A discrete choice experiment to assess patients’ preferences for HIV treatment in the urban population in Colombia

Abstract

Aim: This study aimed to assess patients’ preferences for HIV treatment in an urban Colombian population.

Methods: A Discrete Choice Experiment (DCE) was conducted. Urban Colombian HIV patients were asked to repetitively choose between two hypothetical treatments that differ in regard to five attributes ‘effect on life expectancy’, ‘effect on physical activity’, ‘risk of moderate side effects, ‘accessibility to clinic’ and ‘economic cost to access controls’. Twelve choice sets were made using an efficient design. A Mixed Logit Panel Model was used for the analysis and subgroup analyses were performed according to age, gender, education level and sexual preference.

Results: A total of 224 HIV patients were included. All attributes were significant, indicating that there were differences between at least two levels of each attribute. Patients preferred to be able to perform all physical activity without difficulty, to have large positive effects on life expectancy, to travel less than 2?h, to have lower risk of side-effects and to have subsidized travel costs. The attributes ‘effect on physical activity’ and ‘effects on life expectancy’ were deemed the most important. Sub-analyses showed that higher educated patients placed more importance on the large positive effects of HIV treatment, and a more negative preference for subsidized travel cost (5% level).

Limitations: A potential limitation is selection bias as it is difficult to make a systematic urban/rural division of respondents. Additional, questionnaires were partly administered in the waiting rooms, which potentially led to some noise in the data.

Conclusions: Findings suggests that short-term efficacy (i.e. effect on physical activity) and long-term efficacy (i.e. effect on life expectancy) are the most important treatment characteristics for HIV urban patients in Colombia. Preference data could provide relevant information for clinical and policy decision-making to optimize HIV care.     

Consumers’ preferences for a local food product: a real choice experiment

This paper analyses consumers’ preferences for a local food in Spain and assesses their willingness to pay (WTP) using a real choice experiment to mitigate possible hypothetical bias. In particular, preferences for fresh lamb meat were investigated and two attributes evaluated, “locally grown” and the type of lamb meat. Data came from an experiment conducted in Spain during 2009. An error component random Parameter model with correlated errors was used to estimate the effect of the attributes on consumers’ utility and derive their WTP. Results suggest that consumers positively value both attributes and are willing to pay a premium of 9 % price increase for the “locally grown” lamb meat (“Ojinegra from Teruel”) and 13 % price increase for the “Ternasco” lamb meat. If we assume a market where only “Ternasco” lamb meat without indication of the local origin is sold, and then a new “Ternasco” lamb is introduced in the market with the “Ojinegra from Teruel” label, this new local lamb meat would capture 18 % of the market if the package is assumed to be sold at 3.5 \(\hbox {C}\!\!\!\!\!=\) and a 10 % market share if the package is assumed to be sold at 4 \(\hbox {C}\!\!\!\!\!=\) .     

A best–worst scaling in Colombian patients to rank the characteristics of HIV/AIDS treatment

Aim: To elicit patients’ preferences for HIV/AIDS treatment characteristics in Colombia.

Materials and methods: A best–worst scaling case was used to provide a ranking of 26 HIV/AIDS treatment characteristics that were similar to a previous study conducted in Germany. In each choice task, participants were asked to choose the most important and the least important treatment characteristics from a set of five from the master list. Using the Hierarchical Bayes method, relative importance scores were calculated. Sub-group analyses were conducted according to sex, education, source of infection, symptoms, and age.

Results: A total of 195 patients fully completed the questionnaire. The three most important characteristics were “drug has very high efficacy” (relative importance score [RIS]?=?10.1), “maximum prolongation of life expectancy” (RIS?=?9.7), and “long duration of efficacy” (RIS?=?7.4). Sub-group analysis showed only three significant (but minor) differences between older and younger people.

Conclusion: This study suggests that treatment characteristics regarding efficacy and prolongation of life are particularly important for patients in Colombia. Further investigation on how patients make trade-offs between these important characteristics and incorporating this information in clinical and policy decision-making would be needed to improve adherence with HIV/AIDS medication.     

A subjectivist’s solution to the limits of public choice

In light of Wittman (1995) and Caplan (2007) this paper contends that the rational-choice approach to political science (“Public Choice theory”) has reached a dead end. By critiquing their treatment of rationality, knowledge assumptions, and views of the democratic process, an alternative is presented based on the core insight of the “Epistemic Primacy Thesis”. This subjectivist approach to political economy is introduced in light of an existing debate between the compatibility (or otherwise) of Austrian economics and Public Choice theory.     

What is the right profile for getting a job? A stated choice experiment of the recruitment process

We study the recruitment behaviour of Swedish employers using data from a stated choice experiment. In the experiment, the employers are first asked to describe an employee who recently and voluntarily left the firm and then to choose between two hypothetical applicants to invite to a job interview or to hire as a replacement for their previous employee. The two applicants differ with respect to characteristics such as gender, age, education, work experience, ethnicity, religious beliefs, family situation, weight, and health, but otherwise have similar characteristics as the previous employee. Our results show that employers prefer not to recruit applicants who are old, non-European, Muslim, Jewish, obese, have several children, or have a history of sickness absence. We also calculate the reduction in wage costs needed to make employers indifferent between applicants with and without these characteristics, and find that wage costs would have to be reduced by up to 50 % for applicants with some characteristics.     

Eliciting preferences for collectively financed health programmes: the ‘willingness to assign’ approach

Improving public involvement in health system decision making stands as a primary health policy goal. However, still limited guidance is available on how best to elicit preferences for health care programmes. This study examines a contingent choice technique to elicit preferences among health programmes, and named ‘willingness to assign’ (WTAS). WTAS reveals relative (monetary-based) values of a set of competing public programmes under a hypothetical healthcare budget assessment. Experimental evidence is reported from a deliberative empirical study valuing ten health programmes in the context of the Catalan Health Service. Evidence from this experimental study reveals that within the context of multiple programmes, preferences are internally more consistent and slightly less affected by ‘preference reversals’ as compared to values revealed from an adapted technique eliciting the willingness to pay (WTP) extra taxes. Another finding suggests that although programmes promoting health received the higher relative valuation, those promoting other health benefits were valued highly.     

Empirical study on the fish farmers’ willingness to participate in the Chinese rural cooperative financing organizations

This article attempts to identify the key factors which potentially contribute to the fish farmers’ willingness to participate in the new-form of the rural cooperative finance organization (NFRCFO) sponsored by the Chinese governments. A total of 116 fish farmer households as well as small-micro agricultural enterprises are sampled from the villages of Liaoning province in China. A discrete LOGIT model is used for parameter estimations. The results show that most of the factors being considered exhibit statistically significant effects on the fish farmers’ willingness to take part in the NFRCFO following by addressing the associated policy implications.     

The transition of people’s preferences for the intervention of the government in the economy of re-unified Germany

Covering the first fifteen years immediately after German reunification, this paper analyzes the people??s support to the transition. The focus is on individuals?? preferences for the intervention of the government in the economy and on the opinion about competition per se. Eastern German data are compared with Western German data. Using suitable data that allow for interpersonal comparisons, the paper shows that Eastern Germans have always preferred an intervention of the public hand in the economy deeper than Western Germans; these different positions have hardly converged during the examined period of time. However there are no significant differences with respect to how Germans perceive competition per se: it is considered as a good by the people living in both parts of the country.     

A comparison of preferences for two GLP-1 products – liraglutide and exenatide – for the treatment of type 2 diabetes

Abstract

Objective:

To use time trade-off (TTO) to compare patient preferences for profiles of two glucagon-like peptide (GLP-1) products for the treatment of type 2 diabetes (liraglutide and exenatide) that vary on four key attributes – efficacy (as measured by hemoglobin A_1C), incidence of nausea, incidence of hypoglycemia, and dosing frequency (QD vs. BID) – and measure the contribution of those attributes to preferences.

Methods:

A total of 382 people with T2DM were recruited to participate in an internet-based survey consisting of a series of health-related questions, a conjoint exercise and a set of time trade-off items. In the conjoint exercise, respondents were presented with eight pairs of hypothetical GLP-1 profiles, and completed a time-tradeoff exercise for each pair.

Results:

The product profile representing liraglutide was preferred by 96% of respondents and resulted in significantly higher health utilities (0.038) than the product profile representing exenatide (0.978 vs. 0.94, p?<?0.05). Estimated preference scores from the conjoint analysis revealed that efficacy measured by hemoglobin A_1C is the most important attribute, followed by nausea, hypoglycemia, and dosing schedule.

Limitations:

On-line participants may not represent ‘typical’ type 2 diabetes patients, and brief product profiles represented results from clinical trials, not clinical practice

Conclusion:

Based on the four attributes presented, patients prefer liraglutide over exenatide. Preference is based on superior efficacy and less nausea more than less hypoglycemia and once-daily dosing.     

Testing for heterogeneity of preferences in randomized experiments: a satisfaction-based approach applied to multiplayer prisoners’ dilemmas

We use experimental data from the ‘vote with the wallet’ multiplayer prisoner’s dilemma to investigate with a finite mixture approach the effect of a responsible purchase on players’ satisfaction. We find clear-cut evidence of heterogeneity of preferences with two groups of players that differ significantly in terms of effects of the responsible choice on satisfaction.     

A field experiment to estimate the effects of anchoring and framing on residents’ willingness to purchase water runoff management technologies

Watersheds throughout the world have been severely polluted by nutrient-laden runoff that comes from industrial, agricultural, and residential sources. Efforts to reduce this runoff have focused on industrial and agricultural sources, while little attention has been paid to encouraging residents to reduce runoff from their properties. To study residents’ willingness to adopt landscaping practices that reduce runoff, we conducted a field experiment in the Delaware River watershed. In the experiment, over three hundred adults participated in a series of random-price auctions that revealed their willingness to pay (WTP) for five products that reduce nutrient runoff. To study how WTP can be influenced by attributes of the choice architecture, we randomized the starting bid values (anchors) and the way in which the external benefits of the five practices were framed. Compared to a neutral framing, a positive framing (using the product can improve water quality) increased average WTP by about one-third, while the estimated effect of a negative framing (failing to use the product can worsen water quality) was also positive, but smaller and not statistically different from zero. The estimated effect on average WTP from the anchor depends on how bids of $0 are modeled, but the results imply that higher anchors lead to higher WTP. Although we believe the magnitudes of our results should be considered suggestive and we recommend replications with higher statistical power, the results add to the evidence base that environmental programs can achieve policy-relevant gains in program performance through a series of small changes to the decision environment.     

Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer’s type in the US

Abstract

Objective:

This study evaluates the cost-effectiveness of memantine extended release (ER) as an add-on therapy to acetylcholinesterase inhibitor (AChEI) [combination therapy] for treatment of patients with moderate-to-severe Alzheimer’s disease (AD) from both a healthcare payer and a societal perspective over 3 years when compared to AChEI monotherapy in the US.     

Economic impact of expanded use of biologic therapy for the treatment of rheumatoid arthritis and Crohn’s disease in Argentina,Brazil, Colombia,and Mexico

Objectives: To estimate economic impact resulting from increased biologics use for treatment of rheumatoid arthritis (RA) and Crohn’s disease (CD) in Argentina, Brazil, Colombia, and Mexico.

Methods: The influence of increasing biologics use for treatment of RA during 2012–2022 and for treatment of CD during 2013–2023 was modeled from a societal perspective. The economic model incorporated current and projected medical, indirect, and drug costs and epidemiologic and economic factors. Costs associated with expanded biologics use for RA were compared with non-expanded use in Argentina, Brazil, Colombia, and Mexico. A similar analysis was conducted for CD in Brazil, Colombia, and Mexico.

Results: Accounting for additional costs of biologics and medical and indirect cost offsets, the model predicts that expanded use of biologics for patients with RA from 2012 to 2022 will result in cumulative net cost savings of ARS$2.351 billion in Argentina, R$9.004 billion in Brazil, COP$728.577 billion in Colombia, and MXN$18.02 billion in Mexico; expanded use of biologics for patients with CD from 2013 to 2023 will result in cumulative net cost savings for patients with CD of R$0.082 billion in Brazil, COP$502.74 billion in Colombia, and MXN$1.80 billion in Mexico. Indirect cost offsets associated with expanded biologics use were a key driver in reducing annual per-patient net costs for RA and CD.

Limitations: Future economic projections are limited by the potential variance between projected and actual future values of biologic prices, wages, medical costs, and gross national product for each country.

Conclusions: Increasing biologics use to treat RA and CD may limit cost growth over time by reducing medical and indirect costs. These findings may inform policy decisions regarding biologics use in Argentina, Brazil, Colombia, and Mexico.     

Using stochastic frontier models to mitigate omitted variable bias in hedonic pricing models: A case study for air quality in Bogotá, Colombia

Hedonic pricing models use property value differentials to value changes in environmental quality. If unmeasured quality attributes of residential properties are correlated with an environmental quality measure of interest, conventional methods for estimating implicit prices will be biased. Because many unmeasured quality measures tend to be asymmetrically distributed across properties, it may be possible to mitigate this bias by estimating a heteroskedastic frontier regression model. This approach is demonstrated for a hedonic price function that values air quality in Bogotá, Colombia.     

Urban–rural income disparities and development in a panel data set of China for the period from 1978 to 2006

We examine the relationship between urban–rural income disparities and development in a panel data set of 30 provinces and regional subsets of China during the period of 1978 to 2006. There is an inverted-U relationship between the urban–rural income gap and per capita Gross Domestic Product (GDP). Financial development by scale widens the urban–rural income gap in all regional samples, while financial sector efficiency and rural bank loans may reduce it in some regions. Government spending raises the urban–rural income gap as well. We also examine the effects of urbanization, openness and education.     

Healthcare costs for Crohn’s disease patients treated with infliximab: a propensity weighted comparison of the effects of treatment adherence

Objective:

The objective for the research was to evaluate the direct healthcare costs for Crohn’s disease (CD) patients categorized by adherence status.

Methods:

Adult patients with ≥1 claim for infliximab and ≥2 claims for CD who were continuously insured for 12 months before and after their first infliximab infusion (index date) were identified in a 2006–2009 US managed care database. Patients were excluded if they had rheumatoid arthritis claims, received infliximab billed as a pharmacy benefit, or received another biologic drug. Patients were categorized as being either adherent or intermittently adherent to infliximab using a pre-defined algorithm. Total and component direct costs, CD-related costs, rates of surgery, and days of hospitalization were estimated for the 360-day post-index period. Propensity weighted generalized linear models were used to adjust the cost estimates for potential confounding variables.

Results:

The total propensity weighted cost for infliximab adherent patients was $40,425 (95% CI?=?[$38,686, $42,242]), compared to $41,082 (95% CI?=?[$38,163, $44,223]) for the intermittently adherent (p?=?0.71). However, adherent patients had lower total direct medical costs, exclusive of infliximab, that were $13,097 (95% CI?=?[$12,141, $14,127]) compared with $20,068 (95% CI?=?[$17,676, $22,784]) for intermittently adherent patients as a result of substantially lower hospital and outpatient costs (p?Conclusions:

Greater drug-related costs for infliximab adherent patients were offset by lower costs from hospitalization and outpatient visits. These findings indicate that adherent patients have improved clinical outcomes, at a similar aggregate cost, than patients who are only intermittently adherent to therapy.     

A Return to ‘Civilisational Geopolitics’ in the Mediterranean? Changing Geopolitical Images of the European Union and Turkey in the Post-Cold War Era

The prevalence of the discourse of ideological geopolitics during the Cold War meant that both Turkey and the EU belonged to the West by virtue of their ideological orientation. In the absence of this prevalent geopolitical discourse, both the EU and Turkey have spent the 1990s trying to locate themselves geographically. Drawing on the literature on critical approaches to political geography and international relations, this article seeks to answer the question of whether the EU's post-Cold War security discourse on the Mediterranean in general and on relations with Turkey in particular point to a return to the earlier discourse of civilisational geopolitics. The article also presents a reading of Turkish policy makers’ attempts to resist EU's representation of Turkey in ‘non-Europe’ (as with the ‘Middle East’ or the ‘Mediterranean’) as boundary-producing practices which have served to underline the boundaries between the ‘West’ and the ‘non-West’.     

A DEA study to evaluate the relative efficiency and investigate the reorganization of the credit department of farmers’ associations in Taiwan

In this study data envelopment analysis models were applied to evaluate the relative efficiencies of the credit departments of farmers’ associations (CDFAs) in Taiwan. The findings show that the overall efficiency scores are not best and scale for CDFAs in Taiwan is relative small. It implies that the reorganization of the CDFAs may be appropriate if more efficient organization is to be pursued. Thus, this study investigated CDFAs reorganization to increase the efficiency. The proposed CDFAs reorganization alternatives have higher average efficiency scores than the current CDFAs.