Applications of discrete choice experiments in COVID-19 research:Disparity in survey qualities between health and transport fields

Published choice experiments linked to various aspects of the COVID-19 pandemic are analysed in a rapid review. The aim is to (i) document the diversity of topics as well as their temporal and geographical patterns of emergence, (ii) compare various elements of design quality across different sectors of applied economics, and (iii) identify potential signs of convergent validity across findings of comparable experiments. Of the N = 43 published choice experiments during the first two years of the pandemic, the majority identifies with health applications (n = 30), followed by transport-related applications (n = 10). Nearly 100,000 people across the world responded to pandemic-related discrete choice surveys. Within health applications, while the dominant theme, up until June 2020, was lockdown relaxation and tracing measures, the focus shifted abruptly to vaccine preference since then. Geographical origins of the health surveys were not diverse. Nearly 50% of all health surveys were conducted in only three countries, namely US, China and The Netherlands. Health applications exhibited stronger pre-testing and larger sample sizes compared to transport applications. Limited signs of convergent validity were identifiable. Within some applications, issues of temporal instability as well as hypothetical bias attributable to social desirability, protest response or policy consequentiality seemed likely to have affected the findings. Nevertheless, very few of the experiments implemented measures of hypothetical bias mitigation and those were limited to health studies. Our main conclusion is that swift administration of pandemic-related choice experiments has overall resulted in certain degrees of compromise in study quality, but this has been more so the case in relation to transport topics than health topics

An attempt to decrease social desirability bias:The effect of cheap talk mitigation on internal and external validity of discrete choice experiments

Discrete choice experiments (DCEs) have been used extensively to elicit preferences. However, the hypothetical nature of choices induces socially desirable behaviour and endangers internal and external validity of DCEs. This study experimentally investigated social desirability bias in DCEs and whether it can be mitigated using the cheap talk mitigation method in the context of food choices. Respondents (N = 1027) were randomly allocated to one of four questionnaire versions: default without manipulation, priming socially desirable behaviour, cheap talk mitigation, or both. The effect on internal validity was assessed by comparing respondent-reported characteristics, DCE results, and prediction accuracy for a holdout task between questionnaire versions. The effect on external validity was assessed by comparing stated and revealed preferences. Social desirability bias, if present, was hardly affected by cheap talk mitigation. Respondent-reported characteristics, DCE results and prediction accuracy for the holdout task and actual food choice did not strongly differ between questionnaire versions. Prediction accuracy for the holdout task was lowest in the default version. Prediction accuracy for actual food choice was slightly better among respondents in the versions that were exposed to cheap talk mitigation. Social desirability bias was hard to detect and mitigate in this study, potentially due to limited social desirability, the effectiveness of the cheap talk mitigation method, and other sources of hypothetical bias. The differences in prediction accuracy indicates that cheap talk mitigation slightly improved external validity at minimum cost to internal validity. Recommendations for future research are provided.</p

Construct Validity, Reliability, and Responsiveness of the 10-Item Well-being Instrument for Use in Economic Evaluation Studies

Objectives: Economic evaluations of interventions in health and social care require outcome measures that capture their full benefits, including those beyond health. This study aimed to assess construct validity, test-retest reliability, and responsiveness of the newly developed 10-item Well-being instrument (WiX). Methods: Data were gathered via an online survey in a representative sample of the adult general population in The Netherlands (N = 1045). Construct validity was assessed by inspecting convergent, structural, and discriminant validity, following the COnsensus-based Standards for the selection of health status Measurement INstruments methodology. Regression analyses of the WiX and its items on other validated measures of well-being were performed to assess the convergent validity of the instrument and the relevance of its items. Dimensionality of the WiX was assessed using exploratory factor analysis. To assess discriminant validity, several hypotheses in terms of well-being differences were assessed. Finally, a second survey was sent out 2 weeks after the initial survey (n = 563; 53.9% response rate) to assess the test-retest reliability and responsiveness of the WiX. Results: The WiX showed to be correlated with alternative well-being measures as expected and able to sufficiently differentiate between relevant subgroups in the population. Moreover, the dimensionality analysis indicated that the WiX captures a broad array of elements relevant to well-being, including physical and mental health. The test-retest reliability was good, with an intraclass correlation coefficient of 0.82. Conclusions: The results regarding the WiX are favorable and indicate that this new instrument may be a promising alternative for existing measures of well-being for evaluating interventions in health and social care.</p

Construct Validity, Reliability, and Responsiveness of the 10-Item Well-being Instrument for Use in Economic Evaluation Studies

Objectives: Economic evaluations of interventions in health and social care require outcome measures that capture their full benefits, including those beyond health. This study aimed to assess construct validity, test-retest reliability, and responsiveness of the newly developed 10-item Well-being instrument (WiX). Methods: Data were gathered via an online survey in a representative sample of the adult general population in The Netherlands (N = 1045). Construct validity was assessed by inspecting convergent, structural, and discriminant validity, following the COnsensus-based Standards for the selection of health status Measurement INstruments methodology. Regression analyses of the WiX and its items on other validated measures of well-being were performed to assess the convergent validity of the instrument and the relevance of its items. Dimensionality of the WiX was assessed using exploratory factor analysis. To assess discriminant validity, several hypotheses in terms of well-being differences were assessed. Finally, a second survey was sent out 2 weeks after the initial survey (n = 563; 53.9% response rate) to assess the test-retest reliability and responsiveness of the WiX. Results: The WiX showed to be correlated with alternative well-being measures as expected and able to sufficiently differentiate between relevant subgroups in the population. Moreover, the dimensionality analysis indicated that the WiX captures a broad array of elements relevant to well-being, including physical and mental health. The test-retest reliability was good, with an intraclass correlation coefficient of 0.82. Conclusions: The results regarding the WiX are favorable and indicate that this new instrument may be a promising alternative for existing measures of well-being for evaluating interventions in health and social care.</p

A socially interdependent choice framework for social influences in healthcare decision-making:a study protocol

OBJECTIVES: Current choice models in healthcare (and beyond) can provide suboptimal predictions of healthcare users' decisions. One reason for such inaccuracy is that standard microeconomic theory assumes that decisions of healthcare users are made in a social vacuum. Healthcare choices, however, can in fact be (entirely) socially determined. To achieve more accurate choice predictions within healthcare and therefore better policy decisions, the social influences that affect healthcare user decision-making need to be identified and explicitly integrated into choice models. The purpose of this study is to develop a socially interdependent choice framework of healthcare user decision-making.DESIGN: A mixed-methods approach will be used. A systematic literature review will be conducted that identifies the social influences on healthcare user decision-making. Based on the outcomes of a systematic literature review, an interview guide will be developed that assesses which, and how, social influences affect healthcare user decision-making in four different medical fields. This guide will be used during two exploratory focus groups to assess the engagement of participants and clarity of questions and probes. The refined interview guide will be used to conduct the semistructured interviews with healthcare professionals and users. These interviews will explore in detail which, and how, social influences affect healthcare user decision-making. Focus group and interview transcripts will be analysed iteratively using a constant comparative approach based on a mix of inductive and deductive coding. Based on the outcomes, a social influence independent choice framework for healthcare user decision-making will be drafted. Finally, the Delphi technique will be employed to achieve consensus about the final version of this choice framework.ETHICS AND DISSEMINATION: This study was approved by the Erasmus School of Health Policy and Management Research Ethics Review Committee (ESHPM, Rotterdam, The Netherlands; reference ETH2122-0666).</p

Discrete choice experiment versus swing-weighting:A head-to-head comparison of diabetic patient preferences for glucose-monitoring devices

Introduction Limited evidence exists for how patient preference elicitation methods compare directly. This study compares a discrete choice experiment (DCE) and swing-weighting (SW) by eliciting preferences for glucose-monitoring devices in a population of diabetes patients. Methods A sample of Dutch adults with type 1 or 2 diabetes (n = 459) completed an online survey assessing their preferences for glucose-monitoring devices, consisting of both a DCE and a SW exercise. Half the sample completed the DCE first; the other half completed the SW first. For the DCE, the relative importance of the attributes of the devices was determined using a mixed-logit model. For the SW, the relative importance of the attributes was based on ranks and points allocated to the ‘swing’ from the worst to the best level of the attribute. The preference outcomes and self-reported response burden were directly compared between the two methods. Results Participants reported they perceived the DCE to be easier to understand and answer compared to the SW. Both methods revealed that cost and precision of the device were the most important attributes. However, the DCE had a 14.9-fold difference between the most and least important attribute, while the SW had a 1.4-fold difference. The weights derived from the SW were almost evenly distributed between all attributes. Conclusions The DCE was better received by participants, and generated larger weight differences between each attribute level, making it the more informative method in our case study. This method comparison provides further evidence of the degree of method suitability and trustworthiness.</p

What do patients and dermatologists prefer regarding low-risk basal cell carcinoma follow-up care? A discrete choice experiment

Background Follow-up after low-risk basal cell carcinoma (BCC) is being provided more frequently than recommended by guidelines. To design an acceptable strategy to successfully reduce this ‘low-value’ care, it is important to obtain insights into the preferences of patients and dermatologists. Objective To determine the preferences and needs of patients and dermatologists to reduce low-risk BCC follow-up care, and the trade-offs they are willing to make. Methods A questionnaire including a discrete choice experiment was created, containing attributes regarding amount of follow-up, continuity of care, method of providing addition information, type of healthcare provider, duration of follow-up visits and skin examination. In total, 371 BCC patients and all Dutch dermatologists and dermatology residents (n = 620) were invited to complete the questionnaire. A panel latent class model was used for analysis. Results Eighty-four dermatologists and 266 BCC patients (21% and 72% response rates respectively) completed the discrete choice experiment. If the post-treatment visit was performed by the same person as treatment provider and a hand-out was provided to patients containing personalised information, the acceptance of having no additional follow-up visits (i.e. following the guidelines) would increase from 55% to 77% by patients. Female patients and older dermatologists, however, are less willing to accept the guidelines and prefer additional follow-up visits. Limitations The low response rate of dermatologists. Conclusion This discrete choice experiment revealed a feasible strategy to substantially reduce costs, while maintaining quality of care, based on the preferences and needs of BCC patients, which is supported by dermatologists.Q1Revista Internacional - Indexad

Preferences of patients, clinicians, and healthy controls for the management of a Bethesda III thyroid nodule

Background: Active surveillance is propagated as an alternative for hemithyroidectomy in the management of Bethesda III thyroid nodules. Methods: A cross-sectional survey questioned respondents on their willingness to accept risks related to active surveillance and hemithyroidectomy. Results: In case of active surveillance, respondents (129 patients, 46 clinicians, and 66 healthy controls) were willing to accept a risk of 10%–15% for thyroid cancer and 15% for needing more extensive surgery in the future. Respondents were willing to accept a risk of 22.5%–30% for hypothyroidism after hemithyroidectomy. Patients and controls were willing to accept a higher risk on permanent voice changes compared with clinicians (10% vs. 3%, p < 0.001). Conclusion: Real-life risks associated which active surveillance and hemithyroidectomy for Bethesda III nodules are equivalent or less than the risks people are willing to accept. Clinicians accepted less risk for permanent voice changes

Discrete choice experiment versus swing-weighting: A head-to-head comparison of diabetic patient preferences for glucose-monitoring devices

INTRODUCTION: Limited evidence exists for how patient preference elicitation methods compare directly. This study compares a discrete choice experiment (DCE) and swing-weighting (SW) by eliciting preferences for glucose-monitoring devices in a population of diabetes patients. METHODS: A sample of Dutch adults with type 1 or 2 diabetes (n = 459) completed an online survey assessing their preferences for glucose-monitoring devices, consisting of both a DCE and a SW exercise. Half the sample completed the DCE first; the other half completed the SW first. For the DCE, the relative importance of the attributes of the devices was determined using a mixed-logit model. For the SW, the relative importance of the attributes was based on ranks and points allocated to the 'swing' from the worst to the best level of the attribute. The preference outcomes and self-reported response burden were directly compared between the two methods. RESULTS: Participants reported they perceived the DCE to be easier to understand and answer compared to the SW. Both methods revealed that cost and precision of the device were the most important attributes. However, the DCE had a 14.9-fold difference between the most and least important attribute, while the SW had a 1.4-fold difference. The weights derived from the SW were almost evenly distributed between all attributes. CONCLUSIONS: The DCE was better received by participants, and generated larger weight differences between each attribute level, making it the more informative method in our case study. This method comparison provides further evidence of the degree of method suitability and trustworthiness

Primary prevention of cardiovascular diseases: a cost study in family practices

Background: Considering the scarcity of health care resources and the high costs associated with cardiovascular diseases, we investigated the spending on cardiovascular primary preventive activities and the prescribing behaviour of primary preventive cardiovascular medication (PPCM) in Dutch family practices (FPs). Methods. A mixed methods design was used, which consisted of a questionnaire (n = 80 FPs), video recordings of hypertension- or cholesterol-related general practitioner visits (n = 56), and the database of Netherlands Information Network of General Practic