Patient Preferences and Willingness to Pay for Cervical Cancer Prevention in Zambia: Protocol for a Multi-Cohort Discrete Choice Experiment

e17509 Background: As patient-centered care becomes more prominent, a better understanding of patient preferences and tradeoffs amongst treatment alternatives and outcomes is needed. This study used a discrete choice experiment to examine the preferences and willingness to pay for prophylactic G-CSF to decrease the incidence of chemotherapy (CT)-induced febrile neutropenia in breast cancer patients who previously received CT. Methods: An online survey was developed with 16 paired treatment choice scenarios comparing 3 alternative G-CSF options (11 versus 1 or 6 versus 1 injections per CT cycle) with a follow-up “no treatment” option. Each scenario had 4 attributes: risk of disruption to CT schedule due to neutropenia, risk of infection requiring hospitalization, frequency of G-CSF administration, and total out-of-pocket (OOP) cost for G-CSF during a CT cycle. Patients’ preferences and willingness to pay (as OOP cost) were estimated using logistic regression. Results: Patients’ (n = 296) preferred G-CSF options with the lowest OOP costs, the fewest injections, and improved outcomes (lowest risk of disruption to CT schedule and lowest risk of infection requiring hospitalization). In the context of this discrete choice experiment, OOP costs and risk of disruption to CT schedule were the most important attributes to patients; risk of infection requiring hospitalization and frequency of G-CSF administration affected patients’ choice of G-CSF option to a smaller but similar degree. Patients were willing to pay OOP $1,076 per cycle to reduce the risk of disrupting the CT schedule from high to low, $884 per cycle to reduce the risk of developing an infection requiring hospitalization from 24% (high) to 7% (low), and $851 and $667 per cycle to decrease the number of G-CSF injections per cycle from 11 to 1 and 6 to 1, respectively. Conclusions: With a current focus on patient-centered approaches in decision-making, physicians need to consider patient preferences when making decisions about therapy, including supportive care agents.

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Patient preferences for management of high blood pressure in the UK: a discrete choice experiment

British Journal of General Practice ◽

10.3399/bjgp19x705101 ◽

2019 ◽

Vol 69 (686) ◽

pp. e629-e637 ◽

Cited By ~ 1

Author(s):

Benjamin Fletcher ◽

Lisa Hinton ◽

Richard McManus ◽

Oliver Rivero-Arias

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Willingness To Pay ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Models Of Care ◽

Self Management ◽

The Uk

BackgroundWith a variety of potentially effective hypertension management options, it is important to determine how patients value different models of care, and the relative importance of factors in their decision-making process.AimTo explore patient preferences for the management of hypertension in the UK.Design and settingOnline survey of patients who have hypertension in the UK including an unlabelled discrete choice experiment (DCE).MethodA DCE was developed to assess patient preferences for the management of hypertension based on four attributes: model of care, frequency of blood pressure (BP) measurement, reduction in 5-year cardiovascular risk, and costs to the NHS. A mixed logit model was used to estimate preferences, willingness-to-pay was modelled, and a scenario analysis was conducted to evaluate the impact of changes in attribute levels on the uptake of different models of care.ResultsOne hundred and sixty-seven participants completed the DCE (aged 61.4 years, 45.0% female, 82.0% >5 years since diagnosis). All four attributes were significant in choice (P<0.05). Reduction in 5-year cardiovascular risk was the main driver of patient preference as evidenced in the scenario and willingness-to-pay analyses. GP management was significantly preferred over self-management. Patients preferred scenarios with more frequent BP measurement, and lower costs to the NHS.ConclusionParticipants had similar preferences for GP management, pharmacist management, and telehealth, but a negative preference for self-management. When introducing new models of care for hypertension to patients, discussion of the potential benefits in terms of risk reduction should be prioritised to maximise uptake.

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Patient Preferences and Willingness to Pay for Cervical Cancer Prevention in Zambia: Protocol for a Multi-Cohort Discrete Choice Experiment (Preprint)

10.2196/preprints.10429 ◽

2018 ◽

Author(s):

Sujha Subramanian ◽

Yevgeniya Kaganova ◽

Yuying Zhang ◽

Sonja Hoover ◽

Namakau Nyambe ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Willingness To Pay ◽

Cervical Cancer Screening ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Sub Saharan Africa ◽

Screening Programs ◽

Sub Saharan

BACKGROUND Although most countries in southern Africa have cervical cancer screening programs, these programs generally fail to reach a significant majority of women because they are often implemented as pilot or research projects, and this limits their scope and ability to scale up screening. Some countries have planned larger-scale programs, but these have either never been implemented or have not been successfully scaled up. Most of the global burden of cervical cancer is experienced in countries with limited resources, and mortality from cervical cancer is the most common cause of cancer-related deaths among women in Sub-Saharan Africa. OBJECTIVE The purpose of this study is to learn about preferences for cervical cancer screening in Zambia, to identify barriers and facilitators for screening uptake, and to evaluate willingness to pay for screening services to support the scaling up of cervical cancer screening programs. METHODS We will conduct a discrete choice experiment by interviewing women and men and asking them to choose among constructed scenarios with varying combinations of attributes relevant to cervical cancer screening. To inform the discrete choice experiment, we will conduct focus groups and interviews about general knowledge and attitudes about cervical screening, perception about the availability of screening, stigma associated with cancer and HIV, and payment for health care services. For the discrete choice experiment, we will have a maximum design of 120 choice sets divided into 15 sets of 8 tasks each with a sample size of 320-400 respondents. We will use a hierarchical Bayesian estimation procedure to assess attributes at the following two levels: group and individual levels. RESULTS The model will generate preferences for attributes to assess the most important features and allow for the assessment of differences among cohorts. We will conduct policy simulations reflecting potential changes in the attributes of the screening facilities and calculate the projected changes in preference for choosing to undergo cervical cancer screening. The findings from the discrete choice experiment will be supplemented with interviews, focus groups, and patient surveys to ensure a comprehensive and context-based interpretation of the results. CONCLUSIONS Because willingness to pay for cervical cancer screening has not been previously assessed, this will be a unique and important contribution to the literature. This study will take into account the high HIV prevalence in Sub-Saharan Africa and prevailing gender attitudes to identify an optimal package of interventions to reduce cervical cancer incidence. This simulation of women’s decisions (and men’s support) to undergo screening will lay the foundation for understanding the stated preferences and willingness to pay to help design future screening programs. REGISTERED REPORT IDENTIFIER RR1-10.2196/10429

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Patient preferences and willingness-to-pay for ADHD treatment with stimulants using discrete choice experiment (DCE) in Sweden, Denmark and Norway

Nordic Journal of Psychiatry ◽

10.3109/08039488.2012.748825 ◽

2012 ◽

Vol 67 (5) ◽

pp. 351-359 ◽

Cited By ~ 16

Author(s):

Anna H. Glenngård ◽

Jonas Hjelmgren ◽

Per Hove Thomsen ◽

Torbjörn Tvedten

Keyword(s):

Willingness To Pay ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Adhd Treatment

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Patient preferences for specialist outpatient video consultations: A discrete choice experiment

Journal of Telemedicine and Telecare ◽

10.1177/1357633x211022898 ◽

2021 ◽

pp. 1357633X2110228

Author(s):

Centaine L Snoswell ◽

Anthony C Smith ◽

Matthew Page ◽

Liam J Caffery

Keyword(s):

General Practitioner ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Healthcare Delivery ◽

General Practitioner Practice ◽

Specialist Care ◽

Time Away ◽

Out Of Pocket Costs

Introduction Telehealth has been shown to improve access to care, reduce personal expenses and reduce the need for travel. Despite these benefits, patients may be less inclined to seek a telehealth service, if they consider it inferior to an in-person encounter. The aims of this study were to identify patient preferences for attributes of a healthcare service and to quantify the value of these attributes. Methods We surveyed patients who had taken an outpatient telehealth consult in the previous year using a survey that included a discrete choice experiment. We investigated patient preferences for attributes of healthcare delivery and their willingness to pay for out-of-pocket costs. Results Patients ( n = 62) preferred to have a consultation, regardless of type, than no consultation at all. Patients preferred healthcare services with lower out-of-pocket costs, higher levels of perceived benefit and less time away from usual activities ( p < 0.008). Most patients preferred specialist care over in-person general practitioner care. Their order of preference to obtain specialist care was a videoconsultation into the patient’s local general practitioner practice or hospital ( p < 0.003), a videoconsultation into the home, and finally travelling for in-person appointment. Patients were willing to pay out-of-pocket costs for attributes they valued: to be seen by a specialist over videoconference ($129) and to reduce time away from usual activities ($160). Conclusion Patients value specialist care, lower out-of-pocket costs and less time away from usual activities. Telehealth is more likely than in-person care to cater to these preferences in many instances.

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Patient preferences for use of virtual consultations in an orthopaedic rehabilitation setting: Results from a discrete choice experiment

Journal of Health Services Research & Policy ◽

10.1177/13558196211035427 ◽

2021 ◽

pp. 135581962110354

Author(s):

Anthony W Gilbert ◽

Emmanouil Mentzakis ◽

Carl R May ◽

Maria Stokes ◽

Jeremy Jones

Keyword(s):

Conceptual Model ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Best Practice ◽

Time Of Day ◽

Problem Area ◽

Fractional Factorial ◽

The Impact

Objective Virtual Consultations may reduce the need for face-to-face outpatient appointments, thereby potentially reducing the cost and time involved in delivering health care. This study reports a discrete choice experiment (DCE) that identifies factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting. Methods Previous research from the CONNECT (Care in Orthopaedics, burdeN of treatmeNt and the Effect of Communication Technology) Project and best practice guidance informed the development of our DCE. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. The design was divided into two blocks of eight scenarios each, to reduce the impact of cognitive fatigue. Data analysis were conducted using binary logit regression models. Results Sixty-one paired response sets (122 subjects) were available for analysis. DCE factors (whether the therapist is known to the patient, duration of appointment, time of day) and demographic factors (patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs) were significant predictors of preference. We estimate that a patient is less than 1% likely to prefer a virtual consultation if the patient has a degree, is without access to the equipment and software to undertake a virtual consultation, does not have difficulties with day-to-day activities, is undergoing rehabilitation for one problem area, has to pay less than £5 to travel, is having a consultation with a therapist not known to them, in 1 weeks’ time, lasting 60 minutes, at 2 pm. We have developed a simple conceptual model to explain how these factors interact to inform preference, including patients’ access to resources, context for the consultation and the requirements of the consultation. Conclusions This conceptual model provides the framework to focus attention towards factors that might influence patient preference for virtual consultations. Our model can inform the development of future technologies, trials, and qualitative work to further explore the mechanisms that influence preference.

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