Girls’ preferences for HPV vaccination: A discrete choice experiment

A discrete choice experiment was developed to investigate if girls aged 12–16 years make trade-offs between various aspects of human papillomavirus (HPV) vaccination, and to elicit the relative weight that girls’ place on these characteristics. Degree of protection against cervical cancer, protection duration, risk of side-effects, and age of vaccination, all proved to influence girls’ preferences for HPV vaccination. We found that girls were willing to trade-off 38% protection against cervical cancer to obtain a lifetime protection instead of a protection duration of 6 years, or 17% to obtain an HPV vaccination with a 1 per 750,000 instead of 1 per 150,000 risk of serious side-effects. We conclude that girls indeed made a trade-off between degree of protection and other vaccine characteristics, and that uptake of HPV vaccination may change considerably if girls are supplied with new evidence-based information about the degree of protection against cervical cancer, the protection duration, and the risk of serious side-effects.     

Parental preferences for HPV vaccination in junior middle school girls in China: A discrete choice experiment

BackgroundCervical cancer is the second most common cancer in Chinese women. Human papillomavirus (HPV) vaccines have not yet been introduced in the Chinese national immunization program, and people vaccinate voluntarily at their own expense. Therefore, it is important to study the factors that could impact parents' decisions for HPV vaccination.ObjectiveTo quantify parental preferences regarding HPV vaccination for junior middle school-aged girls.MethodA discrete choice experiment (DCE) survey was conducted to assess parents' preferences for HPV vaccines. Data were collected from parents of girls aged 12–16 years in 11 middle schools of Shandong Province. We evaluated preferences for five attributes of HPV vaccination (vaccine effectiveness, protection duration, risk of side effects, cost, and vaccination location). Conditional logit regressions were adopted for analyses.Results995 parents completed valid DCE questions. All attributes influenced parents’ willingness to vaccinate. Comparatively highly educated parents preferred more on higher vaccine effectiveness and lower side effects risks while more intended to accept higher prices. Parents were willing to trade 2326.32 CNY for an increase in HPV vaccine effectiveness from 50% to 90%. Nearly 70% percent of the respondents were predicted to prefer multiple improvements in HPV vaccination (protection increased from 70% to 95%, duration increased from 9 years to 15 years, and vaccination location changed from vaccination center to school) to the base case.ConclusionVarious vaccine characteristics and implementation strategies influence respondents’ preferences. Health education with evidence-based information about HPV vaccines would help parents make informed decisions. The findings can also assist agencies responsible for HPV vaccination implementation and cervical cancer prevention in China in decisions regarding vaccination financing and vaccine approval.     

Parental preferences for rotavirus vaccination in young children: A discrete choice experiment

Objective

This study aimed to identify characteristics that affect parental decisions about rotavirus vaccination, to determine the relative importance of those characteristics and subsequently to estimate vaccination coverage for different implementation strategies.

Methods

A Discrete choice experiment (DCE) questionnaire was sent to the parents of 1250 newborns aged 6 weeks (response rate 37.3%). Mixed-logit models were used to estimate the relative importance of the five included rotavirus vaccine and implementation characteristics; vaccine effectiveness, frequency of severe side effects, protection duration, the healthcare facility that administrates vaccination and out-of-pocket costs. Based on the utility functions of the mixed-logit model, the potential vaccination coverage was estimated for different vaccine scenarios and implementation strategies.

Results

All characteristics, except for healthcare facility that administrates vaccination, influenced parental willingness to vaccinate their newborn against rotavirus. Parents were willing to trade 20.2 percentage points vaccine effectiveness for the lowest frequency of severe side effects (i.e., 1 in 1,000,000) or 20.8 percentage points for a higher protection duration. Potential vaccination coverage ranged between 22.7 and 86.2%, depending on vaccine scenario (i.e., vaccine effectiveness and protection duration) and implementation strategy (i.e., out-of-pocket costs and healthcare facility that administrates vaccination).

Conclusions

When deciding about vaccination against rotavirus, parents are mostly driven by the out-of-pocket costs, vaccine effectiveness, protection duration, and frequency of severe side effects. The highest vaccination coverage is expected for a vaccine with high effectiveness and protection duration that is implemented within the current National Immunization Program context. Implementation of the same rotavirus vaccine in the free market will result in lowest coverage.     

The impact of vaccination and patient characteristics on influenza vaccination uptake of elderly people: A discrete choice experiment

ObjectivesTo improve information for patients and to facilitate a vaccination coverage that is in line with the EU and World Health Organization goals, we aimed to quantify how vaccination and patient characteristics impact on influenza vaccination uptake of elderly people.MethodsAn online discrete choice experiment (DCE) was conducted among 1261 representatives of the Dutch general population aged 60 years or older. In the DCE, we used influenza vaccination scenarios based on five vaccination characteristics: effectiveness, risk of severe side effects, risk of mild side effects, protection duration, and absorption time. A heteroscedastic multinomial logit model was used, taking scale and preference heterogeneity (based on 19 patient characteristics) into account.ResultsVaccination and patient characteristics both contributed to explain influenza vaccination uptake. Assuming a base case respondent and a realistic vaccination scenario, the predicted uptake was 58%. One-way changes in vaccination characteristics and patient characteristics changed this uptake from 46% up to 61% and from 37% up to 95%, respectively. The strongest impact on vaccination uptake was whether the patient had been vaccinated last year, whether s/he had experienced vaccination side effects, and the patient’s general attitude towards vaccination.ConclusionsAlthough vaccination characteristics proved to influence influenza vaccination uptake, certain patient characteristics had an even higher impact on influenza vaccination uptake. Policy makers and general practitioners can use these insights to improve their communication plans and information regarding influenza vaccination for individuals aged 60 years or older. For instance, physicians should focus more on patients who had experienced side effects due to vaccination in the past, and policy makers should tailor the standard information folder to patients who had been vaccinated last year and to patient who had not.     

Eliciting preferences for medical devices in South Korea: A discrete choice experiment

This study aims to identify the attributes that contribute to the value of medical devices and quantify the relative importance of them using a discrete choice experiment. Based on a literature review and expert consultation, seven attributes and their levels were identified—severity of disease (2), availability of substitutes (2), improvement in procedure (3), improvement in clinical outcomes (2), increase in survival (2), improvement in quality of life (3), and cost (4). Among 576 hypothetical profiles, optimal choice sets with 20 choices were developed and experts experienced in health technology assessment and reimbursement decision making in South Korea were surveyed. A total of 102 respondents participated in the survey. The results of the random-effect probit model showed that among the seven attributes, six, except for improvement in procedure, had a significant impact on respondents’ choices on medical devices. Respondents were willing to pay the highest amount for devices that provided substantial improvements in quality of life, followed by increased survival, improved clinical outcome, treatment without substitutes, and technology for treating severe diseases. The findings of this experiment will inform decision-makers of the relative importance of the criteria and help them in reimbursement decision making of medical devices.     

The effects of convenience and quality on the demand for vaccination: Results from a discrete choice experiment

BackgroundVaccination is an effective way to prevent infectious diseases. Most studies analysed people's vaccine decisions, but few studies have analysed the effects of convenience such as immunisation schedule and distance and the quality of vaccination service on vaccination uptake.ObjectiveThe aim of this paper was to investigate adults’ preferences for convenience and quality of vaccination service, calculate the private economic benefit from convenience (vaccination schedule and distance) and quality, and predict the uptake rate for different vaccine scenarios.MethodsIn our study, we interviewed 266 adults in 2 counties of Shandong province in China. The discrete choice experiment (DCE) was employed to analyse the preference for hepatitis B virus (HBV) vaccination, and a mixed logit model was used to estimate respondent preferences for vaccination attributes included in the DCE.ResultsThe protection rate against hepatitis B (HB), duration of protection, risk of side effects, vaccination cost, schedule, and vaccination sites were proved to influence adults’ preferences for HBV vaccination. The estimated willingness to pay (WTP) for 1 dose schedule instead of 3 doses and for a third-level vaccination site instead of a first-level site was almost equal (19 RMB). However, if the protection duration of the vaccination programme changed from 5 years to 20 years, the adults were willing to pay 35.05 RMB, and WTP for a 99% protection rate instead of a 79% rate was 67.71 RMB. The predicted uptake rate is almost 43% for the base case of HBV vaccination.ConclusionsAdults made trade-offs between vaccination schedules, vaccination sites, and other characteristics of HBV vaccine. The impact of attributes of the vaccine itself, especially protection rate against HB, duration of protection, and risk of side-effects, is more dramatic than convenience and quality of vaccination service.     

Value judgments for priority setting criteria in genetic testing: A discrete choice experiment

As our understanding of genetics has increased, so has the number of genetic tests that have entered clinical practice. Given the need of many European health care systems to contain costs, the question of how to prioritise genetic tests fairly has become an emerging concern.This study uses a discrete-choice experiment to assess the value judgements of clinical geneticists, patient representatives and other stakeholders regarding the prioritisation of genetic tests. The respondents chose between two hypothetical scenarios that differed in severity of the disease, risk of the disease, aim of the test, medical benefit of the test, and costs of the test. Standard logit models and mixed effects models were used to estimate the weights different stakeholders attached to attribute levels.Responses from 594 participants were analysed. The most highly valued attribute levels were a proven medical benefit of the test, high risk of having the disease and low costs of the test. Results also showed that rankings differ between clinical geneticists and other stakeholders.The priority weights determined within this study can inform the policy debate and improve the consistency of prioritisation in genetics. Further stakeholder deliberation is needed to explore their most appropriate use in decision practice.     

Predictors of interest in HPV vaccination: A study of British adolescents

Human papillomavirus (HPV) vaccination is now offered to adolescent girls in the UK. Adolescents over 16 years old are likely to make their own decision about the vaccination. The purpose of this cross-sectional study was to assess acceptability of HPV vaccination among female adolescents (16–19 years) and investigate socio-cultural variation in intended acceptance. Participants were recruited through two further-education colleges in England. They read information about HPV before responding to questions assessing acceptability, demographics and attitudes based on the Health Belief Model. There were 367 cases included in analyses. Most participants said they would be likely to accept HPV vaccination (89%). Ethnicity, religion and English as a first language were associated with acceptability (pseudo-R² = 0.11). In multivariate analysis only religion remained significant, with girls from Muslim (OR = 0.20, CI: 0.05–0.90) or Hindu/Sikh (OR = 0.09, CI: 0.01–0.56) backgrounds less likely to accept vaccination. Perceived susceptibility, benefits and barriers were also associated with acceptability (pseudo-R² = 0.25), but did not mediate the effect of the ethnicity-related variables. Interventions based on the health belief model may help encourage HPV vaccine acceptance among adolescents. Future research to understand the issues associated with HPV vaccination in different religious groups is needed.     

Preferences for end-of-life care among community-dwelling older adults and patients with advanced cancer: A discrete choice experiment

Singapore is in the midst of several healthcare reforms in efforts to finance and deliver health services for a rapidly aging population. The primary focus of these reforms is to make healthcare services, including those at the end of life (EOL), affordable. Given the increasingly high health care costs at the EOL, policy makers need to consider how best to allocate resources. One strategy is to allocate resources based on the preferences of sub-populations most likely to be affected. This paper thus aims to quantify preferences for EOL care both among community dwelling older adults (CDOAs) and among patients with a life-limiting illness. A discrete choice experiment was administered to CDOAs and advanced cancer patients in Singapore and willingness to pay (WTP) for specific EOL improvements was estimated. We find that patients have a higher WTP for nearly all EOL attributes compared with CDOAs. We also show that, for both groups, moderate life extension is not the most important consideration; WTP for one additional life year is lower than common thresholds for cost-effectiveness. Irrespective of whose preference are considered, the results highlight the importance of pain management and supporting home deaths at the EOL, perhaps at the expense of public funding for costly but only marginally effective treatments.     

Determinants of the choice of GP practice registration in England: Evidence from a discrete choice experiment

There have been growing concerns that general practitioner (GP) services in England, which are based on registration with a single practice located near the patient's home, are not sufficiently convenient for patients. To inform the decision as to whether to change registration rules allowing patients to register ‘out-of-area’ and to estimate the demand for this wider choice, we undertook a discrete choice experiment with 1706 respondents. Latent class models were used to analyse preferences for GP practice registration comparing preferences for neighbourhood and non-neighbourhood practices. We find that there is some appetite for registering outside the neighbourhood, but this preference is not uniformly shared across the population. Specifically individuals who are less mobile (e.g. older people and those with caring responsibilities), or satisfied with their local practice are less likely to be interested in registering at a practice outside their neighbourhood. Overall, people feel most strongly about obtaining an appointment with a GP as quickly as possible. Respondents regarded weekend opening as less important than other factors, and particularly less important than extended practice opening hours from Monday to Friday. Assuming a constant demand for GP services, a policy encouraging GP practices to extend their opening hours during the week is likely to decrease the average patient waiting time for an appointment and is likely to be preferred by patients.     

山东省地市级疾控人员工作偏好研究：基于离散选择实验

目的：探讨地市级疾病预防控制中心人员的工作偏好,为制定有效的激励机制提供依据。方法：本研究采用分层抽样和立意抽样相结合的方法,线上调研山东省6个地市级疾控机构的455名工作人员,利用混合Logit模型和潜在类别模型分析数据,并计算支付意愿和相对重要性。结果：混合Logit模型中,收入、福利水平、编制、工作量、群众的认可与尊重、个人职业发展机会和培训机会均对疾控人员的工作偏好有显著影响(P<0.05),其中编制(β=2.636)和收入(β=0.083)等保健因素较激励因素影响程度大。潜在类别模型显示,相对年轻、月收入较低的疾控人群更重视收入;年龄较大、月收入较高的疾控人群更重视编制。结论：地市级疾控人员偏好有编制、收入较高、福利水平很好、群众认可且尊重、工作量少、个人职业发展机会较多和培训机会丰富的工作。建议合理控制并动态调整编制总量,平衡编制内外工作条件的差异;增加对疾控的财政投入,改善薪酬绩效体系;同时重视保健因素和激励因素,多种手段共同激励疾控人员发展;对不同类别的疾控人员采用差异化的激励措施。     

Quantifying population preferences around vaccination against severe but rare diseases: A conjoint analysis among French university students, 2016

BackgroundSeveral concepts are available to explain vaccine decision making by individual and inter-individual factors, including risk perception, social conformism and altruism. However, only a few studies have quantified the weight of these determinants in vaccine acceptance. Using a conjoint analysis tool, we aimed at eliciting preferences in a student population regarding vaccination against a rare, severe and rapidly evolving hypothetical disease, similar to meningococcal serogroup C meningitis or measles.MethodsDuring March-May 2016, we conducted an emailing survey among university students aged 18–24 years (N = 775) in Rennes, France. Participants were asked to decide for or against immediate vaccination in 24 hypothetical scenarios, containing various levels of four attributes: epidemic situation, adverse events, information on vaccination coverage, and potential for indirect protection. Data were analysed using random effect estimator logit models.ResultsParticipants accepted on average 52% of scenarios and all attributes significantly impacted vaccination acceptance. The highest positive effects were seen with an epidemic situation (OR 3.81, 95%-CI 3.46–4.19), 90% coverage in the community (3.64, 3.15–4.20) and potential for disease elimination from the community (2.87, 2.53–3.26). Information on “insufficient coverage” was dissuasive (vs. none of friends vaccinated: 0.65, 0.56–0.75). Controversy had a significantly greater negative effect than a confirmed risk of severe adverse events (OR 0.05 vs. 0.22). In models including participant characteristics, preference weights were unchanged, while trust in health authorities and vaccination perceptions strongly influenced acceptance themselves. The greatest significant variation of preference weights between subgroups was observed with controversy among students using alternative medicine daily (OR 0.28) and among students relying on scientific vaccine information (OR 0.02).ConclusionsAmong young adults, potential for indirect protection and factual information on coverage in the community and potential side effects positively impact theoretical vaccine acceptance. Conjoint analyses should be conducted to understand vaccine hesitancy in specific vaccination programs.     

Understanding the impact of economic evidence on clinical decision making: A discrete choice experiment in cardiology

The present study aims to evaluate the impact of cost-effectiveness information on clinical decision making using discrete choice experiment (DCE) methodology. Data were collected through a self-completed questionnaire administered to Italian cardiologists in June 2007 (n = 129 respondents, 1143 observations). The questionnaire asked clinicians to make choices between paired scenarios, across which three key dimensions were identified and varied: (1) quality of clinical evidence, (2) size of health gain (reduction of relative and absolute risk), and (3) economic impact (incremental cost-effectiveness ratio). A random effects probit model was used to estimate clinicians' preferences for the different dimensions, while the heterogeneity of preferences was tested in a model with interaction terms. Dominance tests were used to assess the consistency of responses. The results indicate that Italian cardiologists regard economic impact (cost-effectiveness) as an important factor in their decision making. Economic evidence is valued more highly among clinicians with a higher self-assessed level of knowledge regarding economic evaluation techniques, as well as among younger professionals (age<45). While relevant study limitations should be acknowledged, our results suggest that DCEs can be used to elicit clinicians' decision-making criteria and to inform the allocation of resources for future research in a logical manner. Italian cardiologists appear to take cost-effectiveness information into account when deciding whether to use new treatments.     

Parent's preferences for unscheduled paediatric healthcare: A discrete choice experiment

Background

Unscheduled healthcare is a key component of healthcare delivery and makes up a significant proportion of healthcare access, with children being particularly high users of unscheduled healthcare. Understanding the relative importance of factors that influence this behaviour and decision-making is fundamental to ensuring the system is best designed to meet the needs of users and foster appropriate cost-effective usage of health system resources.

Objective

The aim of the study was to identify the parent's preferences for unscheduled healthcare for a common mild childhood illness.

Design

A discrete choice experiment (DCE) was developed to identify the preferences of parents accessing unscheduled healthcare for their children.

Setting and Participants

Data were collected from parents in Ireland (N = 458) to elicit preferences across five attributes: timeliness, appointment type, healthcare professional attended, telephone guidance before attending and cost.

Results

Using a random parameters logit model, all attributes were statistically significant, cost (β = −5.064, 95% confidence interval, CI [−5.60, −4.53]), same-day (β = 1.386, 95% CI [1.19, 1.58]) or next-day access (β = 0.857, 95% CI [0.73, 0.98]), coupled with care by their own general practitioner (β = 0.748, 95% CI [0.61, 0.89]), identified as the strongest preferences of parents accessing unscheduled healthcare for their children.

Discussion

The results have implications for policy development and implementation initiatives that seek to improve unscheduled health services as understanding how parents use these services can maximise their effectiveness.

Patient or Public Contribution

The development of the DCE included a qualitative research component to ensure that the content accurately reflected parents experiences when seeking healthcare. Before data collection, a pilot test was carried out with the target population to gather their views on the survey.     

Preferences for long-term care services: Willingness to pay estimates derived from a discrete choice experiment

Ageing populations increase pressure on long-term care. Optimal resource allocation requires an optimal mix of care services based on costs and benefits. Contrary to costs, benefits remain largely unknown. This study elicits preferences in the general elderly population for long-term care services for varying types of patients.     

Equity and efficiency priorities within the Spanish health system: A discrete choice experiment eliciting stakeholders preferences

Background

The trade-off between efficiency and equity has been largely studied in the health economics literature and for countries with different types of health systems. Even if efficiency and equity are desired, it is not always feasible to attain both simultaneously. In Spain, the National Health System has historically been recognized for its universal access and free of charge provision, with good health outcomes. However, the recent increase in health expenditures together with the economic cycle has turned the orientation of health policy implementation towards efficiency, threatening universality and equity in the access to healthcare.

How to do (or not to do) ... Designing a discrete choice experiment for application in a low-income country

Understanding the preferences of patients and health professionalsis useful for health policy and planning. Discrete choice experiments(DCEs) are a quantitative technique for eliciting preferencesthat can be used in the absence of revealed preference data.The method involves asking individuals to state their preferenceover hypothetical alternative scenarios, goods or services.Each alternative is described by several attributes and theresponses are used to determine whether preferences are significantlyinfluenced by the attributes and also their relative importance.DCEs are widely used in high-income contexts and are increasinglybeing applied in low- and middle-income countries to considera range of policy concerns. This paper aims to provide an introductionto DCEs for policy-makers and researchers with little knowledgeof the technique. We outline the stages involved in undertakinga DCE, with an emphasis on the design considerations applicablein a low-income setting.     

中国居民对家庭医生签约服务内容的偏好研究——基于离散选择实验

目的:通过测量中国居民对家庭医生签约服务内容的偏好,为优化家庭医生签约服务内容提供参考依据。方法:基于离散选择实验,通过对北京、上海、杭州、厦门四市共400名社区卫生服务中心就诊居民进行问卷调查,利用条件logistic模型进行分析。结果:纳入分析的8项家庭医生服务内容都具有统计学意义(P<0.05)。其中,慢性病8周长处方相较于2周处方,居民选择签约的OR(Odds Ratio)为3.46;面对面健康咨询与通过电话、网络进行咨询相比较,OR为2.44;疾病治疗免挂号费、诊查费与自费相比,OR为2.24。"8周长处方+免挂号费、诊查费"、"8周长处方+面对面健康咨询"、"8周长处方+4次/年免费上门服务"、"面对面健康咨询+免挂号费、诊查费"这四种服务组合包能使90%以上居民愿意签约家庭医生服务。结论:对于社区就诊居民来说,最吸引其签约家庭医生的服务内容是获得慢性病长处方、面对面健康咨询、疾病治疗减免挂号费和诊查费、一年4次免费上门服务。根据离散选择实验结果可以优化家庭医生服务内容,吸引居民签约家庭医生并增加签约居民的获得感。     

不同生源地医学生就业偏好及异质性研究——基于北京市6家医院的离散选择实验

目的：分析不同生源地医学生就业偏好及异质性,为优化基层卫生人力管理提供参考。方法：采用整群抽样方法,对北京市6家教学医院的925名医学生开展离散选择实验的线上问卷调查,获得有效问卷741份,有效回收率为80.1%。运用混合logit模型对6个工作属性进行回归分析并估计支付意愿。结果：不同生源地医学生对工作地点的选择具有显著差异。亚组分析结果表明,相比于来自城市的医学生,来自农村和县城的医学生更重视充足的职业发展机会;本科生亚组结果显示,相比于其他生源地的本科生,来自农村的本科生更偏好良好的工作环境。结论：不同生源地的医学生就业偏好存在异质性;政策制定者应关注医学生生源地,兼顾教育程度优化多元工作要素,分类制定针对性的基层卫生人才吸引措施。