21 results on '"LANCSAR, EMILY"'
Search Results
2. Hypothetical bias in stated choice experiments: Part II. Macro-scale analysis of literature and effectiveness of bias mitigation methods
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Haghani, Milad, Bliemer, Michiel C. J., Rose, John M., Oppewal, Harmen, and Lancsar, Emily
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Hypothetical Choice ,1507 Transportation and Freight Services ,Stated Choice ,Hypothetical Bias ,Mitigation Methods ,Choice Experiment ,0104 Statistics ,Stated Preference ,1403 Econometrics ,14 Economics - Abstract
This paper reviews methods of hypothetical bias (HB) mitigation in choice experiments (CEs). It presents a bibliometric analysis and summary of empirical evidence of their effectiveness. The paper follows the review of empirical evidence on the existence of HB presented in Part I of this study. While the number of CE studies has rapidly increased since 2010, the critical issue of HB has been studied in only a small fraction of CE studies. The present review includes both ex-ante and ex-post bias mitigation methods. Ex-ante bias mitigation methods include cheap talk, real talk, consequentiality scripts, solemn oath scripts, opt-out reminders, budget reminders, honesty priming, induced truth telling, indirect questioning, time to think and pivot designs. Ex-post methods include follow-up certainty calibration scales, respondent perceived consequentiality scales, and revealed-preference-assisted estimation. It is observed that the use of mitigation methods markedly varies across different sectors of applied economics. The existing empirical evidence points to their overall effectives in reducing HB, although there is some variation. The paper further discusses how each mitigation method can counter a certain subset of HB sources. Considering the prevalence of HB in CEs and the effectiveness of bias mitigation methods, it is recommended that implementation of at least one bias mitigation method (or a suitable combination where possible) becomes standard practice in conducting CEs. Mitigation method(s) suited to the particular application should be implemented to ensure that inferences and subsequent policy decisions are as much as possible free of HB.
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- 2021
3. Hypothetical bias in stated choice experiments: Part I. Integrative synthesis of empirical evidence and conceptualisation of external validity
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Haghani, Milad, Bliemer, Michiel C. J., Rose, John M., Oppewal, Harmen, and Lancsar, Emily
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1507 Transportation and Freight Services ,0104 Statistics ,1403 Econometrics ,Choice experiment ,stated preference ,hypothetical bias ,external validity ,14 Economics - Abstract
The notion of hypothetical bias (HB) constitutes, arguably, the most fundamental issue in relation to the use of hypothetical survey methods. Whether or to what extent choices of survey participants and subsequent inferred estimates translate to real-world settings continues to be debated. While HB has been extensively studied in the broader context of contingent valuation, it is much less understood in relation to choice experiments (CE). This paper reviews the empirical evidence for HB in CE in various fields of applied economics and presents an integrative framework for how HB relates to external validity. Results suggest mixed evidence on the prevalence, extent and direction of HB as well as considerable context and measurement dependency. While HB is found to be an undeniable issue when conducting CEs, the empirical evidence on HB does not render CEs unable to represent real-world preferences. While health-related choice experiments often find negligible degrees of HB, experiments in consumer behaviour and transport domains suggest that significant degrees of HB are ubiquitous. Assessments of bias in environmental valuation studies provide mixed evidence. Also, across these disciplines many studies display HB in their total willingness to pay estimates and opt-in rates but not in their hypothetical marginal rates of substitution (subject to scale correction). Further, recent findings in psychology and brain imaging studies suggest neurocognitive mechanisms underlying HB that may explain some of the discrepancies and unexpected findings in the mainstream CE literature. The review also observes how the variety of operational definitions of HB prohibits consistent measurement of HB in CE. The paper further identifies major sources and catalogues explanations of HB as well as possible moderating factors. Finally, it explains how HB represents one component of the wider concept of external validity.
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- 2021
4. Additional file 4: of A novel design process for selection of attributes for inclusion in discrete choice experiments: case study exploring variation in clinical decision-making about thrombolysis in the treatment of acute ischaemic stroke
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BrĂşn, Aoife De, Flynn, Darren, Ternent, Laura, Price, Christopher, Rodgers, Helen, Ford, Gary, Rudd, Matthew, Lancsar, Emily, Simpson, Stephen, Teah, John, and Thomson, Richard
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Operational definitions for variable attribute levels in the DCE. Table presenting definitions used for attribute levels in the DCE. (DOCX 13Â kb)
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- 2018
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5. Additional file 2: of A novel design process for selection of attributes for inclusion in discrete choice experiments: case study exploring variation in clinical decision-making about thrombolysis in the treatment of acute ischaemic stroke
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BrĂşn, Aoife De, Flynn, Darren, Ternent, Laura, Price, Christopher, Rodgers, Helen, Ford, Gary, Rudd, Matthew, Lancsar, Emily, Simpson, Stephen, Teah, John, and Thomson, Richard
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DCE pilot testing protocol. Interview schedule for cognitive interviewing and pilot testing of DCE. (DOCX 18Â kb)
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- 2018
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6. Additional file 1: of A novel design process for selection of attributes for inclusion in discrete choice experiments: case study exploring variation in clinical decision-making about thrombolysis in the treatment of acute ischaemic stroke
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BrĂşn, Aoife De, Flynn, Darren, Ternent, Laura, Price, Christopher, Rodgers, Helen, Ford, Gary, Rudd, Matthew, Lancsar, Emily, Simpson, Stephen, Teah, John, and Thomson, Richard
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On-line structured prioritisation exercise (SPE). Full survey used to collect data. (DOCX 42Â kb)
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- 2018
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7. Additional file 3: of A novel design process for selection of attributes for inclusion in discrete choice experiments: case study exploring variation in clinical decision-making about thrombolysis in the treatment of acute ischaemic stroke
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BrĂşn, Aoife De, Flynn, Darren, Ternent, Laura, Price, Christopher, Rodgers, Helen, Ford, Gary, Rudd, Matthew, Lancsar, Emily, Simpson, Stephen, Teah, John, and Thomson, Richard
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Stage 3 (Phase 1): Results of on-line survey (SPE). Table presenting results of SPE online survey. (DOCX 22Â kb)
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- 2018
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8. Mind the (inter-rater) gap. An investigation of self-reported versus proxy-reported assessments in the derivation of childhood utility values for economic evaluation: A systematic review
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Julie Ratcliffe, Joseph Kwon, Emily Lancsar, Jyoti Khadka, Stavros Petrou, Khadka, Jyoti, Kwon, Joseph, Petrou, Stavros, Lancsar, Emily, and Ratcliffe, Julie
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Male ,Health (social science) ,Cost-Benefit Analysis ,direct valuation methods ,CINAHL ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,History and Philosophy of Science ,proxy-reports ,health economics ,Humans ,030212 general & internal medicine ,Child ,Proxy (statistics) ,childhood ,multi-attribute instrument ,030503 health policy & services ,self-reports ,Proxy ,Inter-rater reliability ,Systematic review ,quality of life ,Child, Preschool ,Respondent ,Economic evaluation ,Female ,Quality-Adjusted Life Years ,Self Report ,0305 other medical science ,Psychology ,Clinical psychology ,Dyad - Abstract
Purpose Evidence surrounding utilities for health states, derived either directly from the application of preference-based valuation methods or indirectly from the application of preference-based quality of life instruments, is increasingly being utilised to inform the cost-effectiveness of child health interventions. Proxy (parent or health professional) assessments are common in this area. This study sought to investigate the degree of convergence in childhood utilities generated directly or indirectly within dyad child and proxy assessments. Methods A systematic literature review was conducted following PRISMA guidelines. A comprehensive literature search strategy conducted across six search engines (PubMed, Embase, Web of Science, PsychoINFO, EconLit, CINAHL and Cochrane Library). Original peer-reviewed articles that reported utilities derived directly or indirectly using simultaneous dyad child and proxy assessments were extracted. Mean and median utilities, correlation coefficients and levels of agreement were extracted, catalogued and assessed. Results A total of 35 studies that reported utilities for two or more respondent types were identified. Of these, 29 studies reported dyad childhood self-report and proxy utilities whilst six studies reported levels of agreement and/or correlations only without documenting overall utilities. Proxy assessment was most often conducted by parents with the HUI3 representing the most commonly applied instrument across a range of health conditions. The utilities derived from child and parent proxy assessment were bidirectional with parental proxies tending to underestimate and health professional proxies tending to overestimate relative to child self-reports. Inter-rater agreement between child self-reports and parent-proxy reports were poorer for more subjective attributes (cognition, emotion and pain), relative to physical attributes (mobility, self-care, speech, vision) of health-related quality of life. Conclusions Childhood utilities derived from children or proxies are not interchangeable. The choice of self or proxy assessor may have potentially significant implications for economic evaluations of child health interventions.
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- 2019
9. The impact of vaccination and patient characteristics on influenza vaccination uptake of elderly people : A discrete choice experiment
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Bas Donkers, Marcel F. Jonker, Esther W. de Bekker-Grob, Jan J. Huisman, Joffre J. Swait, Patrick J E Bindels, Cilia L. M. Witteman, Emily E. Lancsar, Sylvia S. Buis, Jorien Veldwijk, Gouke J. Bonsel, Health Technology Assessment (HTA), Public Health, Business Economics, General Practice, Tinbergen Institute, de Bekker-Grob, Esther W, Veldwijk, Jorien, Jonker, Marcel, Donkers, Bas, Huisman, Jan, Buis, Sylvia, Swait, Joffre, Lancsar, Emily, Witteman, Cilia LM, Bonsel, Gouke, and Bindels, Patrick
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Male ,Patient characteristics ,Discrete choice experiment ,Choice Behavior ,0302 clinical medicine ,Surveys and Questionnaires ,Outcome Assessment, Health Care ,80 and over ,Medicine ,Elderly people ,vaccination characteristics ,030212 general & internal medicine ,Non-U.S. Gov't ,patient characteristics ,Multinomial logistic regression ,Aged, 80 and over ,education.field_of_study ,030503 health policy & services ,Research Support, Non-U.S. Gov't ,Vaccination ,Age Factors ,Middle Aged ,influenza vaccination ,Infectious Diseases ,Influenza Vaccines ,Vaccination coverage ,Respondent ,Molecular Medicine ,Female ,Public Health ,0305 other medical science ,Human ,Population ,Research Support ,vaccination uptake ,03 medical and health sciences ,Outcome Assessment (Health Care) ,SDG 3 - Good Health and Well-being ,Immunology and Microbiology(all) ,Influenza, Human ,Journal Article ,Humans ,education ,Geriatric Assessment ,Aged ,General Veterinary ,General Immunology and Microbiology ,business.industry ,discrete choice experiment ,Environmental and Occupational Health ,Public Health, Environmental and Occupational Health ,Patient Acceptance of Health Care ,veterinary(all) ,Influenza ,Socioeconomic Factors ,business ,Developmental Psychopathology ,Demography - Abstract
Contains fulltext : 188598.pdf (Publisher’s version ) (Open Access) Objectives: To 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. Methods: An 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. Results: Vaccination 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. Conclusions: Although 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. 10 p.
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- 2018
10. Understanding what matters: an exploratory study to investigate the views of the general public for priority setting criteria in health care
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Emily Lancsar, Julie Ratcliffe, Ruth Walker, Yuanyuan Gu, Ratcliffe, Julie, Lancsar, Emily, Walker, Ruth, and Gu, Yuanyuan
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mixed methods ,Clinical effectiveness ,Decision Making ,Exploratory research ,Public opinion ,03 medical and health sciences ,0302 clinical medicine ,quantitative ,ranking ,Health care ,health care priority setting ,Medicine ,Humans ,030212 general & internal medicine ,Health policy ,HRHIS ,Actuarial science ,Priority setting ,business.industry ,Health Priorities ,030503 health policy & services ,Health Policy ,Australia ,Public relations ,Focus Groups ,priority setting ,Focus group ,Treatment Outcome ,Public Opinion ,qualitative ,Quality of Life ,focus groups ,0305 other medical science ,business ,Delivery of Health Care - Abstract
Health care policy makers internationally are increasingly expressing commitment to consultation with, and incorporation of, the views of the general public into the formulation of health policy and the process of setting health care priorities. In practice, however, there are relatively few opportunities for the general public to be involved in health care decision-making. In making resource allocation decisions, funders, tasked with managing scarce health care resources, are often faced with difficult decisions in balancing efficiency with equity considerations. A mixed methods (qualitative and quantitative) approach incorporating focus group discussions and a ranking exercise was utilised to develop a comprehensive list of potential criteria for setting priorities in health care formulated from the perspective of members of the general public in Australia. A strong level of congruence was found in terms of the rankings of the key criteria with the size of the health gain, clinical effectiveness, and the ability to provide quality of life improvements identified consistently as the three most important criteria for prioritising the funding of an intervention. Findings from this study will be incorporated into a novel DCE framework to explore how decision makers and members of the general public prioritize and trade off different types of health gain and to quantify the weights attached to specific efficiency and equity criteria in the priority setting process. Refereed/Peer-reviewed
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- 2017
11. Cognitive Overload? An Exploration of the Potential Impact of Cognitive Functioning in Discrete Choice Experiments with Older People in Health Care
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Maria Crotty, Gang Chen, Emily Lancsar, Julie Ratcliffe, Rachel Milte, Michelle Miller, Milte, Rachel, Ratcliffe, Julie, Chen, Gang, Lancsar, Emily, Miller, Michelle, and Crotty, Maria
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cognition ,Male ,discrete choice experiments ,Logit ,Exploratory research ,Choice Behavior ,older people ,03 medical and health sciences ,Cognition ,0302 clinical medicine ,Mixed logit ,Surveys and Questionnaires ,Econometrics ,Humans ,Cognitive Dysfunction ,030212 general & internal medicine ,Cognitive skill ,skin and connective tissue diseases ,health care economics and organizations ,Aged ,Multinomial logistic regression ,Aged, 80 and over ,Hip Fractures ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Patient Preference ,Regression analysis ,Logistic Models ,Female ,0305 other medical science ,Psychology ,Cognitive load ,Clinical psychology - Abstract
Objectives: This exploratory study sought to investigate the effect of cognitive functioning on the consistency of individual responses to a discrete choice experiment (DCE) study conducted exclusively with older people. Methods: A DCE to investigate preferences for multidisciplinary rehabilitation was administered to a consenting sample of older patients (aged 65 years and older) after surgery to repair a fractured hip (N = 84). Conditional logit, mixed logit, heteroscedastic conditional logit, and generalized multinomial logit regression models were used to analyze the DCE data and to explore the relationship between the level of cognitive functioning (specifically the absence or presence of mild cognitive impairment as assessed by the Mini-Mental State Examination) and preference and scale heterogeneity. Results: Both the heteroscedastic conditional logit and generalized multinomial logit models indicated that the presence of mild cognitive impairment did not have a significant effect on the consistency of responses to the DCE. Conclusions: This study provides important preliminary evidence relating to the effect of mild cognitive impairment on DCE responses for older people. It is important that further research be conducted in larger samples and more diverse populations to further substantiate the findings from this exploratory study and to assess the practicality and validity of the DCE approach with populations of older people. Refereed/Peer-reviewed
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- 2014
12. Reconceptualising the External Validity of Discrete Choice Experiments
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Emily Lancsar, Joffre Swait, Lancsar, Emily, and Swait, Joffre
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Validation study ,Process (engineering) ,Decision Making ,Health Care Sector ,Validity ,Discrete choice experiment ,Choice Behavior ,decision making ,External validity ,experience ,Component (UML) ,external validity ,Humans ,traffic and transport ,Economics, Pharmaceutical ,Quality of Life Research ,Mathematics ,Pharmacology ,experiment ,Management science ,Health Policy ,Public Health, Environmental and Occupational Health ,methodology ,economics ,Models, Economic ,marketing ,conceptual framework ,environment - Abstract
External validity is a crucial but under-researched topic when considering using discrete choice experiment (DCE) results to inform decision making in clinical, commercial or policy contexts. We present the theory and tests traditionally used to explore external validity that focus on a comparison of final outcomes and review how this traditional definition has been empirically tested in health economics and other sectors (such as transport, environment and marketing) in which DCE methods are applied. While an important component, we argue that the investigation of external validity should be much broader than a comparison of final outcomes. In doing so, we introduce a new and more comprehensive conceptualisation of external validity, closely linked to process validity, that moves us from the simple characterisation of a model as being or not being externally valid on the basis of predictive performance, to the concept that external validity should be an objective pursued from the initial conceptualisation and design of any DCE. We discuss how such a broader definition of external validity can be fruitfully used and suggest innovative ways in which it can be explored in practice. Refereed/Peer-reviewed
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- 2014
13. A Systematic Review of Stated Preference Studies Reporting Public Preferences for Healthcare Priority Setting
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Julie Ratcliffe, Kylie Maree Rixon, Jennifer A. Whitty, Emily Lancsar, Xanthe Angela Golenko, Whitty, Jennifer A, Lancsar, Emily, Rixon, Kylie, Golenko, Xanthe, and Ratcliffe, Julie
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Gerontology ,age factors ,Cost-Benefit Analysis ,Health Behavior ,socioeconomic factors ,Context (language use) ,Choice Behavior ,Severity of Illness Index ,Health administration ,choice behavior ,Life Expectancy ,health behavior ,quality of health care ,Social Justice ,Health care ,social justice ,severity of illness index ,Humans ,Medicine ,Preference elicitation ,quality-adjusted life years ,humans ,Health Services Administration ,Health policy ,Quality of Health Care ,Contingent valuation ,Health Care Rationing ,Actuarial science ,Health economics ,health care rationing ,Health Priorities ,business.industry ,cost-benefit analysis ,Health Policy ,Age Factors ,health policy ,Preference ,Socioeconomic Factors ,Public Opinion ,public opinion ,life expectancy ,health services administration ,Quality-Adjusted Life Years ,business ,health priorities - Abstract
Results: Thirty-nine studies applying 40 elicitation methods reported in 41 papers met the inclusion criteria. The discrete choice experiment method was most commonly applied (n = 18, 45.0 %), but other approaches, including contingent valuation and the person trade-off, were also used. Studies prioritised health systems (n = 4, 10.2 %), policies/programmes/services/interventions (n = 16, 41.0 %), or patient groups (n = 19, 48.7 %). Studies generally confirmed the importance of a wide range of process, non-health and patient-related characteristics in priority setting in selected contexts, alongside health outcomes. However, inconsistencies were observed for the relative importance of some prioritisation criteria, suggesting context and/or elicitation approach matter.Conclusions: Overall, findings suggest caution in directly incorporating public preferences as weights for priority setting unless the methods used to elicit the weights can be shown to be appropriate and robust in the priority-setting context.Background: There is current interest in incorporating weights based on public preferences for health and healthcare into priority-setting decisions.Objective: The aim of this systematic review was to explore the extent to which public preferences and trade-offs for priority-setting criteria have been quantified, and to describe the study contexts and preference elicitation methods employed.Methods: A systematic review was performed in April 2013 to identify empirical studies eliciting the stated preferences of the public for the provision of healthcare in a priority-setting context. Studies are described in terms of (i) the stated preference approaches used, (ii) the priority-setting levels and contexts, and (iii) the criteria identified as important and their relative importance. Refereed/Peer-reviewed
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- 2014
14. Is Dimension Order Important when Valuing Health States Using Discrete Choice Experiments Including Duration?
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Rosalie Viney, John Brazier, Paula Lorgelly, Julie Ratcliffe, Emily Lancsar, Brendan Mulhern, Richard Norman, Mulhern, Brendan, Norman, Richard, Lorgelly, Paula, Lancsar, Emily, Ratcliffe, Julie, Brazier, John, and Viney, Rosalie
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Adult ,Male ,Adolescent ,discrete choice ,Health Status ,Discrete choice experiment ,Logistic regression ,health state valuation studies ,Choice Behavior ,Health administration ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Surveys and Questionnaires ,Statistics ,Order dimension ,Econometrics ,Humans ,030212 general & internal medicine ,Valuation (finance) ,Mathematics ,Aged ,Pharmacology ,Health economics ,dimension order ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Middle Aged ,Models, Theoretical ,Quality-adjusted life year ,EQ-5D-5L ,Logistic Models ,Health Policy & Services ,Female ,Quality-Adjusted Life Years ,utility values ,0305 other medical science ,Scale parameter - Abstract
© 2016, Springer International Publishing Switzerland. Background: Discrete choice experiments with duration (DCETTO) can be used to estimate utility values for preference-based measures, such as the EQ-5D-5L. For self-completion, the health dimensions are presented in a standard order. However, for valuation, this may result in order effects. Thus, it is important to understand whether health state dimension ordering affects values. The aim of this study was to examine the importance of dimension ordering on DCE values using EQ-5D-5L. Methods: A choice experiment presenting two health profiles and a third immediate death option was developed. A three-arm study was used, with the same 120 choice sets presented online across each arm (n = 360 per arm). Arm 1 presented the standard EQ-5D-5L dimension order, arm 2 randomised order between respondents, and arm 3 randomised within respondents. Conditional logit regression was used to assess model consistency, and scale parameter testing was used to assess model poolability. Results: There were minor inconsistencies across each arm, but the magnitudes of the coefficients produced were generally consistent. Arm 3 produced the largest range of utility values (1 to −0.980). Scale parameter testing suggested that the models did not differ, and the data could be pooled. Follow-up questions did not suggest variation in terms of difficulty. Conclusions: The results suggest that the level of randomisation used in DCE health state valuation studies does not significantly impact values, and dimension order may not be as important as other study design issues. The results support past valuation studies that use the standard order of dimensions.
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- 2016
15. Best worst discrete choice experiments in health: Methods and an application
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Emily Lancsar, Gillian Currie, Jordan J. Louviere, Leonie Burgess, Cam Donaldson, Lancsar, Emily, Louviere, Jordan, Donaldson, Cam, Currie, Gillian, and Burgess, Leonie
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Adult ,Male ,Canada ,Health (social science) ,Adolescent ,media_common.quotation_subject ,cardiac arrest ,Empirical Research ,Models, Psychological ,Choice Behavior ,Young Adult ,Empirical research ,ranking ,History and Philosophy of Science ,Econometrics ,Economics ,Humans ,Relevance (information retrieval) ,Preference elicitation ,Quality (business) ,sequential best worst ,media_common ,Choice set ,Data collection ,Data Collection ,Job design ,Patient Preference ,Middle Aged ,best worst discrete choice experiments ,Ranking ,Female ,best worst scaling ,Public Health ,Health Services Research ,heterogeneity ,Out-of-Hospital Cardiac Arrest - Abstract
A key objective of discrete choice experiments is to obtain sufficient quantity of high quality choice data to estimate choice models to be used to explore various policy/clinically relevant issues. This paper focuses on a relatively new form of choice experiment, ‘Best Worst Discrete Choice Experiments’ (BWDCEs) and their relevance to health research as a new way to meet such an objective. We explain what BWDCEs are, how and when to apply them and we present several analytical approaches to model the resulting data. We demonstrate this preference elicitation approach in an empirical application exploring preferences of 898 members of the general public in Edmonton and Calgary, Canada for treatment of cardiac arrest occurring in a public place and show the gains achieved compared to traditional analysis of first best data. We suggest that BWDCEs are a valuable way to investigate preferences in the health sector and discuss implications for task design, analysis and areas for future research. Refereed/Peer-reviewed
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- 2013
16. Does one size fit all? Assessing the preferences of older and younger people for attributes of quality of life
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Mary A. Luszcz, Thomas Flint, Gill Lewin, Billingsley Kaambwa, Ruth Walker, Julie Ratcliffe, Ian D. Cameron, Emily Lancsar, Ratcliffe, Julie, Lancsar, Emily, Flint, Thomas, Kaambwa, Billingsley, Walker, Ruth, Lewin, Gill, Luszcz, Mary, and Cameron, Ian D
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Gerontology ,Adult ,Male ,medicine.medical_specialty ,economic evaluation ,Adolescent ,Health Status ,Psychological intervention ,health status ,older people ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Quality of life ,medicine ,Humans ,030212 general & internal medicine ,Geriatrics ,030503 health policy & services ,Public health ,Perspective (graphical) ,Public Health, Environmental and Occupational Health ,Age Factors ,Middle Aged ,Mental health ,Ranking ,quality of life ,younger people ,Economic evaluation ,Quality of Life ,Female ,0305 other medical science ,Psychology - Abstract
Purpose: To systematically compare, via ranking and best worst tasks, the relative importance of key dimensions of quality of life for younger and older people. Methods: A web-based survey was developed for administration to two Australia-wide community-based samples comprising younger people aged 18–64 years and older people aged 65 years and above. Respondents were asked to rank 12 quality of life dimensions. Respondents also completed a successive best worst task using the same 12 quality of life dimensions. Results: The relative importance of the quality of life dimensions differed for younger and older person samples. For older people, the ability to be independent and to have control over their daily lives were particularly important for their overall quality of life whereas for younger people, mental health was considered most important. Conclusions: Many interventions accessed by older people in geriatric medicine and aged care sectors have a broader impact upon quality of life beyond health status. The findings from this study indicate that a focus on broader aspects of quality of life may also be consistent with the preferences of older people themselves as to what constitutes quality of life from their perspective. Refereed/Peer-reviewed
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- 2016
17. Investigating consumers' and informal carers' views and preferences for consumer directed care: A discrete choice experiment
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Maria Crotty, Julie Ratcliffe, Gang Chen, Liz Gill, Ian D. Cameron, Emily Lancsar, Billingsley Kaambwa, Nikki McCaffrey, Kaambwa, Billingsley, Lancsar, Emily, McCaffrey, Nicola, Chen, Gang, Gill, Liz, Cameron, Ian D, Crotty, Maria, and Ratcliffe, Julie
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Male ,personal budgets ,Health (social science) ,Service delivery framework ,media_common.quotation_subject ,Empirical Research ,Choice Behavior ,consumers ,03 medical and health sciences ,0302 clinical medicine ,Empirical research ,History and Philosophy of Science ,Medicine ,Humans ,030212 general & internal medicine ,Marketing ,media_common ,Aged ,Service (business) ,Aged, 80 and over ,business.industry ,030503 health policy & services ,discrete choice experiment ,Australia ,Flexibility (personality) ,Patient Preference ,Service provider ,Models, Theoretical ,Home Care Services ,Preference ,Caregivers ,community aged care services ,informal carers ,Care work ,Female ,0305 other medical science ,business ,consumer directed care ,Attitude to Health ,Autonomy - Abstract
Consumer directed care (CDC) is currently being embraced internationally as a means to promote autonomy and choice for consumers (people aged 65 and over) receiving community aged care services (CACSs). CDC involves giving CACS clients (consumers and informal carers of consumers) control over how CACSs are administered. However, CDC models have largely developed in the absence of evidence on clients' views and preferences. We explored CACS clients' preferences for a variety of CDC attributes and identified factors that may influence these preferences and potentially inform improved design of future CDC models. Study participants were clients of CACSs delivered by five Australian providers. Using a discrete choice experiment (DCE) approach undertaken in a group setting between June and December 2013, we investigated the relative importance to CACS consumers and informal (family) carers of gradations relating to six salient features of CDC (choice of service provider(s), budget management, saving unused/unspent funds, choice of support/care worker(s), support-worker flexibility and level of contact with service coordinator). The DCE data were analysed using conditional, mixed and generalised logit regression models, accounting for preference and scale heterogeneity. Mean ages for 117 study participants were 80 years (87 consumers) and 74 years (30 informal carers). All participants preferred a CDC approach that allowed them to: save unused funds from a CACS package for future use; have support workers that were flexible in terms of changing activities within their CACS care plan and; choose the support workers that provide their day-to-day CACSs. The CDC attributes found to be important to both consumers and informal carers receiving CACSs will inform the design of future CDC models of service delivery. The DCE approach used in this study has the potential for wide applicability and facilitates the assessment of preferences for elements of potential future aged care service delivery not yet available in policy. Refereed/Peer-reviewed
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- 2014
18. A health economic model for the development and evaluation of innovations in aged care: an application to consumer-directed care - study protocol
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Maria Crotty, Julie Ratcliffe, Mary A. Luszcz, Leonard C. Gray, Janice Paterson, Ian D. Cameron, Emily Lancsar, Ratcliffe, Julie, Lancsar, Emily, Luszcz, Mary, Crotty, Maria, Gray, Len, Paterson, Jan, and Cameron, Ian
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medicine.medical_specialty ,economic ,Service delivery framework ,Health Services for the Aged ,media_common.quotation_subject ,Geriatric Medicine ,patient-centered care ,models ,Quality of life (healthcare) ,Health Economics ,Nursing ,Patient-Centered Care ,health services for the aged ,Protocol ,Medicine ,Humans ,humans ,media_common ,Aged ,Research ethics ,Medical education ,Health economics ,Cost–benefit analysis ,business.industry ,Public health ,General Medicine ,research design ,aged ,Models, Economic ,Research Design ,Economic evaluation ,Public Health ,business ,Autonomy - Abstract
Introduction: Consumer-directed care is currently being embraced within Australia and internationally as a means of promoting autonomy and choice in the delivery of health and aged care services. Despite its wide proliferation little research has been conducted to date to assess the views and preferences of older people for consumer-directed care or to assess the costs and benefits of such an approach relative to existing models of service delivery. Methods and analysis: A comprehensive health economic model will be developed and applied to the evolution, implementation and evaluation of consumer-directed care in an Australian community aged care setting. A mixed methods approach comprising qualitative interviews and a discrete choice experiment will determine the attitudes and preferences of older people and their informal carers for consumer-directed care. The results of the qualitative interviews and the discrete choice experiment will inform the introduction of a new consumer-directed care innovation in service delivery. The cost-effectiveness of consumer-directed care will be evaluated by comparing incremental changes in resource use, costs and health and quality of life outcomes relative to traditional services. The discrete choice experiment will be repeated at the end of the implementation period to determine the extent to which attitudes and preferences change as a consequence of experience of consumer-directed care. The proposed framework will have wide applicability in the future development and economic evaluation of new innovations across the health and aged care sectors. Ethics and dissemination: The study is approved by Flinders University Social and Behavioural Research Ethics Committee (Project No. 6114/SBREC). Findings from the qualitative interviews, discrete choice experiments and the economic evaluation will be reported at a workshop of stakeholders to be held in 2015 and will be documented in reports and in peer reviewed journal articles. Refereed/Peer-reviewed
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- 2014
19. How important is health status in defining quality of life for older people? An exploratory study of the views of older South Australians
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Mary A. Luszcz, Emily Lancsar, Catherine M. Milte, Billingsley Kaambwa, Julie Ratcliffe, Ruth Walker, Milte, Catherine M, Walker, Ruth, Luszcz, Mary A, Lancsar, Emily, Kaambwa, Billingsley, and Ratcliffe, Julie
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Gerontology ,safety ,Male ,Economics and Econometrics ,medicine.medical_specialty ,Cost-Benefit Analysis ,Health Status ,Exploratory research ,Psychological intervention ,health status ,socioeconomic factors ,rehabilitation centers ,Rehabilitation Centers ,Health administration ,Quality of life (healthcare) ,male ,middle aged ,Activities of Daily Living ,South Australia ,Medicine ,Humans ,humans ,Internal-External Control ,Qualitative Research ,Aged ,Aged, 80 and over ,Health economics ,business.industry ,Health Policy ,Public health ,cost-benefit analysis ,General Medicine ,Focus Groups ,Middle Aged ,Focus group ,aged ,internal-external control ,female ,quality of life ,Socioeconomic Factors ,Economic evaluation ,Quality of Life ,focus groups ,Female ,Safety ,business ,activities of daily living ,aged, 80 and over ,qualitative research - Abstract
Background: Cost-effectiveness analyses of interventions for older adults have traditionally focused on health status. However, there is increasing recognition of the need to develop new instruments to capture quality of life in a broader sense in the face of age-associated increasing frailty and declining health status, particularly in the economic evaluation of aged and social care interventions that may have positive benefits beyond health. Objective: To explore the relative importance of health and broader quality of life domains for defining quality of life from the perspective of older South Australians. Methods: Older adults (n = 21) from a day rehabilitation facility in Southern Adelaide, South Australia attended one of two audio-recorded focus groups. A mixed methods (qualitative and quantitative) study design was adopted. The study included three main components. First was a general group discussion on quality of life and the factors of importance in defining quality of life. Second was a structured ranking exercise in which individuals were asked to rank domains from the brief Older People's Quality of Life (OPQOL-brief) questionnaire and Adult Social Care Outcomes Toolkit (ASCOT) in order of importance. Third, participants were asked to self-complete the EuroQol five-dimension (EQ-5D), a measure of health status, and two broader quality-of-life measures: the OPQOL-brief and ASCOT. Results: Mean scores on the EQ-5D, OPQOL-brief and ASCOT were 0.71 (standard deviation [SD] 0.20, range 0.06-1.00), 54.6 (SD 5.5, range 38-61) and 0.87 (SD 0.13, range 0.59-1.00), respectively, with higher scores reflecting better ratings. EQ-5D scores were positively associated with OPQOL-brief (Spearman's Rho: 0.730; p < 0.01), but not ASCOT. Approximately half (52.4 %) of the participants ranked either 'health' or 'psychological and emotional well-being' as the domain most important to their quality of life. However, one-third (33.3 %) of the total sample ranked a non-health domain from the ASCOT or OPQOL-brief (safety, dignity, independence) as the most important contributing factor to their overall quality of life. Qualitative analysis of focus group transcripts supported the high value of both health-related (health, psychological well-being) and social (independence, safety) domains to quality of life. Conclusions: Older adults value both health and social domains as important to their overall quality of life. Future economic evaluations of health, community and aged-care services for older adults should include assessment of both health-related and broader aspects of quality of life. Refereed/Peer-reviewed
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- 2013
20. Conducting discrete choice experiments to inform healthcare decision making: a user's guide
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Jordan J. Louviere, Emily Lancsar, Lancsar, Emily, and Louviere, Jordan
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Operations research ,Cost effectiveness ,Choice Behavior ,decision making ,Economics ,Humans ,Preference elicitation ,Policy Making ,Valuation (finance) ,Pharmacology ,Discrete choice ,Data collection ,cost effectiveness ,Health Policy ,Public Health, Environmental and Occupational Health ,Health services research ,health policy ,Consumer Behavior ,Policy analysis ,Risk analysis (engineering) ,Patient Satisfaction ,Economic evaluation ,Health Policy & Services ,Costs and Cost Analysis ,conjoint analysis ,Health Services Research ,Attitude to Health ,patient preference ,Models, Econometric - Abstract
Discrete choice experiments (DCEs) are regularly used in health economics to elicit preferences for healthcare products and programmes. There is growing recognition that DCEs can provide more than information on preferences and, in particular, they have the potential to contribute more directly to outcome measurement for use in economic evaluation. Almost uniquely, DCEs could potentially contribute to outcome measurement for use in both cost-benefit and cost-utility analysis. Within this expanding remit, our intention is to provide a resource for current practitioners as well as those considering undertaking a DCE, using DCE results in a policy/commercial context, or reviewing a DCE. We present the fundamental principles and theory underlying DCEs. To aid in undertaking and assessing the quality of DCEs, we discuss the process of carrying out a choice study and have developed a checklist covering conceptualizing the choice process, selecting attributes and levels, experimental design, questionnaire design, pilot testing, sampling and sample size, data collection, coding of data, econometric analysis, validity, interpretation and welfare and policy analysis. In this fast-moving area, a number of issues remain on the research frontier. We therefore outline potentially fruitful areas for future research associated both with DCEs in general, and with health applications specifically, paying attention to how the results of DCEs can be used in economic evaluation. We also discuss emerging research trends. We conclude that if appropriately designed, implemented, analysed and interpreted, DCEs offer several advantages in the health sector, the most important of which is that they provide rich data sources for economic evaluation and decision making, allowing investigation of many types of questions, some of which otherwise would be intractable analytically. Thus, they offer viable alternatives and complements to existing methods of valuation and preference elicitation.
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- 2008
21. An empirical comparison of the OPQoL-Brief, EQ-5D-3 L and ASCOT in a community dwelling population of older people
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Maria Crotty, Nikki McCaffrey, Ian D. Cameron, Emily Lancsar, Liz Gill, Billingsley Kaambwa, Leonard C. Gray, Julie Ratcliffe, Kaambwa, Billingsley, Gill, Liz, McCaffrey, Nicola, Lancsar, Emily, Cameron, Ian D, Crotty, Maria, Gray, Len, and Ratcliffe, Julie
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Male ,convergent validity ,Gerontology ,Activities of daily living ,Intraclass correlation ,Health Status ,Population ,Context (language use) ,Empirical Research ,Community-dwelling ,Level of agreement ,older people ,Quality of life (healthcare) ,Convergent validity ,EQ-5D ,Activities of Daily Living ,South Australia ,Health Status Indicators ,Humans ,Medicine ,education ,Geriatric Assessment ,Aged ,Aged, 80 and over ,level of agreement ,education.field_of_study ,business.industry ,Research ,ASCOT ,Public Health, Environmental and Occupational Health ,Reproducibility of Results ,General Medicine ,community-dwelling ,Quality-adjusted life year ,OPQoL-Brief ,Quality of Life ,EQ-5D-3 L ,Female ,Independent Living ,Older people ,business ,Demography - Abstract
Background: This study examined the relationships between a newly developed older person-specific non-preference-based quality of life (QoL) instrument (Older People's Quality of Life brief questionnaire (OPQoL-brief)) and two generic preference-based instruments (the EQ-5D-3L Level (EQ-5D-3 L) and the Adult Social Care Outcomes Toolkit (ASCOT) in a community-dwelling population of Australian older people receiving aged care services. Methods: We formulated hypotheses about the convergent validity between the instruments (examined by Wilcoxon-Mann Whitney, Kruskal Wallis and Spearman's correlation tests) and levels of agreement (assessed using intra class correlation (ICC) and modified Bland-Altman plots based on normalized Z EQ-5D-3L and ASCOT utilities and OPQoL-Brief summary scores). Results: The utilities/summary scores for 87 participants (aged 65-93 years) were moderately but positively correlated. Moderate convergent validity was evident for a number of instrument dimensions with the strongest relationship (r = 0.57) between 'enjoy life' (OPQoL-Brief) and 'social contact' (ASCOT). The overall ICC was 0.54 and Bland-Altman scatter plots showed 3-6% of normalized Z-scores were outside the 95% limits of agreement suggesting moderate agreement between all three instruments (agreement highest between the OPQoL-Brief and the ASCOT). Conclusions: Our results suggest that the OPQoL-Brief, the ASCOT and the EQ-5D_3L are suitable for measuring quality of life outcomes in community-dwelling populations of older people. Given the different constructs underpinning these instruments, we recommend that choice of instrument should be guided by the context in which the instruments are being applied. Currently, the OPQoL-Brief is not suitable for use in cost-utility analyses as it is not preference-based. Given their different perspectives, we recommend that both the ASCOT and the EQ-5D are applied simultaneously to capture broader aspects of quality of life and health status within cost-utility analyses within the aged care sector. Future research directed towards the development of a new single preference-based instrument that incorporates both health status and broader aspects of quality of life within quality adjusted life year calculations for older people would be beneficial. Refereed/Peer-reviewed
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