas to increase retention

An Analytic Approach to Selecting a Nonprofit

Charity giving continues to be an important aspect of the economic and social fabric of the United States. The number and total assets of nonprofits registered with the Internal Revenue Service (IRS) under the section 501(c)(3) of the tax code have grown significantly over the past decade. Given the significant share of donations in supporting the activities of nonprofits, it is important for donors to have a better understanding of their operations and governance. As the number of nonprofits with similar objectives increases, it becomes overly complicated for donors to make a choice that is consistent with their own purpose for giving. The goal of this paper is to develop an analytic framework for selecting a nonprofit from among competing alternatives. Specifically, we propose a process in which consultants or financial advisors help donors evaluate nonprofits using a set of financial and governance criteria to generate a ranked short list of alternatives for further evaluation. Donors differ in their criteria for evaluating the performance of nonprofits. The methodology we use allows donors to incorporate their preferences for specific criteria to the selection of a nonprofit in a consistent manner.http://deepblue.lib.umich.edu/bitstream/2027.42/64420/1/wp951.pd

Cattle farmers' preferences for disease-free zones in Kenya: an application of the choice experiment method

Management of livestock diseases is important in ensuring food safety to consumers in both domestic and export markets. Various measures are prescribed under the Sanitary and Phytosanitary Standards (SPS) agreement of the World Trade Organization. In order to prevent the spread of trans-boundary cattle diseases, the SPS agreement recommends the establishment of Disease-Free Zones (DFZs). These have been implemented successfully in some major beef-exporting countries, but in Kenya are still at a pilot stage. To understand Kenyan farmers' preferences on the type of DFZ that would be readily acceptable to them, a choice experiment was conducted using a D-optimal design. Results show that farmers would be willing to pay to participate in a DFZ where: adequate training is provided on pasture development, record keeping and disease monitoring; market information is provided and sales contract opportunities are guaranteed; cattle are properly labelled for ease of identification; and some monetary compensation is provided in the event that cattle die due to severe disease outbreaks. Preferences for the DFZ attributes are shown to be heterogeneous across three cattle production systems. We also derive farmers' preferences for various DFZ policy scenarios. The findings have important implications for policy on the design of DFZ programmes in Kenya and other countries that face similar cattle disease challenges. © 2011 Blackwell Publishing Ltd

Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A binary choice experiment

Background: NICE is an independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health in England and Wales. One of NICE’s main roles is to produce national guidance on the use of health technologies within the NHS. Despite the Institute’s recent efforts to clarify the way in which its Appraisal Committees reach their recommendations concerning the use of health technologies, there remains ambiguity about how cost-effectiveness evidence is interpreted alongside other considerations such as the degree of clinical need within the patient population, and the degree of uncertainty surrounding cost-effectiveness estimates. Objective: To explore whether the NICE takes account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services. Methods: A binary choice experiment was undertaken using NICE’s three Appraisal Committees. The experiment included five attributes: (1) Incremental cost-effectiveness (2) Degree of economic uncertainty (3) Age of the target population (4) Baseline health-related quality of life (5) Availability of other therapies A choice questionnaire detailing 18 scenarios was administered to NICE’s Appraisal Committees. For each scenario, respondents were asked to indicate whether they would recommend the intervention under consideration or not. The stated preference data obtained from respondents were analysed using a random effects logit regression model. Results: A response rate of 46% was obtained from the Appraisal Committees. The regression model suggests that increases in cost-effectiveness, economic uncertainty, and the availability of other therapies are associated with statistically significant reductions in the odds of adoption (p<0.05). The transition from a very low to a comparatively high level of health-related quality of life is also associated with a statistically significant reduction in the odds of a positive recommendation. Smaller changes in health-related quality of life, and the age of the target population are not associated with a statistically significant reduction in the odds of a positive recommendation. Analysis of revealed preference data indicates that the model is capable of distinguishing between those technologies which the Appraisal Committees would be highly likely to recommend, and those technologies which appear to be less attractive, although further external validation is warranted. Conclusion: The modelling suggests that cost-effectiveness, uncertainty and certain equity concerns influence the NICE Appraisal Committees’ recommendations on the use of health technologies. The modelling results appear to support Rawlins and Culyer’s notion of a probabilistic cost-effectiveness threshold approach; the "mythical" £30,000 per QALY gained threshold assumed within the literature is not supported by this stated preference modelling analysis

Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A binary choice experiment

Background NICE is an independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health in England and Wales. One of NICE’s main roles is to produce national guidance on the use of health technologies within the NHS. Despite the Institute’s recent efforts to clarify the way in which its Appraisal Committees reach their recommendations concerning the use of health technologies, there remains ambiguity about how cost-effectiveness evidence is interpreted alongside other considerations such as the degree of clinical need within the patient population, and the degree of uncertainty surrounding cost-effectiveness estimates. Objective To explore whether the NICE takes account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services. Methods A binary choice experiment was undertaken using NICE’s three Appraisal Committees. The experiment included five attributes: (1) Incremental cost-effectiveness (2) Degree of economic uncertainty (3) Age of the target population (4) Baseline health-related quality of life (5) Availability of other therapies A choice questionnaire detailing 18 scenarios was administered to NICE’s Appraisal Committees. For each scenario, respondents were asked to indicate whether they would recommend the intervention under consideration or not. The stated preference data obtained from respondents were analysed using a random effects logit regression model. Results A response rate of 46% was obtained from the Appraisal Committees. The regression model suggests that increases in cost-effectiveness, economic uncertainty, and the availability of other therapies are associated with statistically significant reductions in the odds of adoption (puncertainty; equity; cost-effectiveness; public health

A review of multi-criteria decision making methods for enhanced maintenance delivery

Conventionally there is a strong relation between manufacturing and services in complex engineering industries. For companies which aim to last in the competitive manufacturing market choosing appropriate decision making methods to improve their maintenance delivery has a vital role. The aim of this paper is to review Multi Criteria Decision Making (MCDM) models, evaluate each method and do a critical comparison to assess them from a maintenance management point of view. The first section of this paper reviews MCDM methods in different literature, and then the second part develops a set of criteria to classify different techniques. At the end methods are compared based on developed criteria. This paper assesses different MCDM models, and provides a framework to select approaches for maintenance management

AN ANALYTIC APPROACH TO SELECTING A NONPROFIT

Charity giving continues to be an important aspect of the economic and social fabric of the United States. The number and total assets of nonprofits registered with the Internal Revenue Service (IRS) under the section 501(c)(3) of the tax code have grown significantly over the past decade. Given the significant share of donations in supporting the activities of nonprofits, it is important for donors to have a better understanding of their operations and governance. As the number of nonprofits with similar objectives increases, it becomes overly complicated for donors to make a choice that is consistent with their own purpose for giving. The goal of this paper is to develop an analytic framework for selecting a nonprofit from among competing alternatives. Specifically, we propose a process in which consultants or financial advisors help donors evaluate nonprofits using a set of financial and governance criteria to generate a ranked short list of alternatives for further evaluation. Donors differ in their criteria for evaluating the performance of nonprofits. The methodology we use allows donors to incorporate their preferences for specific criteria to the selection of a nonprofit in a consistent manner.

Consumer trust and willingness to pay for certified animal-friendly products

Increasing animal welfare standards requires changes along the supply chain which involve several stakeholders: scientists, farmers and people involved in transportation and slaughtering. The majority of researchers agree that compliance with these standards increases costs along the livestock value chain, especially for monitoring and certifying animal-friendly products. Knowledge of consumer willingness to pay (WTP) in such a decision context is paramount to understanding the magnitude of market incentives necessary to compensate all involved stakeholders. The market outcome of certification programs is dependent on consumer trust. Particularly, there is a need to understand to what extent consumers believe that stakeholders operating in the animal-friendly supply chain will respect certification standards. We examine these issues using a contingent valuation survey administered in five economically dominant EU countries. The implied WTP estimates are found to be sensitive to robust measures of consumer trust for certified animal-friendly products. Significant differences across countries are discussed

Sustainable Retirement: A Look At Consumer Desires

This paper examines the findings of the research project, 'Retirement Savings: Drivers and Desires', commissioned by the Investment and Financial Services Association Ltd (IFSA) in 2001. The paper investigates retirement savings decision-making and retirement income product stream choice. This paper presents a quantitative analysis of questionnaire data relating to decision-making and product stream choice and discusses these issues in the context of established research findings about retirement income. The paper consists of five sections. The first is a brief review of the 'Drivers and Desires' research project conducted in 2001. An important theme to emerge from the initial project was that participants reported a high level of risk aversion and a strong desire to obtain the publicly funded age pension. Based on the findings of the initial project, the remaining sections of this paper focuses on consumer preferences, particularly relating to risk aversion and demand for the age pension. The second section focuses on a specific issue emanating from the initial project, specifically the market for annuities. The third section considers retirement income streams in terms of risks to investors. The fourth section carries out a quantitative analysis of consumer preferences toward the identified risks in previous sections, and specifically considers various trade-offs in the decision-making process. The fifth section outlines various policy alternatives and issues for future consideration.