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

Michela Tinelli; Mandy Ryan; Christine Bond

doi:10.1186/s13561-016-0108-4

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

Michela Tinelli^* (Corresponding Author), Mandy Ryan, Christine Bond

^*Corresponding author for this work

London School of Economics and Political Science

Research output: Contribution to journal › Article › peer-review

20 Citations (Scopus)

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Abstract

Background: Economic evaluation focuses on Quality-Adjusted-Life-Years (QALYs) as the main valuation method. However, it is well known that factors beyond health related quality of life are important to patients and the public. Whilst discrete-choice-experiments (DCE) have been extensively used to value such factors, their incorporation within an economic evaluation framework is limited. This study is the first to incorporate patient preferences for factors beyond QALYs into an economic evaluation and compare results with the standard cost-per-QALY approach, using randomised-controlled-trial (RCT) participants.
Methods: Costings, clinical-effectiveness (appropriateness-of-treatment), QALYs and patient satisfaction data were collected at baseline and 12-month follow-up for a new pharmacy-service within a randomised-controlled-trial. Trial participants who replied to the follow-up survey and had not subsequently withdrawn from the study were mailed a DCE questionnaire at 24-months. WTP for the standard and new service was derived from the DCE. Results from QALYs and the DCE were compared.
Results: At 12 months, costs, clinical-effectiveness and QALYs did not differ between the intervention and control; however there was a significant increase in satisfaction in the intervention. The DCE valued this increased satisfaction in the intervention (positive net-benefit). The longer the time patients experienced the new service the greater the reported net-benefit.
Conclusion: When incorporating a DCE into an economic evaluation a number of questions are raised: what factors should be valued, whose values (trial-groups vs. all–trial-population) and when should they be elicited (still-receiving-the-intervention or afterwards). Consideration should also be given to status quo bias.

Original language	English
Article number	31
Number of pages	9
Journal	Health Economics Review
Volume	6
DOIs	https://doi.org/10.1186/s13561-016-0108-4
Publication status	Published - 29 Jul 2016

Bibliographical note

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.

Keywords

economic evaluation
discrete choice experiment (DCE)
willingness to pay (WTP)
quality adjusted life year (QALY)
cost-benefit analysis (CBA)
randomised controlled trial (RCT)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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What, who and when? Incorporating a discrete choice experiment into an economic evaluation
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Christine Bond
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Emeritus Professor
Person: Honorary
Mandy Ryan
- School of Medicine, Medical Sciences & Nutrition, Health Economics Research Unit - Director of H E R U
- Institute of Applied Health Sciences
Person: Academic

Cite this

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abstract = "Background: Economic evaluation focuses on Quality-Adjusted-Life-Years (QALYs) as the main valuation method. However, it is well known that factors beyond health related quality of life are important to patients and the public. Whilst discrete-choice-experiments (DCE) have been extensively used to value such factors, their incorporation within an economic evaluation framework is limited. This study is the first to incorporate patient preferences for factors beyond QALYs into an economic evaluation and compare results with the standard cost-per-QALY approach, using randomised-controlled-trial (RCT) participants. Methods: Costings, clinical-effectiveness (appropriateness-of-treatment), QALYs and patient satisfaction data were collected at baseline and 12-month follow-up for a new pharmacy-service within a randomised-controlled-trial. Trial participants who replied to the follow-up survey and had not subsequently withdrawn from the study were mailed a DCE questionnaire at 24-months. WTP for the standard and new service was derived from the DCE. Results from QALYs and the DCE were compared. Results: At 12 months, costs, clinical-effectiveness and QALYs did not differ between the intervention and control; however there was a significant increase in satisfaction in the intervention. The DCE valued this increased satisfaction in the intervention (positive net-benefit). The longer the time patients experienced the new service the greater the reported net-benefit. Conclusion: When incorporating a DCE into an economic evaluation a number of questions are raised: what factors should be valued, whose values (trial-groups vs. all–trial-population) and when should they be elicited (still-receiving-the-intervention or afterwards). Consideration should also be given to status quo bias. ",

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AU - Bond, Christine

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N2 - Background: Economic evaluation focuses on Quality-Adjusted-Life-Years (QALYs) as the main valuation method. However, it is well known that factors beyond health related quality of life are important to patients and the public. Whilst discrete-choice-experiments (DCE) have been extensively used to value such factors, their incorporation within an economic evaluation framework is limited. This study is the first to incorporate patient preferences for factors beyond QALYs into an economic evaluation and compare results with the standard cost-per-QALY approach, using randomised-controlled-trial (RCT) participants. Methods: Costings, clinical-effectiveness (appropriateness-of-treatment), QALYs and patient satisfaction data were collected at baseline and 12-month follow-up for a new pharmacy-service within a randomised-controlled-trial. Trial participants who replied to the follow-up survey and had not subsequently withdrawn from the study were mailed a DCE questionnaire at 24-months. WTP for the standard and new service was derived from the DCE. Results from QALYs and the DCE were compared. Results: At 12 months, costs, clinical-effectiveness and QALYs did not differ between the intervention and control; however there was a significant increase in satisfaction in the intervention. The DCE valued this increased satisfaction in the intervention (positive net-benefit). The longer the time patients experienced the new service the greater the reported net-benefit. Conclusion: When incorporating a DCE into an economic evaluation a number of questions are raised: what factors should be valued, whose values (trial-groups vs. all–trial-population) and when should they be elicited (still-receiving-the-intervention or afterwards). Consideration should also be given to status quo bias.

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KW - quality adjusted life year (QALY)

KW - cost-benefit analysis (CBA)

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DO - 10.1186/s13561-016-0108-4

M3 - Article

SN - 2191-1991

VL - 6

JO - Health Economics Review

JF - Health Economics Review

M1 - 31

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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Christine Bond

Mandy Ryan

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