On the Optimization of Bayesian D-Efficient DCE Designs for the Estimation of QALY Tariffs That are Corrected for Nonlinear Time Preferences

Objectives: This article explains how to optimize Bayesian D-efficient discrete choice experiment (DCE) designs for the estimation of quality-adjusted life year (QALY) tariffs that are unconfounded by respondents' time preferences. Methods: The calculation of Bayesian D-errors is explained for DCE designs that allow for the disentanglement of respondents' time and health-state preferences. Time preferences are modelled via an exponential, hyperbolic, or power discount function and the performance of the proposed DCE designs is compared with that of several conventional DCE designs that do not take nonlinear time preferences into account. Results: Based on the achieved D-error, asymptotic standard error, and estimated sample size to obtain statistically significant estimates of the discount rate parameters, the proposed designs outperform the conventional DCE designs. Conclusions: We recommend that applied researchers use appropriately optimized DCE designs for the estimation of QALY tariffs that are corrected for time preferences. The TPC-QALY software package that accompanies this article makes the recommended designs easily accessible for health-state valuation researchers

Severity-Stratified Discrete Choice Experiment Designs for Health State Evaluations

__Background:__ Discrete choice experiments (DCEs) are increasingly used for health state valuations. However, the values derived from initial DCE studies vary widely. We hypothesize that these findings indicate the presence of unknown sources of bias that must be recognized and minimized. Against this background, we studied whether values derived from a DCE are sensitive to how well the DCE design spans the severity range. __Methods:__ We constructed an experiment involving three variants of DCE tasks for health state valuation: standard DCE, DCE-death, and DCE-duration. For each type of DCE, an experimental design was generated under two different conditions, enabling a comparison of health state values derived from current best practice Bayesian efficient DCE designs with values derived from ‘severity-stratified’ designs that control for coverage of the severity range in health state selection. About 3000 respondents participated in the study and were randomly assigned to one of the six study arms. __Results:__ Imposing the severity-stratified restriction had a large effect on health states sampled for the DCE-duration approach. The unstratified efficient design returned a skewed distribution of selected health states, and this introduced bias. The choice probability of bad health states was underestimated, and time trade-offs to avoid bad states were overestimated, resulting in too low values. Imposing the same restriction had limited effect in the DCE-death approach and standard DCE. __Conclusion:__ Variation in DCE-derived values can be partially explained by differences in how well selected health states spanned the severity range. Imposing a ‘severity stratification’ on DCE-duration designs is a validity requirement

Sample Size Requirements for Discrete-Choice Experiments in Healthcare: a Practical Guide

Discrete-choice experiments (DCEs) have become a commonly used instrument in health economics and patient-preference analysis, addressing a wide range of policy questions. An important question when setting up a DCE is the size of the sample needed to answer the research question of interest. Although theory exists as to the calculation of sample size requirements for stated choice dat

Comparison of bayesian random-effects and traditional life expectancy estimations in small-area applications

There are several measures that summarize the mortality experience of a population. Of these measures, life expectancies are generally preferred based on their simpler interpretation and direct age standardization, which makes them directly comparable between different populations. However, traditional life expectancy estimations are highly inaccurate for smaller populations and consequently are seldom used in small-area applications. In this paper, the authors compare the relative performance of traditional life expectancy estimation with a Bayesian random-effects approach that uses correlations (i.e., borrows strength) between different age groups, geographic areas, and sexes to improve the small-area life expectancy estimations. In the presented Monte Carlo simulations, the Bayesian random-effects approach outperforms the traditional approach in terms of bias, root mean square error, and coverage of the 95 confidence intervals. Moreover, the Bayesian random-effects approach is found to be usable for populations as small as 2,000 person-years at risk, which is considerably smaller than the minimum of 5,000 person-years at risk recommended for the traditional approach. As such, the proposed Bayesian random-effects approach is well-suited for estimation of life expectancies in small areas

Population preferences for breast cancer screening policies: Discrete choice experiment in Belarus

Background Reaching an acceptable participation rate in screening programs is challenging. With the objective of supporting the Belarus government to implement mammography screening as a single intervention, we analyse the main determinants of breast cancer screening participation. Methods We developed a discrete choice experiment using a mixed research approach, comprising a literature review, in-depth interviews with key informants (n = 23), “think aloud” pilots (n = 10) and quantitative measurement of stated preferences for a representative sample of Belarus women (n = 428, 89% response rate). The choice data were analysed using a latent class logit model with four classes selected based on statistical (consistent Akaike information criterion) and interpretational considerations. Results Women in the sample were representative of all six geographic regions, mainly urban (81%), and high-education (31%) characteristics. Preferences of women in all four classes were primarily influenced by the perceived reliability of the test (sensitivity and screening method) and costs. Travel and waiting time were important components in the decision for 34% of women. Most women in Belarus preferred mammography screening to the existing clinical breast examination (90%). However, if the national screening program is restricted in capacity, this proportion of women will drop to 55%. Women in all four classes preferred combined screening (mammography with clinical breast examination) to single mammography. While this preference was stronger if lower test sensitivity was assumed, 28% of women consistently gave more importance to combined screening than to test sensitivity. Conclusion Women in Belarus were favourable to mammography screening. Population should be informed that there are no benefits of combined screening compared to single mammography. The results of this study are directly relevant to policy mak

Attribute level overlap (and color coding) can reduce task complexity, improve choice consistency, and decrease the dropout rate in discrete choice experiments

A randomized controlled discrete choice experiment (DCE) with 3,320 participating respondents was used to investigate the individual and combined impact of level overlap and color coding on task complexity, choice consistency, survey satisfaction scores, and dropout rates. The systematic differences between the study arms allowed for a direct comparison of dropout rates and cognitive debriefing scores and accommodated the quantitative comparison of respondents' choice consistency using a heteroskedastic mixed logit model. Our results indicate that the introduction of level overlap made it significantly easier for respondents to identify the differences and choose between the choice options. As a stand-alone design strategy, attribute level overlap reduced the dropout rate by 30%, increased the level of choice consistency by 30%, and avoided learning effects in the initial choice tasks of the DCE. The combination of level overlap and color coding was even more effective: It reduced the dropout rate by 40% to 50% and increased the level of choice consistency by more than 60%. Hence, we can recommend attribute level overlap, with color coding to amplify its impact, as a standard design strategy in DCEs

Summarizing Patient Preferences for the Competitive Landscape of Multiple Sclerosis Treatment Options

Objective. Quantitatively summarize patient preferences for European licensed relapsing-remitting multiple scle

The Fold-in, Fold-out Design for DCE Choice Tasks: Application to Burden of Disease

Background. In discrete-choice experiments (DCEs), choice alternatives are described by attributes. The importance of each attribute can be quantified by analyzing respondents’ choices. Estimates are valid only if alternatives are defined comprehensively, but choice tasks can become too difficult for respondents if too many attributes are included. Several solutions for this dilemma have been proposed, but these have practical or theoretical drawbacks and cannot be applied in all settings. The objective of the current article is to demonstrate an alternative solution, the fold-in, fold-out approach (FiFo). We use a motivating example, the ABC Index for burden of disease in chronic obstructive pulmonary disease (COPD). Methods. Under FiFo, all attributes are part of all choice sets, but they are grouped into domains. These are either folded in (all attributes have the same level) or folded out (levels may differ). FiFo was applied to the valuation of the ABC Index, which included 15 attributes. The data were analyzed in Bayesian mixed logit regression, with additional parameters to account for increased complexity in folded-out questionnaires and potential differences in weight due to the folding status of dom

What Factors Influence Non‑Participation Most in Colorectal Cancer Screening? A Discrete Choice Experiment

Background and Objective Non-participation in colorectal cancer (CRC) screening needs to be decreased to achieve its full potential as a public health strategy. To facilitate successful implementation of CRC screening towards unscreened individuals, this study aimed to quantify the impact of screening and individual characteristics on non-participation in CRC screening. Methods An online discrete choice experiment partly based on qualitative research was used among 406 representatives of the Dutch general population aged 55–75 years. In the discrete choice experiment, respondents were ofered a series of choices between CRC screening scenarios that difered on fve characteristics: efectiveness of the faecal immunochemical screening test, risk of a false-negative outcome, test frequency, waiting time for faecal immunochemical screening test results and waiting time for a colonoscopy follow-up test. The discrete choice experiment data were analysed in a systematic manner using random-utility-maximisation choice processes with scale and/or preference heterogeneity (based on 15 individual characteristics) and/or random intercepts. Results Screening characteristics proved to infuence non-participation in CRC screening (21.7–28.0% non-participation rate), but an individual’s characteristics had an even higher impact on CRC screening non-participation (8.4–75.5% nonparticipation rate); particularly the individual’s attitude towards CRC screening followed by whether the individual had participated in a cancer screening programme before, the decision style of the individual and the educational level of the individual. Our fndings provided a high degree of confdence in the internal–external validity. Conclusions This study showed that although screening characteristics proved to infuence non-participation in CRC screening, a respondent’s characteristics had a much higher impact on CRC screening non-participation. Policy makers and physicians can use our study insights to improve and tailor their communication plans regarding (CRC) screening for unscreened individuals