Preferences of older patients regarding hip fracture rehabilitation service configuration:A feasibility discrete choice experiment

Objective: As part of a wider feasibility study, the feasibility of gaining older patients’ views for hip fracture rehabilitation services was tested using a discrete choice experiment in a UK context. Design: Discrete choice experiment is a method used for eliciting individuals’ preferences about goods and services. Subjects/patients: The discrete choice experiment was administered to 41 participants who had experienced hip fracture (mean age 79.3 years; standard deviation (SD) 7.5 years), recruited from a larger feasibility study exploring a new multidisciplinary rehabilitation for hip fracture. Methods: Attributes and levels for this discrete choice experiment were identified from a systematic review and focus groups. The questionnaire was administered at the 3-month follow-up. Results: Participants indicated a significant preference for a fully-qualified physiotherapist or occupational therapist to deliver the rehabilitation sessions (β = 0·605, 95% confidence interval (95% CI) 0.462–0.879), and for their rehabilitation session to last less than 90 min (β = –0.192, 95% CI –0.381 to –0.051). Conclusion: The design of the discrete choice experiment using attributes associated with service configuration could have the potential to inform service implementation, and assist rehabilitation service design that incorporates the preferences of patients

Would you train me with my mental illness? Evidence from a discrete choice experiment

The low employment among people with disabilities in general, and mental disorders in particular, generates high costs to the society. This raises the need to develop effective vocational rehabilitation methods. Supported Education/Employment is effective in increasing sustainable employment for people with mental disorders. This vocational rehabilitation method places patients directly in realistic work settings instead of training them in a protected work environment. Supported Education and Employment has not yet been widely implemented. Using a discrete choice experiment, we demonstrate that one of the key problems is to find employers willing to provide training. Non-cognitive dysfunctions are the main deterrents.upported Vocational Education & Training; vocational rehabilitation; mental disorders; discrete choice experiment

Preferences for work arrangements:A discrete choice experiment

This study investigates individual preferences for work arrangements in a discrete choice experiment. Based on sociological and economic literature, we identified six essential job attributes—earnings, job security, training opportunities, scheduling flexibility, prestige of the company, and gender composition of the work team—and mapped these into hypothetical job offers. Out of three job offers, with different specifications in the respective job attributes, respondents had to choose the offer they considered as most attractive. In 2017, we implemented our choice experiment in two large-scale surveys conducted in two countries: Germany (N = 2,659) and the Netherlands (N = 2,678). Our analyses revealed that respondents considered all six job attributes in their decision process but had different priorities for each. Moreover, we found gendered preferences. Women preferred scheduling flexibility and a company with a good reputation, whereas men preferred jobs with high earnings and a permanent contract. Despite different national labor market regulations, different target populations, and different sampling strategies for the two surveys, job preferences for German and Dutch respondents were largely parallel

A discrete choice experiment exploring farmer preferences for insurance against extreme weather events

peer-reviewedAgriculture represents one of the most vulnerable sectors to extreme weather events that are projected to increase with climate change. Insurance has been advocated as a more efficient means to ensure financial security to farmers, than post-disaster aid for damages. A potential drawback of insurance however, is that unless carefully designed it could dis-incentivise farmers to engage in wider farm adaptation measures or lead to more risk-taking behaviour. This paper analyses the attractiveness of publicly-backed climate risk insurance offerings to farmers and explores their preferences for elements of insurance schemes that do not negatively affect incentives for wider farm adaptation. Specifically, a discrete choice experiment is used to reveal Irish farmers’ preferences for multi-annual insurance contracts and weather-indexed versus traditional indemnity insurance and cost. Results indicate that a majority of farmers are willing to buy publicly-backed insurance for protection from extreme weather events. Younger farmers, farmers who currently have farm insurance, farmers from certain geographical locations and farmers who have been previously affected by extreme weather events are more likely to buy insurance. With respect to the design of insurance schemes, farmers prefer multi-annual coverage versus annual renewal. They also prefer indexed-insurance and have a strong preference for cheaper coverage. Despite the important role that insurance could play in protecting farms financially from damage caused by extreme weather events, few studies have examined preference for weather-indexed insurance within a European context. New evidence on farmer preferences and intended behaviours is therefore critical to inform policy in this area

Using rank and discrete choice data to estimate health state utility values on the QALY scale

Objective: Recent years have seen increasing interest in the use of ordinal methods to elicit health state utility values as an alternative to conventional methods such as standard gamble and time trade-off. However, in order to use these health state values in cost effectiveness analysis using cost per quality adjusted life year (QALY) analysis, these values must be anchored on the full health-dead scale. This study addresses this challenge and examines how rank and discrete choice experiment data can be used to elicit health state utility values anchored on the full health-dead scale and compares the results to time trade-off (TTO) results. Methods: Two valuation studies were conducted using identical methods for two health state classification systems: asthma and overactive bladder. Each valuation study involved interviews of 300 members of the general population using ranking and TTO plus a postal survey using discrete choice experiment sent to all consenting interviewees and a "cold" sample of the general population who were not interviewed. Results: Overall DCE produced different results from ranking and time trade-off, whereas ranking produced similar results to TTO in one study, but not the other. Conclusions: Ordinal methods offer a promising alternative to conventional cardinal methods of standard gamble and TTO. However, the results do not appear to be robust across different health state classification systems and potentially different medical conditions. There remains a large and important research agenda to address.ranking; discrete choice experiment; preference-based measures; QALYs

Assessing user preferences for sexually transmitted infection testing services: a discrete choice experiment

Objective: To assess user preferences for different aspects of sexually transmitted infection (STI) testing services. Design: A discrete choice experiment. Setting: 14 centres offering tests for STIs in East Sussex, England. Participants: People testing for STIs. Main outcome measure: (Adjusted) ORs in relation to preferred service characteristics. Results: 3358 questionnaires were returned; mean age 26 (SD 9.4) years. 70% (2366) were recruited from genitourinary medicine (GUM) clinics. The analysis suggested that the most important characteristics to users were whether 'staff had specialist STI knowledge' compared with 'staff without it' (OR 2.55; 95% CI 2.47 to 2.63) and whether 'tests for all STIs' were offered rather than 'some' (OR 2.19; 95% CI 2.12 to 2.25). They remained the most important two service characteristics despite stratifying the analysis by variables such as age and sex. Staff levels of expertise were viewed as particularly important by people attending CASH centres, women and non-men who have sex with men. A 'text or call to a mobile phone' and 'dropping in and waiting' were generally the preferred methods of results reporting and appointment system, respectively. Conclusions: This study suggests that people testing for STIs place particular importance on testing for all infections rather than some and staff with specialist STI knowledge. Thus, targets based purely on waiting up to 48 h for an appointment are misguided from a user perspectiv

What, who and when? Incorporating a discrete choice experiment into an economic evaluation

Acknowledgements The Medman study was funded by the Department of Health for England and Wales and managed by a collaboration of the National Pharmaceutical Association, the Royal Pharmaceutical Society of Great Britain, the Company Chemist Association and the Co-operative Pharmacy Technical Panel, led by the Pharmaceutical Services Negotiating Committee. The research in this paper was undertaken while the lead author MT was undertaking a doctoral research fellowship jointly funded by the Economic and Social Research Council (ESRC) and the Medical Research Council (MRC). The Health Economics Research Unit (HERU), University of Aberdeen is funded by the Chief Scientific Office of the Scottish Government Health and Social Care Directorate.Peer reviewedPublisher PD

Farmers’ preferences for cotton cultivation characteristics : a discrete choice experiment in Burkina Faso

While a fierce debate about the advantages and disadvantages of genetically modified crops is ongoing, it is surprising that farmers are often not consulted. In Burkina Faso, where insect resistant Bollgard II (R) cotton (further termed Bt cotton) was commercially released in 2008, studies highlight that cotton producers are in general satisfied with the reduction in insecticide use while the economic benefits are a source of controversy. To gain insight into farmers' preferences towards attributes in cotton cultivation, a discrete choice experiment (DCE) was developed. Five key attributes were identified to describe improved cotton varieties: seed development and provenance, seed costs, yield, required number of insecticide sprays, and preservation of agricultural practices. Farm-gate surveys were conducted among 324 cotton farmers in Western Burkina Faso. The results show that overall, farmers have a positive preference towards yield improvements and a negative preference towards pure private seed development and towards an increase in the requested number of insecticide applications or in the seed costs. According to their varieties at the time of the surveys (Bt and non-Bt), a difference was observed regarding their preferences for a status quo situation, indicating that those growing Bt had a stronger preference to keep the status quo than non-Bt farmers. When dividing the sample in segments based on the farm size, it was shown that there were different preferences with respect to the development of the variety and the required number of insecticide applications. Overall, it can be concluded from this study that economic benefits (linked to higher yields, lower seed costs, or reduced pesticide use) shape farmer's preferences

Patients' preferences for the management of non-metastatic prostate cancer: discrete choice experiment

Objective To establish which attributes of conservative treatments for prostate cancer are most important to men. Design Discrete choice experiment. Setting Two London hospitals. Participants 129 men with non-metastatic prostate cancer, mean age 70 years; 69 of 118 (58%) with T stage 1 or 2 cancer at diagnosis. Main outcome measures Men's preferences for, and trade-offs between, the attributes of diarrhoea, hot flushes, ability to maintain an erection, breast swelling or tenderness, physical energy, sex drive, life expectancy, and out of pocket expenses. Results The men's responses to changes in attributes were all statistically significant. When asked to assume a starting life expectancy of five years, the men were willing to make trade-offs between life expectancy and side effects. On average, they were most willing to give up life expectancy to avoid limitations in physical energy (mean three months) and least willing to trade life expectancy to avoid hot flushes (mean 0.6 months to move from a moderate to mild level or from mild to none). Conclusions Men with prostate cancer are willing to participate in a relatively complex exercise that weighs up the advantages and disadvantages of various conservative treatments for their condition. They were willing to trade off some life expectancy to be relieved of the burden of troublesome side effects such as limitations in physical energy