A discrete choice experiment to determine patient preferences for injection devices in multiple sclerosis

Abstract

Objective:

Relapsing-remitting multiple sclerosis (MS) is usually managed with disease modifying drugs (DMDs), most commonly administered via self-injection. The aim of this study was to estimate the influence that different treatment-related attributes have for MS patients on their choice of MS DMD device. By establishing the relative importance of these characteristics for patients it should be possible to better understand the acceptability of a given device and to optimize the development of future devices.

Methods:

A discrete choice experiment (DCE) survey was developed on the basis of a review of published literature. Attributes identified for inclusion in the survey were: ease of use; comfort of use; presence of additional functions, needle visibility; practicality and efficacy. Choice sets were presented as pairs of hypothetical treatments based upon a fractional factorial design. One-hundred device-using MS patients completed the survey online. Analysis was conducted using a mixed-logit approach.

Results:

Analysis of the DCE data revealed that all attributes significantly predicted treatment choice. Efficacy exhibited the largest effect on treatment selection and this provided context for understanding the magnitude of impact for the other attributes. Reducing the discomfort associated with device use and eliminating the necessity for assembly or drug reconstitution were highly valued. The addition of reminder and time-stamping functions, improved needlestick injury prevention, and reduction in device size were secondary concerns but still deemed desirable.

Conclusion:

Efficacy is of primary importance to MS patients, but characteristics of drug delivery devices can play an important role in treatment decision-making. Not all device characteristics could be included, and results are based upon 100 participants only. Findings suggest there is significant potential value in developing self-injection devices that are not only efficacious but also convenient and comfortable to use. Reducing barriers to adherence could potentially translate into improved treatment outcomes for patients with MS.     

A discrete-choice experiment to assess treatment modality preferences of patients with depression

Aims: There is an increasing interest in understanding patients’ preferences in the area of healthcare decision-making to better match treatment with patients’ preferences and improve treatment uptake and adherence. The aim of this study was to elicit the preferences of patients with a depressive disorder regarding treatment modalities.

Materials and methods: In a discrete-choice experiment, patients chose repetitively between two hypothetical depression treatments that varied in four treatment attributes: waiting time until the start of treatment, treatment intensity, level of digitalization, and group size. A Bayesian-efficient design was used to develop 12 choice sets, and patients’ preferences and preference variation was estimated using a random parameters logit model.

Results: A total of 165 patients with depression completed the survey. Patients preferred short (over long) waiting times, face-to-face (over digital) treatment, individual (over group) treatment, and one session per week over two sessions per week or one session per 2 weeks. Patients disfavoured digital treatment and treatment in a large group. Waiting time and treatment intensity were substantially less important attributes to patients than face-to-face (vs digital) and group size. Significant variation in preferences was observed for each attribute, and sub-group analyses revealed that these differences were in part related to education.

Limitations: The convenience sample over-represented the female and younger population, limiting generalizability. Limited information on background characteristics limited the possibilities to explore preference heterogeneity.

Conclusion: This study demonstrated how different treatment components for depression affect patients’ preferences for those treatments. There is significant variation in treatment preferences, even after accounting for education. Incorporating individual patients’ preferences into treatment decisions could potentially lead to improved adherence of treatments for depressive disorders.     

A critique of the new comparative economics

We examine the “new comparative economics” as proposed by Djankov et al. (2003) and their use of the concept of an institutional possibilities frontier. While we agree with their general argument that one must consider a variety of institutions and their respective social costs, including legal systems and cultural characteristics, when comparing the performance of different economic systems, we find various complications and difficulties with the framework they propose. We propose that a broader study of clusters of institutions and such newly emerging forms as the new traditional economy may be better suited as ways to approach the study of comparative economics in the era after the breakdown of the old comparison of market capitalism and command socialism that came to an end with the breakup of the Soviet Union.

A discrete-choice experiment to assess treatment modality preferences of patients with anxiety disorder

Aims: The aim of this study was to elicit the preference of patients with an anxiety disorder regarding treatment modalities. Understanding patients’ preferences could help optimize treatment uptake and adherence to therapeutic interventions.

Materials and methods: A discrete-choice experiment was used to elicit patients’ preferences with regard to four treatment characteristics: waiting time until first treatment, intensity of treatment, face-to-face vs digital treatment, and group size. In 12 choice sets, participants were asked to choose between two treatment alternatives. A random parameters logit model was used to analyse the data.

Results: A total of 126 participants, aged 18?years and older, currently or in the previous year in treatment for an anxiety disorder, completed the survey. Respondents preferred short (over long) waiting times, face-to-face (over digital) treatment, individual (over group) treatment and a treatment intensity of one session per week rather than two sessions per week or one session every two weeks. Waiting time and treatment intensity were substantially less important to patients than level of digitalization and group size. Heterogeneity in preference was significant for each attribute, and sub-group analyses revealed this was partly related to education level and age.

Limitations: The convenience sample over-represented the female and younger population, limiting generalizability. Limited information on background characteristics limited the possibilities to explore preference heterogeneity.

Conclusions: This study demonstrated how different treatment components for anxiety disorders affect patients’ preferences for those treatments. There is significant variation in treatment preferences, even after accounting for age and education. Incorporating patients’ preferences into treatment decisions could potentially lead to improved adherence of treatments for anxiety disorders.     

Job preferences of students and new graduates in nursing

This article investigates the preferences of student and newly graduated nurses for pecuniary and nonpecuniary aspects of nursing jobs. It is the first study applying methods based on discrete choice experiments to a developed country nursing workforce. It is also the first to focus on the transition through university training and into work. This is particularly important as junior nurses have the lowest retention levels in the profession. We sample 526 individuals from nursing programmes in two Australian universities. Flexible and newly developed models combining heteroscedasticity with unobserved heterogeneity in scale and preference weights are estimated. Overall, salary remains the most important feature in increasing the probability that a job will be selected. ‘Supportive management/staff’ and ‘quality of care’ follow as the most important attributes from a list of 11 nonpecuniary characteristics. However, the subset of new graduates rank ‘supportive management/staff’ above salary increases, emphasizing the importance of a supportive workplace in the transition from university to the workplace. We find substantial preference heterogeneity and some attributes, such as the opportunity for clinical rotations, are found to be attractive to some nurses while seen as negative by others. Nursing retention could be improved by designing different employment packages to appeal to these different tastes.     

Societal preferences for fertility treatment in Australia: a stated preference discrete choice experiment

Objective: To investigate preferences for fertility treatment from the Australian general population with the aims of calculating the willingness to pay in tax contribution for attributes (characteristics) that make up treatment and for an “ideal” fertility treatment program. We also assessed whether willingness-to-pay varies by the relationship status or sexual orientation of the patient.

Methods: A stated preference discrete choice experiment was administered to a panel of 801 individuals representative of the Australian general population. Seven attributes of fertility treatment under three broad categories were included: outcome, process, and cost. Attributes were identified through published literature, focus group discussions, expert knowledge, and a pilot study. A Bayesian fractional experimental design was used, and data analysis was performed using a generalized multinomial logit model. Further analyses included interaction terms and latent class modeling.

Results: Six of the seven attributes influenced the choice of a treatment program. Under process attributes, individuals preferred: continuity of care of clinic staff, where patients are seen by the same doctor but different nurses at each visit; “alternative” treatments being offered to all patients; and onsite clinic counseling and peer-support groups. Personalization and tailoring of the treatment journey were not important. Among outcome attributes, the improved success rate of having a baby per cycle and significant side-effects were considered important. Cost of treatment also influenced the choice of treatment program. Individual preferences for fertility treatment were not associated with patients’ relationship status or sexual orientation. Latent class modeling revealed sub-groups with distinct fertility treatment preferences.

Conclusion: This study provides important insights into the attributes that influence the preferences of fertility treatment in Australia. It also estimates socially-inclusive willingness-to-pay values in tax contributions for an “ideal” package of treatment. The results can inform economic evaluations of fertility treatment programs.     

A Comparison of Value Elicitation Question Formats in Multiple-Good Contingent Valuation

This paper provides a convergent validity test of two types of multinomial choice questions vis-a-vis a dichotomous choice question by formally testing whether these stated preference elicitation question formats provide comparable welfare estimates. In particular, a dichotomous choice question, a traditional multinomial choice question, and a modified multinomial choice question suggested by Carson and Groves （2007） were applied in split samples to assess the influence of the informational and incentive properties on the respondents＇ annual willingness to accept compensation for adopting costly conservation practices in agriculture that benefit the environment. Our findings suggest that the two multinomial choice question formats elicit a similar mean willingness to accept distributions, but they are both different from a standarddichotomous choice question. Further, the willingness to accept distributions derived from the multinomial choice question formats are more dispersed than those from the dichotomous choice question.     

Teacher training for PhD students and new faculty in economics

Past studies suggest that a majority of economics graduate students engage in teaching-related activities during graduate school and many go on to academic positions afterwards. However, not all graduate students are formally prepared to teach while in graduate school nor are they fully prepared to teach in their first academic position. The authors characterize current teaching experience and training of graduate students from the point of view of directors of graduate studies and of newly minted academic economists. The authors also query department chairs and new faculty about teacher training, support available for new faculty, and the degree to which newly hired Ph.D. economists are prepared to teach. Findings indicate that while some training is available, there is room for enhancing teacher training in economics.     

北京城镇居民对不同猪肉质量安全特征的消费偏好和支付意愿

利用针对北京市城镇居民的问卷调查数据,运用选择实验法,采用多元条件Logit模型实证分析了消费者对生鲜猪肉的不同质量安全特征的偏好和支付意愿。结果表明:对猪肉产品的不同质量安全特征进行标识有助于提高消费者的效用水平;北京市城镇居民对生鲜猪肉建立质量安全可追溯体系的偏好和支付意愿最高,其次是生鲜猪肉通过产品质量安全认证、柔嫩度较好,对生鲜猪肉具有无瘦肉精和兽药残留的质量安全标识的偏好和支付意愿最低。据此提出:中国应加强生鲜猪肉质量安全可追溯体系建设;政府监管部门应规范农产品质量安全标识的申请和使用行为,确保农产品生产者进行安全生产,确保质量安全标识制度的有效实施。     

A discrete choice experiment to determine UK patient preference for attributes of disease modifying treatments in Multiple Sclerosis

Aims: The recent licensing of Disease Modifying Treatments (DMTs) for Multiple Sclerosis (MS) has increased available treatment options. The aim of this study was to explore MS patients’ preference for the different attributes of DMTs in the UK.

Materials and methods: Attributes (treatment characteristics) for inclusion in the discrete choice experiment (DCE) were determined through published literature and interviews with 12 people with MS. Seven attributes were selected. Participants were presented with three hypothetical treatment options sampled from included attributes and asked for their most/least preferred options. The influence of patient characteristics and demographics on patient preference was also investigated.

Results: The DCE was completed by 350 people with MS (81% female, mean age?=?39). Results showed that method of taking medication was the strongest determinant of preference (27%; relative importance out of 100%), followed by relapse free rate (21%) and symptom progression (14%). Risk of fatigue (8%) and type of monitoring (6%) were the weakest determinants of preference. Once-daily oral treatment was preferred over all other methods of administration. Participant characteristics did not influence data on strength of preference.

Limitations: This study assumed adequate participant understanding of the discrete choice experiment task, and recruitment targeted those with access to the internet.

Conclusions: These results, derived from people with MS in the UK, should be used to inform individual discussions with patients about DMT choices.     

An Analytical Framework for Joint vs Separate Decisions by Couples in Choice Experiments: The Case of Coastal Water Quality in Tobago

This paper offers an analytical framework for analyzing joint and separate decisions by couples in the context of choice experiments for nonmarket valuation. It reports results from an attribute-based stated preference study in which members of couples are asked to conduct a choice-experiment first individually and then jointly. The choice context was the selection of which beach to visit while on vacation in Tobago. Available alternatives differed in attributes related to coastal water and beach quality such as level of coastal development and fish abundance. Tests of preference equality are reported and structured so as to identify the intra-couple decision-making patterns under taste heterogeneity with both finite and continuous mixed logit. Results from the latter suggest that women’s preferences are found to be predominant in the joint choice-experiment. Results suggest caution in using individual choice rather than joint couple choice when valuing quality changes impacting on couple activities, such as water and beach quality in Tobago, and call for further research on the topic.     

长株潭新农村景观偏爱模型研究——以长沙光明村为例

通过调查光明村的村民及游客对其现有景观的评价,运用数学中多元回归法原理,建立适合于新农村景观评价的方法一景观偏爱模型。应用此模型计算出光明村村落及村野景观偏爱值核心区间,能为今后新农村建设中景观规划设计时提供参考。     

Patients’ preferences for the treatment of anxiety and depressive disorders: a systematic review of discrete choice experiments

Abstract

Introduction: Matching available mental health services to patients’ preferences, as well as is possible, may increase patient satisfaction and help increase adherence to certain treatments. This study systematically reviewed discrete-choice experiments (DCEs) on patients’ preferences for treatment of depressive and anxiety disorders and assessed the relative importance of outcome, process and cost attributes to improve the current and future treatment situations.

Methods: A systematic literature review using PubMed, EMBASE and PsychInfo was conducted to retrieve all relevant DCEs published up to 15 April 2019, eliciting patient preferences for treatment of depressive and anxiety disorders. Data were extracted using an extraction sheet, and attributes were classified into outcome, process and cost attributes. The relative importance of each attribute category was then assessed, and studies were evaluated according to their reporting quality, using validated checklists.

Results: A total of 11 studies were identified for qualitative analysis. All studies received an aggregate score of 4 on the five-point PREFS checklist (Purpose, Respondents, Explanation, Findings and Significance). Most attributes were outcome related (52%), followed by process (42%) and cost (6%) attributes. Comparing the attribute categories and summing up the relative importance weights for each category within the studies, process attributes were ranked as most important, followed by cost and outcome attributes.

Conclusions: In this systematic review, heterogeneous results were observed regarding the inclusion and framing of different attributes across studies. Overall, patients considered process and cost attributes to be more important than outcome attributes. Outcomes and process are important for patients, and thus clinicians should be particularly aware of this and take patients’ preferences into account, although the attribute importance may depend on chosen attributes and related levels.     

Testing for Utility Maximization with Error and the Loss of Power

A procedure is suggested to decide whether or not to treat a consumer who violates the Generalized Axiom of Revealed Preference as ‘close enough’ to utility maximization. It is based on the reduction of the power the test has against random behaviour. It can also be used to compare different efficiency indices.     

A new definition and framework for the development of a national technology strategy: The case of nanotechnology for Iran

In this research, we use the concepts of “national technology policy” as well as the “firm technology strategy” in defining a new definition for “national technology strategy”. Then, by examining several national technology strategies in a variety of fields in different countries the national nanotechnology strategy for Iran is developed. Furthermore, using capability-effectiveness matrix and SWOT analysis we identify strategies of nanotechnology development in Iran. Finally, considering other countries' strategies and the results of PROMETHEE Method, we prioritize different areas of nanotechnology for Iranian economy, and test for the validity of the extracted strategies.     

Technology roadmapping in review: A tool for making sustainable new product development decisions

Typically, firms decide whether or not to develop a new product based on their resources, capabilities and the return on investment that the product is estimated to generate. We propose that firms adopt a broader heuristic for making new product development choices. Our heuristic approach requires moving beyond traditional finance-based thinking, and suggests that firms concentrate on technological trajectories by combining technology roadmapping, information technology (IT) and supply chain management to make more sustainable new product development decisions. Using the proposed holistic heuristic methods, versus relying on traditional finance-based decision-making tools (e.g., emphasizing net present value or internal rate of return projections), enables firms to plan beyond the short-term and immediate set of technologies at hand. Our proposed heuristic approach enables firms to forecast technologies and markets, and hence, new product priorities in the longer term. Investments in new products should, as a result, generate returns over a longer period than traditionally expected, giving firms more sustainable investments. New products are costly and need to have a durable presence in the market. Transaction costs and resources will be saved, as firms make new product development decisions less frequently.     

超声联合核磁共振检查诊断乳腺癌的效率及经济性分析

目的：结合病理组织学探讨联合应用彩色超声成像和核磁共振（MRI）对乳腺癌的诊断价值。方法：回顾性分析经手术或组织学活检病理证实的74例乳腺癌患者（97个病灶）及良性肿块70例患者（75个病灶）的术前彩色超声成像及核磁共振检查资料,比较两种检查方法及联合应用的诊断效率,同时与病理组织学结果对照。结果：超声、核磁共振及两者联合应用,对乳腺癌诊断的敏感性分别为76．3％、82．5％和87．6％,特异性分别为92．0％、88．0％和96．0％,符合率分别为83．1％、84．9％和91．3％,统计学分析比较无显著性差异（P〉0．05）。两种检查方法及联合应用的经济性分析显示,采用超声检查,其费用支出仅为MRI的约1／10,为联合应用法的约1／11;如都实施穿刺病理检查,则超声穿刺法的费用支出较MRI或联合法节约一半以上。结论：超声、核磁共振检查对乳腺癌的诊断都具有较高的特异性和敏感性,而联合检查可以有效地提高符合率。考虑到经济性效率,采用超声结合病理穿刺诊断乳腺癌更适于高危人群筛查。     

The role of risk and risk-aversion in adoption of alternative marketing arrangements by the US farmers

The objective of this article is to analyse the relationship between farmers’ risk-aversions and the riskiness of various agricultural enterprises to see which marketing arrangements would typically emerge. Relying on the basic agency theory model, we hypothesize the prevalence of alternative marketing arrangements (AMAs) in situations with high risk-averse farmers and high-risk enterprises and the prevalence of spot (cash) markets for low risk-averse participants and less risky enterprises. Our empirical tests are carried out using the 2004 Agricultural Resource Management Survey (ARMS). The empirical results are largely supportive of the agency theory of contract choice.     

Heterogeneity in preferences for redistribution and public spending: A cross-country analysis

Political coordination and policy outcomes may be the result not only of the position of the ‘median voter’ in a political scale but also of the heterogeneity of preferences around the median. Depending on the level of government and the type of policy, such heterogeneity may lead to lower public spending and redistribution. We assess this issue empirically by analyzing the relationship between the distribution of preferences for redistribution and the amount of public expenditure at different levels of government and for several types of spending in 23 European countries. Our results suggest a negative and significant correlation between heterogeneity of preferences for redistribution and public spending that is stronger at the local level and for redistributive functions, independent of the median individual's preferences.     

Anomalies and Stated Preference Techniques: A Framework for a Discussion of Coping Strategies

This paper introduces a symposium on the issue of how stated preference (SP) research can best cope with ‘anomalies’ (i.e. systematic deviations from the predictions of standard economic theory) in survey responses. It proposes a framework for constructive debate, recognising (i) the legitimate aspirations of SP research, (ii) the relevance of evidence from sources other than best-practice SP, and (iii) the precautionary value of investigating strategies for coping with suspected anomalies, even if questions about the robustness of anomalies have not been finally resolved. Five alternative coping strategies, discussed in more detail in the symposium, are briefly introduced. JEL classifications: D61, D63, Q51