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Patient-centred trial design and delivery; improves recruitment and retention; increases participant satisfaction; encourages participation by a more representative cohort; and allows researchers to better meet participants’ needs. Research in this area mostly focusses on narrow facets of trial participation. We aimed to systematically identify the breadth of patient-centred factors influencing participation and engagement in trials, and collate them into a framework. Through this we hoped to assist researchers to identify factors that could improve patient-centred trial design and delivery. Robust qualitative and mixed methods systematic reviews are becoming increasingly common in health research. The protocol for this review was prospectively registered on PROSPERO, CRD42020184886. We used the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research Type) framework as a standardised systematic search strategy tool. 3 databases were searched as well as references checking, and thematic synthesis was conducted. Screening agreement was performed and code and theme checking were conducted by 2 independent researchers. Data were drawn from 285 peer-reviewed articles. 300 discrete factors were identified, and sorted into 13 themes and subthemes. The full catalogue of factors is included in the Supplementary Material. A summary framework is included in the body of the article. This paper focusses on outlining common ground that themes share, highlighting critical features, and exploring interesting points from the data. Through this, we hope researchers from multiple specialities may be better able to meet patients’ needs, protect patients’ psychosocial wellbeing, and optimise trial recruitment and retention, with direct positive impact on research time and cost efficiency.

Supplemental material, sj-docx-2-shr-10.1177_20542704231166621 for A systematic review to identify and collate factors influencing patient journeys through clinical trials by Rebecca Dobra, Gemma Wilson, Jessie Matthews, Marco Boeri, Stuart Elborn, Frank Kee, Jane C Davies and Susan Madge in JRSM Open

Additional file 1: Table S1. Summary of Respondents’ Experience with Hepatocellular Carcinoma Treatments. Table S2. Results of Covariate-Adjusted Threshold Model: Tablet Sample (N = 92). Table S3. Results of Covariate-Adjusted Threshold Model: Intravenous Infusion Sample (N = 58). Figure S1. Threshold Question Sequence for Risk of Decreased Appetite if “Four Tablets” is Initially Preferred. Figure S2. Threshold Question Sequence for Risk of Hand-Foot Skin Reaction if “Four Tablets” is Initially Preferred. Figure S3. Threshold Question Sequence for Risk of Diarrhea if “Four Tablets” is Initially Preferred. Figure S4. Threshold Question Sequence for Risk of Ascites if “Four Tablets” is Initially Preferred. Figure S5. Threshold Question Sequence for Risk of Proteinuria if “Four Tablets” is Initially Preferred. Figure S6. Threshold Question Sequence for Risk of Peripheral Edema if “Four Tablets” is Initially Preferred. Figure S7. Threshold Question Sequence for Risk of Hypertension if Intravenous Infusion is Initially Preferred. Figure S8. Threshold Question Sequence for Risk of Decreased Appetite if Intravenous Infusion is Initially Preferred. Figure S9. Threshold Question Sequence for Risk of Hand-Foot Skin Reaction if Intravenous Infusion is Initially Preferred. Figure S10. Threshold Question Sequence for Risk of Diarrhea if Intravenous Infusion is Initially Preferred. Figure S11. Threshold Question Sequence for Risk of Ascites if Intravenous Infusion is Initially Preferred. Figure S12. Threshold Question Sequence for Risk of Proteinuria if Intravenous Infusion is Initially Preferred. Figure S13. Threshold Question Sequence for Risk of Peripheral Edema if Intravenous Infusion is Initially Preferred. Figure S14. Minimum Reduction in Risk of Hypertension to Switch From Tablets Every Day to Intravenous Infusion Every 2 Weeks. Figure S15. Minimum Reduction in Risk of Decreased Appetite to Switch From Tablets Every Day to Intravenous Infusion Every 2 Weeks. Figure S16. Minimum Reduction in Risk of Hand-Foot Skin Reaction to Switch From Tablets Every Day to Intravenous Infusion Every 2 Weeks. Figure S17. Minimum Reduction in Risk of Diarrhea to Switch From Tablets Every Day To Intravenous Infusion Every 2 Weeks. Figure S18. Minimum Reduction in Risk of Ascites to Switch From Tablets Every Day to Intravenous Infusion Every 2 Weeks. Figure S19. Minimum Reduction in Risk of Proteinuria to Switch From Tablets Every Day to Intravenous Infusion Every 2 Weeks. Figure S20. Minimum Reduction in Risk of Peripheral Edema to Switch From Tablets Every Day to Intravenous Infusion Every 2 Weeks. Figure S21. Maximum Increase in Risk of Hypertension to Keep Intravenous Infusion Every 2 Weeks Instead of Switching to Tablets Every Day. Figure S22. Maximum Increase in Risk of Lower Appetite to Keep Intravenous Infusion Every 2 Weeks Instead of Switching to Tablets Every Day. Figure S23. Maximum Increase in Risk of Hand-foot Reaction to Keep Intravenous Infusion Every 2 Weeks Instead of Switching to Tablets Every Day. Figure S24. Maximum Increase in Risk of Diarrhea to Keep Intravenous Infusion Every 2 Weeks Instead of Switching to Tablets Every Day. Figure S25. Maximum Increase in Risk of Ascites to Keep Intravenous Infusion Every 2 Weeks Instead of Switching to Tablets Every Day. Figure S26. Maximum Increase in Risk of Proteinuria to Keep Intravenous Infusion Every 2 Weeks Instead of Switching to Tablets Every Day. Figure S27. Maximum Increase in Risk of Peripheral Edema to Keep Intravenous Infusion Every 2 Weeks Instead of Switching to Tablets Every Day.

Supplemental material, sj-docx-2-shr-10.1177_20542704231166621 for A systematic review to identify and collate factors influencing patient journeys through clinical trials by Rebecca Dobra, Gemma Wilson, Jessie Matthews, Marco Boeri, Stuart Elborn, Frank Kee, Jane C Davies and Susan Madge in JRSM Open

Supplemental material, sj-docx-1-shr-10.1177_20542704231166621 for A systematic review to identify and collate factors influencing patient journeys through clinical trials by Rebecca Dobra, Gemma Wilson, Jessie Matthews, Marco Boeri, Stuart Elborn, Frank Kee, Jane C Davies and Susan Madge in JRSM Open

Supplemental material, sj-docx-1-shr-10.1177_20542704231166621 for A systematic review to identify and collate factors influencing patient journeys through clinical trials by Rebecca Dobra, Gemma Wilson, Jessie Matthews, Marco Boeri, Stuart Elborn, Frank Kee, Jane C Davies and Susan Madge in JRSM Open

Marco Boeri,1 Kelley Myers,2 Claire Ervin,2 Amy Marren,3 Marco DiBonaventura,4 Joseph C Cappelleri,5 Brett Hauber,2 David T Rubin61RTI Health Solutions, Health Preference Assessment, Belfast, BT2 8LA, UK; 2RTI Health Solutions, Health Preference Assessment, Research Triangle Park, NC, 27709, USA; 3Pfizer, Inflammation and Immunology, Collegeville, PA, 19426, USA; 4Pfizer, Health Economics and Outcomes Research, New York, NY, 10017, USA; 5Pfizer, Global Product Development, Groton, CT, 06340, USA; 6Department of Medicine, Inflammatory Bowel Disease Center, University of Chicago, Chicago, IL 60637, USAPurpose: This study aimed to elicit patient and physician preferences for ulcerative colitis (UC) treatments in the United States (US).Patients and methods: The following UC treatment attributes included in the discrete-choice experiment (DCE) were identified during qualitative interviews with both patients and physicians: time to symptom improvement, chance of long-term symptom control, risks of serious infection and malignancy, mode and frequency of administration, and need for steroids. The DCE survey instruments were developed and administered to patients and physicians. A random-parameters logit model was used to estimate preference weights and conditional relative importance for these attributes.Results: A total of 200 patients with moderate to severe UC (status determined using self-reported medication history) and 200 gastroenterologists completed the survey. Patients’ average age was 42 years; most (59%) were female. Patients considered symptom control 2.5 times as important as time to symptom improvement and 5-year risk of malignancy almost as important as long-term symptom control (relative importance, 0.79 vs 0.96 for long-term symptom control); they preferred oral to subcutaneous or intravenous administration (relative importance, 0.47 vs 0.11 and 0.18, respectively). For physicians, symptom control was the most important attribute and was five times as important as the risk of malignancy.Conclusion: Both patients and physicians considered long-term symptom control the most important attribute relative to others; however, risk of malignancy was of almost-equal importance to patients but not physicians. Differences between patients’ and physicians’ preferences highlight the need for improved communication about the relevant benefits and risks of different UC treatments to improve therapeutic decision-making.Keywords: ulcerative colitis, discrete-choice experiments, maximum acceptable risk, patient preference, physician preference &nbsp

BACKGROUND: There is a growing interest in quantifying the degree of heterogeneity in stated preferences for health. A popular investigation into preference heterogeneity involves split-sample analysis to make comparisons across subgroups. However, subgroups may differ in many observed characteristics. Not accounting for these other characteristics may bias comparisons if these are also associated with preferences. This study explores matching and weighting approaches to identify differences in preferences.METHODS: We compare simulated stated preferences of patients and the public for a hypothetical healthcare intervention, where patients are older and have lower household income. The utility function for both is specified to be identical (preference homogeneity) and utility is assumed to increase with health and life years, and decrease with risk and cost. Utility for cost is specified as a function of income and age. We conduct unmatched, propensity score-matched, and entropy balanced analyses.RESULTS: Due to differences in age and income, unmatched analysis detects statistically significant differences in the preference for cost when comparing the public’s preferences with those of patients. Both propensity score matching and entropy balancing reduce imbalance in the individual characteristics across subgroups, although the reduction is greater when using entropy balancing. Following matching or weighting, there are no significant differences in the preference weights for any attributes.CONCLUSION: Unweighted and unmatched analyses may produce erroneous conclusions regarding heterogeneity in preferences when making comparisons across subgroups. Matching and weighting methods may be useful for researchers seeking to compare preferences for health and health care when there are too many characteristics to feasibly incorporate with interaction terms.

This study aimed to elicit preferences for psoriasis treatment features and to test for preference heterogeneity across groups of respondents. A discrete-choice experiment was employed to elicit preferences of patients with plaque psoriasis in multiple countries. The survey instrument included a series of choice questions between three hypothetical treatments, each characterized by varying levels of six attributes (namely, lesion reduction, risk of impairing side effects, time to reach results, mode and frequency of administration, itching reduction, and side effects). Random parameters logit was used to model the data. Results were compared across a total of 18 subgroup sets. The data analysis from 1,123 respondents showed that, on average, respondents receive more utility gain from higher levels of lesion reduction and lower risks of impairing side effects than changes in other attributes included in the study. Systematic differences were detected for 13 sets; the most pronounced differences were observed based on disease severity, nail psoriasis, biologic experience, and quality-of-life scores. These many sources of preference heterogeneity identified by our analysis suggest that to improve patient satisfaction and, probably, adherence and persistence, clinicians should discuss options with patients when prescribing their treatment.

Peita L Graham-Clarke,1 Brett Hauber,2 Marco Boeri,3 Felice Leonardi,4 Russel T Burge,5 Maria Fernandez,2 Antje Tockhorn-Heidenreich,6 Sandra Florez4,7 1Global Patient Outcomes and Real World Evidence, Eli Lilly Australia, West Ryde, NSW 2114, Australia; 2Health Preference Assessment Group, RTI Health Solutions, Research Triangle Park, NC 27709, USA; 3Health Preference Assessment Group, RTI Health Solutions, Belfast BT2 8LA, UK; 4Eli Lilly Interamerica Inc, Bogotá, Colombia; 5Global Patient Outcomes and Real World Evidence, Eli Lilly and Co, Lilly Corporate Center, Indianapolis, IN 46285, USA; 6Global Patient Outcomes and Real World Evidence, Eli Lilly and Co, Erl Wood Manor, Surrey GU20 6PH, UK; 7Pain and Palliative Care Unit, Universidad De La Sabana, Bogotá, ColombiaCorrespondence: Marco BoeriRTI Health Solutions, Forsyth House, Cromac Square Belfast, Belfast BT2 8LA, UKTel +44 (0)161 447 6016Fax +1.919.541.7222Email mboeri@rti.orgPurpose: Teriparatide is used to treat patients with established osteoporosis but is often reserved for patients who have inadequate response to antiresorptive therapy. Biosimilar teriparatide, which is believed to have efficacy and safety similar to the originator product, is now available in Colombia. However, little is known about patients’ preferences for originator biologic and biosimilar treatments. Our objective was to quantify the relative importance that patients in Colombia place on features of injectable osteoporosis treatments including whether the treatment is an originator biologic or a biosimilar.Patients and Methods: We used a discrete choice experiment (DCE) to elicit preferences of patients with osteoporosis treatment devices in Colombia. The survey was completed by 200 respondents at high risk of fracture, with or without teriparatide experience. Each treatment alternative within the DCE was characterized by five attributes: type of medicine (originator biologic, biosimilar), needle length, angle of injection, how to measure the medicine dose, and how long the medicine can be left unrefrigerated. A random parameters logit regression was used to estimate preferences and conditional relative attribute importance, while controlling for preference heterogeneity.Results: A total of 200 patients (mean age = 58.3 years) completed the survey. Most were female (84.5%) and married (54.5%); 50.5% had secondary education or less, 21% had current teriparatide exposure. The attribute with the highest conditional relative importance estimate (standard error) was biologic versus biosimilar (10 [1.11]), followed by needle length (8.06 [1.11]), dose measurement (6.38 [0.87]), refrigeration (3.81 [1.18]), and angle of injection (1.30 [0.66]). Unobserved preference heterogeneity was present and controlled for in the analyses.Conclusion: Despite the availability of biosimilar teriparatide in Colombia, patients expressed a strong preference for an originator biologic osteoporosis medicine over a biosimilar osteoporosis medicine, when the efficacy, safety, and cost of the two options were assumed to be the same.Keywords: discrete choice experiment, injection, devices, teriparatide, fractures

Supplemental Digital Content is Available in the Text., Background: Integrating end-user perspectives into the design of new biomedical HIV prevention products is recognized as vital to informing the product development pipeline. Setting: Kisumu, Kenya; and Soshanguve, South Africa. Methods: We conducted a discrete choice experiment survey with 536 women aged 18–30 years to assess preferences for hypothetical HIV prevention products characterized by the attributes of efficacy, pregnancy prevention, delivery form, dosing frequency, and side effects. Participants included product-experienced women from Tablet, Ring, Injection as Options TRIO, a cross-over clinical study evaluating 3 placebo delivery forms (oral tablets, vaginal rings, and injections), and a product-naive sample recruited from the same communities. Analyses used random parameters logit and latent class models. Results: HIV prevention efficacy was a strong determinant of stated choice overall; however, in South Africa, delivery form was just as important, with an injection every 2–3 months most preferred and a daily oral tablet least preferred. In Kenya, product-experienced women preferred monthly injections and least preferred a monthly ring. Respondents indicated a preference for multipurpose prevention technologies that combine HIV and pregnancy protection. Latent class analyses confirmed these findings and delineated heterogeneity in preferences across subgroups defined by age, past experience with the delivery forms, and education. Conclusions: Despite an overall preference for products with high efficacy, we identified attributes salient to future uptake and use of HIV prevention products. Preferences for injectable products underscored interest in this pre-exposure prophylaxis delivery form. Likewise, the multipurpose prevention technology feature was valued in both Kenya and South Africa and most influenced interest in vaginal rings.

Marco Boeri,1 Boglarka Szegvari,2 Brett Hauber,3 Brennan Mange,3 Irina Mountian,2 Michael Schiff,4 Nikolaos Maniadakis51RTI Health Solutions, Belfast, UK; 2UCB Pharma, Brussels, Belgium; 3RTI Health Solutions, Research Triangle Park, NC, USA; 4Rheumatology Division, University of Colorado School of Medicine, Denver, CO, USA; 5Health Services Management, National School of Public Health, Athens, GreecePurpose: To quantify rheumatology patient preferences and willingness to pay (WTP) for features differentiating enhanced from standard self-injection devices and to investigate differences among subgroups.Patients and methods: Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) were recruited in the UK. A discrete-choice experiment was used to elicit preferences; respondents were presented with 10 choices between 3 different devices: a free standard disposable device, and 2 hypothetical reusable devices characterized by presence/absence of skin sensor, injection speed control, on-screen instructions, injection reminders, electronic log, and large grip. Every hypothetical device included a cost component to assess WTP for each enhanced feature. A random-parameters logit model was used to estimate preference weights and WTP.Results: Data were collected from 323 respondents by electronic survey (15/11/2017–15/02/2018; RA: 108; PsA: 103; axSpA: 112). On average, the skin sensor was the most preferred feature (£30), followed by injection speed control, injection reminders, electronic log (∼£20 each), on-screen instructions (∼£12), and a device with a small, rather than large grip (∼£7). Similar preferences for attributes were observed across condition subgroups except for grip size: axSpA patients preferred small grip (∼£27); PsA patients preferred large grip (∼£19). Overall, respondents preferred reusable devices with all enhanced features (WTP value: £85) over the standard device. RA patients exhibited a higher WTP (£145) than PsA (£102) or axSpA (£62) for the same enhanced device.Conclusion: Patients positively valued reusable self-injection devices with enhanced features, which may improve patient experience, potentially improving treatment adherence, clinical, and economic outcomes.Keywords: rheumatology, subcutaneous injection, self-administration, patient preference, discrete-choice experiment

Purpose: To quantify rheumatology patient preferences and willingness to pay (WTP) for features differentiating enhanced from standard self-injection devices and to investigate differences among subgroups. Patients and methods: Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) were recruited in the UK. A discrete-choice experiment was used to elicit preferences; respondents were presented with 10 choices between 3 different devices: a free standard disposable device, and 2 hypothetical reusable devices characterized by presence/absence of skin sensor, injection speed control, on-screen instructions, injection reminders, electronic log, and large grip. Every hypothetical device included a cost component to assess WTP for each enhanced feature. A random-parameters logit model was used to estimate preference weights and WTP. Results: Data were collected from 323 respondents by electronic survey (15/11/2017-15/02/2018; RA: 108; PsA: 103; axSpA: 112). On average, the skin sensor was the most preferred feature (30) pound, followed by injection speed control, injection reminders, electronic log (similar to 20 pound each), on-screen instructions (similar to 12) pound, and a device with a small, rather than large grip (similar to 7) pound. Similar preferences for attributes were observed across condition subgroups except for grip size: axSpA patients preferred small grip (similar to 27); pound PsA patients preferred large grip (similar to 19) pound. Overall, respondents preferred reusable devices with all enhanced features (WTP value: 85) pound over the standard device. RA patients exhibited a higher WTP (145) pound than PsA (102) pound or axSpA (62) pound for the same enhanced device. Conclusion: Patients positively valued reusable self-injection devices with enhanced features, which may improve patient experience, potentially improving treatment adherence, clinical, and economic outcomes.

Supplemental material, DS_10.1177_0272989X18758279 for Physician-Specific Maximum Acceptable Risk in Personalized Medicine: Implications for Medical Decision Making by Marco Boeri, Alan J. McMichael, Joseph P. M. Kane, Francis A. O’Neill, and Frank Kee in Medical Decision Making

Using census data on work commuting in Albania –collected for the first time in 2011 – this study examines the spatial adjustment processes between demand and supply of labour across the country.The first part focuses on the spatial adjustment of labour forces that occur within and between Albanian’s prefectures. Several statistical indicators,derived using origin-destination matrices, measure the differential levels of attraction and expulsion of each prefecture. Results show a high level of heterogeneity and emphasise the crucial role of spatial contiguity among prefectures on this spatial dynamic. The second part examines the role of the municipality of Tirana. This is first investigated within a three-territorial-units system (the municipality of Tirana, rest of the prefecture and rest of Albania) and then within the prefecture as a closed system. Interestingly, 71.5% of all the commuting flows directed to the Municipality originate from municipalities located very close to Tirana (less than 10 km). We conclude that the spatial structure of the prefecture, reasonably extendable to the whole country, can be defined as monocentric. Further studies should focus on the implied costs of this system to the society and environment of Albania.

The recent ‘horse meat scandal’ in Europe has sparked huge concerns among consumers, as horse meat was found in beef lasagne ready to be consumed. This study investigates consumers’ preferences towards characteristics of ready to heat lasagne, including origin of the meat, whether the meat is tested as beef, safety of the lasagne, and nutritional value, using Discrete Choice Experiments in six EU. Our sample of 4,598 consumers makes this the largest cross sectional study of this kind. The results of this study present evidence that consumers in Europe are concerned about the authenticity and origin of the meat.

The recent ‘horse meat scandal’ in Europe has sparked huge concerns among consumers, as horse meat was found in beef lasagne ready to be consumed. This study investigates consumers’ preferences towards characteristics of ready to heat lasagne, including origin of the meat, whether the meat is tested as beef, safety of the lasagne, and nutritional value, using Discrete Choice Experiments in six EU. Our sample of 4,598 consumers makes this the largest cross sectional study of this kind. The results of this study present evidence that consumers in Europe are concerned about the authenticity and origin of the meat.

We investigate how different levels of information affect respondents’ preferences as well as choice behaviour in choice experiments by analysing respondents’ choices using two choice paradigms: the Random Utility Maximisation (RUM) and the Random Regret Minimization (RRM). The RRM offers a tractable, regret-based model complementary to the dominant RUM. Analysing choice related to hypothetical programmes for the promotion of renewable energy, we find that varying the level of information does not affect preferences and scale, whilst it does affect the choice paradigm. Additional information increases the probability that a respondent’s choices are better explained by the RUM than the RRM.

We examine the effect of energy efficiency incentives on household energy-efficiency home improvements. Starting in February 2007, Italian homeowners have been able to avail themselves of tax credits on the purchase and installation costs of certain types of energy efficiency renovations. We examine two such renovations-door/windows replacements and heating system replacements-using multi-year cross-section data from the Italian Consumer Expenditure Survey and focusing on a narrow period around the introduction of the tax credits. Our regressions control for dwelling and household characteristics and economy-wide factors likely to influence the replacement rates. The effects of the policy are different for the two types of renovations. With window replacements, the policy is generally associated with a 30% or stronger increase in the renovation rates and number of renovations. In the simplest econometric models, the effect is not statistically significant, but the results get stronger when we allow for heterogeneous effects across the country. With heating system replacements, simpler models suggest that the tax credits policy had no effect whatsoever or that free riding was rampant, i.e., people are now accepting subsidies for replacements that they would have done anyway. Further examination suggests a strong degree of heterogeneity in the effects across warmer and colder parts of the country, and effects in the colder areas that are even more pronounced than those for windows replacements. These results should, however, be interpreted with caution due to the low rate of renovations and the imprecisely estimated effects.

We examine the effect of energy efficiency incentives on household energy-efficiency home improvements. Starting in February 2007, Italian homeowners have been able to avail themselves of tax credits on the purchase and installation costs of certain types of energy efficiency renovations. We examine two such renovations—door/windows replacements and heating system replacements—using multi-year cross-section data from the Italian Consumer Expenditure Survey and focusing on a narrow period around the introduction of the tax credits. Our regressions control for dwelling and household characteristics and economy-wide factors likely to influence the replacement rates. The effects of the policy are different for the two types of renovations. With window replacements, the policy is generally associated with a 30% or stronger increase in the renovation rates and number of renovations. In the simplest econometric models, the effect is not statistically significant, but the results get stronger when we allow for heterogeneous effects across the country. With heating system replacements, simpler models suggest that the tax credits policy had no effect whatsoever or that free riding was rampant, i.e., people are now accepting subsidies for replacements that they would have done anyway. Further examination suggests a strong degree of heterogeneity in the effects across warmer and colder parts of the country, and effects in the colder areas that are even more pronounced than those for windows replacements. These results should, however, be interpreted with caution due to the low rate of renovations and the imprecisely estimated effects.

This paper develops and compares two alternative approaches to accommodate scale heterogeneity (also referred to as heteroskedasticity) in latent class models. Our modelling approach compares two different representations of heteroskedasticity, respectively associating the heterogeneity in scale factor with respondent's characteristics (i.e. observed scale heterogeneity) or deriving it probabilistically (i.e. unobserved scale heterogeneity). The results reveal a number of benefits associated with this type of approach, particularly when heterosckedasticity can be linked to observed characteristics of the respondent. Our data comes from a discrete choice experiment eliciting recreational users preferences for farmland walking trails in Ireland

This paper develops and compares two alternative approaches to accommodate scale heterogeneity (also referred to as heteroskedasticity) in latent class models. Our modelling approach compares two different representations of heteroskedasticity, respectively associating the heterogeneity in scale factor with respondent's characteristics (i.e. observed scale heterogeneity) or deriving it probabilistically (i.e. unobserved scale heterogeneity). The results reveal a number of benefits associated with this type of approach, particularly when heterosckedasticity can be linked to observed characteristics of the respondent. Our data comes from a discrete choice experiment eliciting recreational users preferences for farmland walking trails in Ireland

OBJECTIVESColorectal cancer (CRC) is the second most common cancer worldwide and has poorer prognosis when metastasized, tackling this is the main driver of prevention programs which have focused on early detection and removal of adenomatous polyps. As more is known about the influences dietary and lifestyle factors on development of CRC, efforts are moving towards primary prevention as a means of optimising cancer prevention. We set out to elicit how patients with adenoma consider trade-offs and weigh up their choices between different surveillance options; to examine the patient and healthcare-related characteristics that could influence these choices; to determine whether preferences of patients with adenoma vary by literacy or other non-health related factors; to examine the concordance of these preferences with studies of adherence to exercise programs for individuals with pre-cancerous detected lesions.METHODSPilot online discrete choice experiment, n=231 participants (of 1200 invitees with known intermediate or high risk polyps removed during CRC screening test,) completed 8 sequential choice grids, containing information about 5 attributes related to risk reduction; diet & lifestyle program options combined with clinical testing information, estimated out-of-pocket costs for participation in primary prevention programs added to surveillance.RESULTSPredominantly male, married respondents, with 25.13% university educated, and self reported comorbidities, 27.6% with high blood pressure, 25.4% with high cholesterol, 10.1% with cardiac problems, demonstrate risk aversion preferences. 37.1% of participants were unaware of their own risk status following polypectomy, despite 41% receiving their results on the day of their procedure by their treating health professional. 38.3% were willing to make changes to diet and lifestyle, with 35.1% already making changes to reduce their risk of cancer.CONCLUSIONSParticipants report preferences for risk minimization and are willing to engage in diet and lifestyle programs which may optimize cancer prevention efforts following removal of adenomatous polyps in cancer screening programs.

We examine the effect of energy efficiency incentives on household energy efficiency home improvements. Starting in February 2007, Italian homeowners have been able to avail themselves of tax credits on the purchase and installation costs of certain types of energy efficiency renovations. We examine two such renovations—door/window replacements and heating system replacements—using multi-year cross-section data from the Italian Consumer Expenditure Survey and focusing on a narrow period around the introduction of the tax credits. Our regressions control for dwelling and household characteristics and economy-wide factors likely to influence the replacement rates. The effects of the policy are different for the two types of renovations. With window replacements, the policy is generally associated with a 30 % or stronger increase in the renovation rates and number of renovations. In the simplest econometric models, the effect is not statistically significant, but the results get stronger when we allow for heterogeneous effects across the country. With heating system replacements, simpler models suggest that the tax credits policy had no effect whatsoever or that free riding was rampant, i.e., people are now accepting subsidies for replacements that they would have done anyway. Further examination suggests a strong degree of heterogeneity in the effects across warmer and colder parts of the country, and effects in the colder areas that are even more pronounced than those for window replacements. These results should, however, be interpreted with caution due to the low rates of renovations, which imply that the effects are estimated relatively imprecisely., Energy Efficiency, 7 (4), ISSN:1570-646X, ISSN:1570-6478