407 results on '"LANCSAR, EMILY"'
Search Results
102. The social value of a QALY: raising the bar or barring the raise?
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Loomes Graham, Bateman Ian, Wildman John, Lancsar Emily, Jones-Lee Michael, Mason Helen, Baker Rachel, Donaldson Cam, Robinson Angela, Sugden Robert, Prades Jose, Ryan Mandy, Shackley Phil, and Smith Richard
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Since the inception of the National Institute for Health and Clinical Excellence (NICE) in England, there have been questions about the empirical basis for the cost-per-QALY threshold used by NICE and whether QALYs gained by different beneficiaries of health care should be weighted equally. The Social Value of a QALY (SVQ) project, reported in this paper, was commissioned to address these two questions. The results of SVQ were released during a time of considerable debate about the NICE threshold, and authors with differing perspectives have drawn on the SVQ results to support their cases. As these discussions continue, and given the selective use of results by those involved, it is important, therefore, not only to present a summary overview of SVQ, but also for those who conducted the research to contribute to the debate as to its implications for NICE. Discussion The issue of the threshold was addressed in two ways: first, by combining, via a set of models, the current UK Value of a Prevented Fatality (used in transport policy) with data on fatality age, life expectancy and age-related quality of life; and, second, via a survey designed to test the feasibility of combining respondents' answers to willingness to pay and health state utility questions to arrive at values of a QALY. Modelling resulted in values of £10,000-£70,000 per QALY. Via survey research, most methods of aggregating the data resulted in values of a QALY of £18,000-£40,000, although others resulted in implausibly high values. An additional survey, addressing the issue of weighting QALYs, used two methods, one indicating that QALYs should not be weighted and the other that greater weight could be given to QALYs gained by some groups. Summary Although we conducted only a feasibility study and a modelling exercise, neither present compelling evidence for moving the NICE threshold up or down. Some preliminary evidence would indicate it could be moved up for some types of QALY and down for others. While many members of the public appear to be open to the possibility of using somewhat different QALY weights for different groups of beneficiaries, we do not yet have any secure evidence base for introducing such a system.
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- 2011
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103. Pricing the Priceless. A Health Care Conundrum
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Lancsar, Emily J.
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Pricing the Priceless. A Health Care Conundrum (Book) -- Book reviews ,Books -- Book reviews ,Business, international ,Economics - Published
- 2004
104. Antipsychotic choice: understanding shared decision-making among doctors and patients.
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Yeo, Vivien, Dowsey, Michelle, Alguera-Lara, Victoria, Ride, Jemimah, Lancsar, Emily, and Castle, David J.
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PILOT projects ,PHYSICIAN-patient relations ,DECISION making ,CONTROLLED release preparations ,DRUGS ,DRUG side effects ,PATIENT compliance ,ANTIPSYCHOTIC agents - Abstract
In deciding pharmacotherapy treatment, doctors have to balance the risks and benefits of treatment, and their preferences may not always align with patient preferences. A pilot study to explore decision-making regarding treatment with antipsychotic medications among doctors and patients. A discrete choice experiment (DCE), comprised of systematically structured choice tasks, in which doctors and patients were asked to trade off between attributes of antipsychotic medications, each described in terms of mode of administration, effectiveness (on positive and negative symptoms) and side effect profiles. Participants also ranked different factors that they consider important when choosing an antipsychotic medication. 52 doctors and 49 patients completed the survey. Doctors accepted a higher risk of side effects than patients if it achieved better efficacy. Patients perceived long-acting injectables (LAIs) to be easier than taking tablets every day. Issues of embarrassment, pain and fear of needles were not rated as highly by patients, as anticipated by doctors. Doctors and patients demonstrated differences in decision-making about treatment with antipsychotic medications. Addressing these issues could facilitate shared decision-making, with the goal of improving patient adherence to antipsychotic medications, and thereby improve patient outcomes. [ABSTRACT FROM AUTHOR]
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- 2021
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105. Revealed and Stated Preferences of Decision Makers for Priority Setting in Health Technology Assessment: A Systematic Review
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Ghijben, Peter, primary, Gu, Yuanyuan, additional, Lancsar, Emily, additional, and Zavarsek, Silva, additional
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- 2017
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106. Factors that influence clinicians’ decisions to offer intravenous alteplase in acute ischemic stroke patients with uncertain treatment indication: Results of a discrete choice experiment
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De Brún, Aoife, primary, Flynn, Darren, additional, Ternent, Laura, additional, Price, Christopher I, additional, Rodgers, Helen, additional, Ford, Gary A, additional, Rudd, Matthew, additional, Lancsar, Emily, additional, Simpson, Stephen, additional, Teah, John, additional, and Thomson, Richard G, additional
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- 2017
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107. Factors that influence variation in clinical decision-making about thrombolysis in the treatment of acute ischaemic stroke: results of a discrete choice experiment
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Thomson, Richard G, primary, De Brún, Aoife, additional, Flynn, Darren, additional, Ternent, Laura, additional, Price, Christopher I, additional, Rodgers, Helen, additional, Ford, Gary A, additional, Rudd, Matthew, additional, Lancsar, Emily, additional, Simpson, Stephen, additional, and Teah, John, additional
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- 2017
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108. Is Dimension Order Important when Valuing Health States Using Discrete Choice Experiments Including Duration?
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Mulhern, Brendan, primary, Norman, Richard, additional, Lorgelly, Paula, additional, Lancsar, Emily, additional, Ratcliffe, Julie, additional, Brazier, John, additional, and Viney, Rosalie, additional
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- 2016
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109. From representing views to representativeness of views: Illustrating a new (Q2S) approach in the context of health care priority setting in nine European countries
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Mason, Helen, primary, van Exel, Job, additional, Baker, Rachel, additional, Brouwer, Werner, additional, Donaldson, Cam, additional, Mason, Helen, additional, Pennington, Mark, additional, Bell, Sue, additional, Jones-Lee, Michael, additional, Wildman, John, additional, Lancsar, Emily, additional, Robinson, Angela, additional, Bacon, Philomena, additional, Olsen, Jan Abel, additional, Gyrd-Hansen, Dorte, additional, Kjaer, Trine, additional, Beck, Mickael, additional, Nielsen, Jytte Seested, additional, Persson, Ulf, additional, Bergman, Annika, additional, Protière, Christel, additional, Moatti, Jean Paul, additional, Luchini, Stephane, additional, Pinto Prades, Jose Luis, additional, Mataria, Awad, additional, Khatib, Rana, additional, Jaralla, Yara, additional, Topór-Madry, Roman, additional, Kozierkiewicz, Adam, additional, Poznanski, Darek, additional, Kocot, Ewa, additional, Gulácsi, László, additional, Péntek, Márta, additional, Kharroubi, Samer, additional, Manca, Andrea, additional, and Shackley, Phil, additional
- Published
- 2016
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110. Cost of SalmonellaInfections in Australia, 2015
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Ford, Laura, Haywood, Philip, Kirk, Martyn D., Lancsar, Emily, Williamson, Deborah A., and Glass, Kathryn
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Gastroenteritis caused from infections with Salmonella enterica(salmonellosis) causes significant morbidity in Australia. In addition to acute gastroenteritis, approximately 8.8% of people develop irritable bowel syndrome (IBS) and 8.5% of people develop reactive arthritis (ReA). We estimated the economic cost of salmonellosis and associated sequel illnesses in Australia in a typical year circa 2015. We estimated incidence, hospitalizations, other health care usage, absenteeism, and premature mortality for four age groups using a variety of complementary data sets. We calculated direct costs (health care) and indirect costs (lost productivity and premature mortality) by using Monte Carlo simulation to estimate 90% credible intervals (CrI) around our point estimates. We estimated that 90,833 cases, 4,312 hospitalizations, and 19 deaths occurred from salmonellosis in Australia circa 2015 at a direct cost of AUD 23.8 million (90% CrI, 19.3 to 28.9 million) and a total cost of AUD 124.4 million (90% CrI, 107.4 to 143.1 million). When IBS and ReA were included, the estimated direct cost was 35.7 million (90% CrI, 29.9 to 42.7 million) and the total cost was AUD 146.8 million (90% CrI, 127.8 to 167.9 million). Foodborne infections were responsible for AUD 88.9 million (90% CrI, 63.9 to 112.4 million) from acute salmonellosis and AUD 104.8 million (90% CrI, 75.5 to 132.3 million) when IBS and ReA were included. Targeted interventions to prevent illness could considerably reduce costs and societal impact from Salmonellainfections and sequel illnesses in Australia.
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- 2019
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111. Does one size fit all? Assessing the preferences of older and younger people for attributes of quality of life
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Ratcliffe, Julie, primary, Lancsar, Emily, additional, Flint, Thomas, additional, Kaambwa, Billingsley, additional, Walker, Ruth, additional, Lewin, Gill, additional, Luszcz, Mary, additional, and Cameron, Ian D., additional
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- 2016
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112. Women’s Preferences for Treatment of Perinatal Depression and Anxiety: A Discrete Choice Experiment
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Ride, Jemimah, primary and Lancsar, Emily, additional
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- 2016
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113. 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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Kaambwa, Billingsley, primary, Gill, Liz, additional, McCaffrey, Nicola, additional, Lancsar, Emily, additional, Cameron, Ian D., additional, Crotty, Maria, additional, Gray, Len, additional, and Ratcliffe, Julie, additional
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- 2015
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114. Cost-effectiveness analysis of the New South Wales adult drug court program
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Shanahan, Marian, Lancsar, Emily, Haas, Marion, Lind, Bronwyn, Weatherburn, Don, and Chen, Shuling
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Cost control -- Evaluation ,Drug courts -- Evaluation ,Drug courts -- Finance ,Company financing ,Cost reduction ,Law ,Social sciences - Abstract
A cost-effective evaluation of an adult drug court (ADC) program was conducted in New South Wales, in Australia. Survey results show that, for the 23-month period of the evaluation, the ADC was more cost-effective in decreasing the frequency of offending for those outcome measures selected. The key issues faced in the evaluation are discussed.
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- 2004
115. Factors that influence clinicians' decisions to offer intravenous alteplase in acute ischemic stroke patients with uncertain treatment indication: Results of a discrete choice experiment.
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Brún, Aoife De, Flynn, Darren, Ternent, Laura, Price, Christopher I, Rodgers, Helen, Ford, Gary A, Rudd, Matthew, Lancsar, Emily, Simpson, Stephen, Teah, John, and Thomson, Richard G
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ALTEPLASE ,STROKE patients ,DISCRETE choice models ,THROMBOLYTIC therapy ,LIKELIHOOD ratio tests - Abstract
Background: Treatment with intravenous alteplase for eligible patients with acute ischemic stroke is underused, with variation in treatment rates across the UK. This study sought to elucidate factors influencing variation in clinicians' decision-making about this thrombolytic treatment. Methods: A discrete choice experiment using hypothetical patient vignettes framed around areas of clinical uncertainty was conducted with UK-based clinicians. Mixed logit regression analyses were conducted on the data. Results: A total of 138 clinicians completed the discrete choice experiment. Seven patient factors were individually predictive of increased likelihood of immediately offering IV alteplase (compared to reference levels in brackets): stroke onset time 2 h 30 min [50 min]; pre-stroke dependency mRS 3 [mRS 4]; systolic blood pressure 185 mm/Hg [140 mm/Hg]; stroke severity scores of NIHSS 5 without aphasia, NIHSS 14 and NIHSS 23 [NIHSS 2 without aphasia]; age 85 [68]; Afro-Caribbean [white]. Factors predictive of withholding treatment with IV alteplase were: age 95 [68]; stroke onset time of 4 h 15 min [50 min]; severe dementia [no memory problems]; SBP 200 mm/Hg [140 mm/Hg]. Three clinicianrelated factors were predictive of an increased likelihood of offering IV alteplase (perceived robustness of the evidence for IV alteplase; thrombolyzing more patients in the past 12 months; and high discomfort with uncertainty) and one with a decreased likelihood (high clinician comfort with treating patients outside the licensing criteria). Conclusions: Both patient- and clinician-related factors have a major influence on the use of alteplase to treat patients with acute ischemic stroke. Clinicians' views of the evidence, comfort with uncertainty and treating patients outside the license criteria are important factors to address in programs that seek to reduce variation in care quality regarding treatment with IV alteplase. Further research is needed to further understand the differences in clinical decision-making about treating patients with acute ischemic stroke with IV alteplase. [ABSTRACT FROM AUTHOR]
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- 2018
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116. Public preferences for engagement in Health Technology Assessment decision-making: protocol of a mixed methods study
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Wortley, Sally, primary, Tong, Allison, additional, Lancsar, Emily, additional, Salkeld, Glenn, additional, and Howard, Kirsten, additional
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- 2015
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117. 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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Milte, Catherine M., primary, Walker, Ruth, additional, Luszcz, Mary A., additional, Lancsar, Emily, additional, Kaambwa, Billingsley, additional, and Ratcliffe, Julie, additional
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- 2013
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118. Searchers vs surveyors in estimating the monetary value of a QALY: resolving a nasty dilemma for NICE
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Baker, Rachel, primary, Chilton, Sue, additional, Donaldson, Cam, additional, Jones-Lee, Michael, additional, Lancsar, Emily, additional, Mason, Helen, additional, Metcalf, Hugh, additional, Pennington, Mark, additional, and Wildman, John, additional
- Published
- 2011
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119. The social value of a QALY: raising the bar or barring the raise?
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Donaldson, Cam, primary, Baker, Rachel, additional, Mason, Helen, additional, Jones-Lee, Michael, additional, Lancsar, Emily, additional, Wildman, John, additional, Bateman, Ian, additional, Loomes, Graham, additional, Robinson, Angela, additional, Sugden, Robert, additional, Prades, Jose Luis Pinto, additional, Ryan, Mandy, additional, Shackley, Phil, additional, and Smith, Richard, additional
- Published
- 2011
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120. Choice experiments in health: the good, the bad, the ugly and toward a brighter future
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LOUVIERE, JORDAN J., primary and LANCSAR, EMILY, additional
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- 2009
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121. Patient preferences for managing asthma: results from a discrete choice experiment
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King, Madeleine T., primary, Hall, Jane, additional, Lancsar, Emily, additional, Fiebig, Denzil, additional, Hossain, Ishrat, additional, Louviere, Jordan, additional, Reddel, Helen K., additional, and Jenkins, Christine R., additional
- Published
- 2007
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122. Deleting ‘irrational’ responses from discrete choice experiments: a case of investigating or imposing preferences?
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Lancsar, Emily, primary and Louviere, Jordan, additional
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- 2006
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123. Introducing Best Worst Choice Experiments to Investigate Preferences and Values
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Lancsar, Emily, primary and Louviere, Jordan J. J., additional
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- 2006
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124. Deriving welfare measures from discrete choice experiments: a response to Ryan and Santos Silva
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Lancsar, Emily, primary and Savage, Elizabeth, additional
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- 2004
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125. Deriving welfare measures from discrete choice experiments: inconsistency between current methods and random utility and welfare theory
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Lancsar, Emily, primary and Savage, Elizabeth, additional
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- 2004
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126. Diagnosis and prognosis of Australia&s health information for evidence-based policy
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Gool, Kees Van, primary, Lancsar, Emily, additional, Viney, Rosalie, additional, Hall, Jane, additional, and Haywood, Philip, additional
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- 2002
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127. The Use of a Discrete Choice Experiment Including Both Duration and Dead for the Development of an EQ-5D-5L Value Set for Australia.
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Norman, Richard, Mulhern, Brendan, Lancsar, Emily, Lorgelly, Paula, Ratcliffe, Julie, Street, Deborah, and Viney, Rosalie
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COST effectiveness , *AUSTRALIANS , *POPULATION aging - Abstract
Background/Aims: Discrete choice experiments (DCEs) with either duration included an attribute or with dead included as an option can be used as a stand-alone approach to value health states. This paper reports on a DCE with both of these features to develop an EQ-5D-5L value set for Australia. Methods: A DCE was undertaken using a large Australian panel of internet respondents, from which a sample of more than 4000 Australian adults was chosen, stratified to be population representative on age and gender. The DCE contained 500 choice triplets, with two EQ-5D-5L health states with duration, and dead as the third option. Each respondent answered 12 choice sets from the 500, stating both the best and worst options from the three available. The design was constructed to estimate a utility algorithm with main effects plus some key interaction terms. A variety of approaches to parameterising interactions, and to anchoring the value set on the required 0–1 scale, were tested. A preferred Australian adult utility algorithm for use in cost-utility analysis was then generated. Results: In total, 4477 people completed at least one choice set and were included in the analysis. The results reflected the monotonic structure of the EQ-5D-5L, in that moving from no problems to extreme problems led to worsening utility in each dimension. Inclusion of interaction terms demonstrates that the disutility of the first dimension moving to a poor level (defined as either level 5, or level 4 or 5) had a large impact, but subsequent dimensions moving to a poor level had a relatively smaller disutility. Discussion: This work develops a value set for the EQ-5D-5L in Australia, and also provides a range of methodological insights which can inform future work using a stand-alone DCE to value health in other countries. [ABSTRACT FROM AUTHOR]
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- 2023
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128. Understanding clinicians' decisions to offer intravenous thrombolytic treatment to patients with acute ischaemic stroke: a protocol for a discrete choice experiment.
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De Brún, Aoife, Flynn, Darren, Joyce, Kerry, Ternent, Laura, Price, Christopher, Rodgers, Helen, Ford, Gary A., Lancsar, Emily, Rudd, Matthew, and Thomson, Richard G.
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Background: Intravenous thrombolysis is an effective emergency treatment for acute ischaemic stroke for patients meeting specific criteria. Approximately 12% of eligible patients in England, Wales and Northern Ireland received thrombolysis in the first quarter of 2013, yet as many as 15% are eligible to receive treatment. Suboptimal use of thrombolysis may have been largely attributable to structural factors; however, with the widespread implementation of 24/7 hyper acute stroke services, continuing variation is likely to reflect differences in clinical decision-making, in particular the influence of ambiguous areas within the guidelines, licensing criteria and research evidence. Clinicians' perceptions about thrombolysis may now exert a greater influence on treatment rates than structural/service factors. This research seeks to elucidate factors influencing thrombolysis decision-making by using patient vignettes to identify (1) patient-related and clinician-related factors that may help to explain variation in treatment and (2) associated trade-offs in decision-making based on the interplay of critical factors. Methods/analysis: A discrete choice experiment (DCE) will be conducted to better understand how clinicians make decisions about whether or not to offer thrombolysis to patients with acute ischaemic stroke. To inform the design, exploratory work will be undertaken to ensure that (1) all potentially influential factors are considered for inclusion; and (2) to gain insights into the 'grey areas' of patient factors. A fractional factorial design will be used to combine levels of patient factors in vignettes, which will be presented to clinicians to allow estimation of the variable effects on decisions to offer thrombolysis. Ethics and dissemination: Ethical approval for this study was obtained from the Newcastle University Research Ethics Committee. The results will be disseminated in peer review publications and at national conferences. Findings will be translated into continuing professional development activities and will support implementation of a computerised decision aid for thrombolysis (COMPASS) in acute stroke care. [ABSTRACT FROM AUTHOR]
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- 2014
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129. 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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Ratcliffe, Julie, Lancsar, Emily, Luszcz, Mary, Crotty, Maria, Gray, Len, Paterson, Jan, and Cameron, Ian D.
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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. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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130. Considerations Around the Inclusion of Children and Young People’s Time in Economic Evaluation: Findings from an International Delphi Study.
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Morgan, Cameron, Donaldson, Cam, Lancsar, Emily, Petrou, Stavros, and Andronis, Lazaros
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YOUNG adults , *RATE setting , *OPPORTUNITY costs , *RESEARCH personnel , *SCIENTIFIC community - Abstract
Background: People’s time is a finite resource and a valuable input that ought to be considered in economic evaluations taking a broad, societal perspective. Yet, evaluations of interventions focusing on children and young people (CYP) rarely account for the opportunity cost of time in this population. As a key reason for this, health economists have pointed to uncertainty around when it is appropriate to include CYP time-related costs in an economic evaluation and highlighted the lack of clear guidance on the topic.With this in mind, we carried out a Delphi study to establish a list of relevant considerations for researchers to utilise whilst making decisions about whether and when to include CYP time in their economic evaluations. Delphi panellists were asked to propose and rate a set of possible considerations and provide additional thoughts on their ratings. Ratings were summarised using descriptive statistics, and text comments were interrogated through thematic analysis.A total of 73 panellists across 16 countries completed both rounds of a two-round Delphi study. Panellists’ ratings showed that, when thinking about whether to include displaced CYP time in an economic evaluation, it is very important to consider whether: (1) inclusion would be in line with specified perspective(s) (median score: 9), (2) CYP’s time may already be accounted for in other parts of the evaluation (median score: 8), (3) the amount of forgone time is substantial, either in absolute or relative terms (median score: 7) and (4) inclusion of CYP’s time costs would be of interest to decision-makers (median score: 7). Respondents thought that considerations such as (1) whether inclusion would be of interest to the research community (median score: 6), (2) whether CYP’s time displaced by receiving treatment is ‘school’ or ‘play’ time (median score: 5), and (3) whether CYP’s are old enough for their time to be considered valuable (median score: 5) are moderately important. A range of views was offered to support beliefs and ratings, many of which were underpinned by compelling normative questions.Methods: People’s time is a finite resource and a valuable input that ought to be considered in economic evaluations taking a broad, societal perspective. Yet, evaluations of interventions focusing on children and young people (CYP) rarely account for the opportunity cost of time in this population. As a key reason for this, health economists have pointed to uncertainty around when it is appropriate to include CYP time-related costs in an economic evaluation and highlighted the lack of clear guidance on the topic.With this in mind, we carried out a Delphi study to establish a list of relevant considerations for researchers to utilise whilst making decisions about whether and when to include CYP time in their economic evaluations. Delphi panellists were asked to propose and rate a set of possible considerations and provide additional thoughts on their ratings. Ratings were summarised using descriptive statistics, and text comments were interrogated through thematic analysis.A total of 73 panellists across 16 countries completed both rounds of a two-round Delphi study. Panellists’ ratings showed that, when thinking about whether to include displaced CYP time in an economic evaluation, it is very important to consider whether: (1) inclusion would be in line with specified perspective(s) (median score: 9), (2) CYP’s time may already be accounted for in other parts of the evaluation (median score: 8), (3) the amount of forgone time is substantial, either in absolute or relative terms (median score: 7) and (4) inclusion of CYP’s time costs would be of interest to decision-makers (median score: 7). Respondents thought that considerations such as (1) whether inclusion would be of interest to the research community (median score: 6), (2) whether CYP’s time displaced by receiving treatment is ‘school’ or ‘play’ time (median score: 5), and (3) whether CYP’s are old enough for their time to be considered valuable (median score: 5) are moderately important. A range of views was offered to support beliefs and ratings, many of which were underpinned by compelling normative questions.Findings: People’s time is a finite resource and a valuable input that ought to be considered in economic evaluations taking a broad, societal perspective. Yet, evaluations of interventions focusing on children and young people (CYP) rarely account for the opportunity cost of time in this population. As a key reason for this, health economists have pointed to uncertainty around when it is appropriate to include CYP time-related costs in an economic evaluation and highlighted the lack of clear guidance on the topic.With this in mind, we carried out a Delphi study to establish a list of relevant considerations for researchers to utilise whilst making decisions about whether and when to include CYP time in their economic evaluations. Delphi panellists were asked to propose and rate a set of possible considerations and provide additional thoughts on their ratings. Ratings were summarised using descriptive statistics, and text comments were interrogated through thematic analysis.A total of 73 panellists across 16 countries completed both rounds of a two-round Delphi study. Panellists’ ratings showed that, when thinking about whether to include displaced CYP time in an economic evaluation, it is very important to consider whether: (1) inclusion would be in line with specified perspective(s) (median score: 9), (2) CYP’s time may already be accounted for in other parts of the evaluation (median score: 8), (3) the amount of forgone time is substantial, either in absolute or relative terms (median score: 7) and (4) inclusion of CYP’s time costs would be of interest to decision-makers (median score: 7). Respondents thought that considerations such as (1) whether inclusion would be of interest to the research community (median score: 6), (2) whether CYP’s time displaced by receiving treatment is ‘school’ or ‘play’ time (median score: 5), and (3) whether CYP’s are old enough for their time to be considered valuable (median score: 5) are moderately important. A range of views was offered to support beliefs and ratings, many of which were underpinned by compelling normative questions. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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131. Menu choice stated preference tasks to capture demand complementarity in health.
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Huynh, Elisabeth, Swait, Joffre, Lancsar, Emily, and Ride, Jemimah
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RESEARCH , *HEALTH policy , *NUTRITION , *PATIENTS' attitudes , *FOOD preferences , *EXERCISE , *HEALTH behavior , *DECISION making , *AUSTRALIANS , *MENU planning , *STATISTICAL correlation , *POLICY sciences , *BEHAVIOR modification - Abstract
Health programs/services are often bundled, allowing for both substitution and complementarity. We adapt Discrete Choice Experiments to capture bundling, with application to a case study of exercise and nutrition; complementarity arises due to the goal of improving health. Our contributions are (1) to present a menu-based choice experiment to explore bundling; (2) to analyse the menu-based data using an extension of the choice set generation model (GenL) to account for correlations between bundles and component singles. A nationally representative sample of 333 Australians chose between a nutrition program only; exercise program only; both nutrition and exercise programs; or their status quo. Overall, we show that by incorporating the menu choice task and introducing the combined alternative, we capture a significant portion of the population seeking both exercise and nutrition components. We estimate a latent class GenL model, and identify two latent classes: Class 1 preferred to choose programs on offer, and Class 2 was more price sensitive and had a stronger preference for staying with their status quo. We show in the post-estimation analysis that heterogeneity in preferences translates into heterogeneity in the way alternatives are bundled, indicating that the combined offering is appealing to specific classes of individuals who prefer bundling. By implementing the menu choice task, researchers and policymakers can effectively identify, cater to and influence the demand for combined exercise and nutrition options, leading to more targeted and impactful interventions in promoting healthier lifestyle choices. • We propose a menu-based choice experiment to explore bundling for health-related options. • Bundling accounts for a significant portion of demand in a case study exploring choice of nutrition and exercise programs. • Ignoring bundling leads to an overstatement of demand for single alternatives, leading to misprediction of demand. • Combined offering is appealing to specific classes of individuals who prefer bundling. • We provide insights as to why policy interventions to improve uptake may not be effective for everybody. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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132. Longitudinal associations between socioeconomic position and overall health of children with chronic kidney disease and their carers.
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Shingde, Rashmi, Guha, Chandana, van Zwieten, Anita, Kim, Siah, Walker, Amanda, Francis, Anna, Didsbury, Madeleine, Teixeira-Pinto, Armando, Prestidge, Chanel, Lancsar, Emily, Mackie, Fiona, Kwon, Joseph, Howard, Kirsten, Howell, Martin, Jaure, Allison, Hayes, Alison, Raghunandan, Rakhee, Petrou, Stavros, Lah, Suncica, and McTaggart, Steven
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HEALTH status indicators , *INCOME , *SOCIOECONOMIC factors , *SOCIOECONOMIC disparities in health , *SCIENTIFIC observation , *DESCRIPTIVE statistics , *LONGITUDINAL method , *ODDS ratio , *CHRONIC kidney failure in children , *PSYCHOLOGY of caregivers , *CONFIDENCE intervals , *HEALTH equity , *DATA analysis software , *CAREGIVER attitudes , *REGRESSION analysis , *EMPLOYMENT - Abstract
Background: Disadvantaged socioeconomic position (SEP) is an important predictor of poor health in children with chronic kidney disease (CKD). The time course over which SEP influences the health of children with CKD and their carers is unknown. Methods: This prospective longitudinal study included 377 children, aged 6–18 years with CKD (stages I–V, dialysis, and transplant), and their primary carers. Mixed effects ordinal regression was performed to assess the association between SEP and carer-rated child health and carer self-rated health over a 4-year follow-up. Results: Adjusted for CKD stage, higher family household income (adjusted odds ratio (OR) (95% CI) 3.3, 1.8–6.0), employed status of primary carers (1.7, 0.9–3.0), higher carer-perceived financial status (2.6, 1.4–4.8), and carer home ownership (2.2, 1.2–4.0) were associated with better carer-rated child health. Household income also had a differential effect on the carer's self-rated health over time (p = 0.005). The predicted probabilities for carers' overall health being 'very good' among lower income groups at 0, 2, and 4 years were 0.43 (0.28–0.60), 0.34 (0.20–0.51), and 0.25 (0.12–0.44), respectively, and 0.81 (0.69–0.88), 0.84 (0.74–0.91), and 0.88 (0.76–0.94) for carers within the higher income group. Conclusions: Carers and their children with CKD in higher SEP report better overall child and carer health compared with those in lower SEP. Carers of children with CKD in low-income households had poorer self-rated health compared with carers in higher-income households at baseline, and this worsened over time. These cumulative effects may contribute to health inequities between higher and lower SEP groups over time. [ABSTRACT FROM AUTHOR]
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- 2024
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133. The RETRIEVE Checklist for Studies Reporting the Elicitation of Stated Preferences for Child Health-Related Quality of Life.
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Bailey, Cate, Howell, Martin, Raghunandan, Rakhee, Dalziel, Kim, Howard, Kirsten, Mulhern, Brendan, Petrou, Stavros, Rowen, Donna, Salisbury, Amber, Viney, Rosalie, Lancsar, Emily, and Devlin, Nancy
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QUALITY of life , *RESEARCH personnel - Abstract
Background: Recent systematic reviews show varying methods for eliciting, modelling, and reporting preference-based values for child health-related quality-of-life (HRQoL) outcomes, thus producing value sets with different characteristics. Reporting in many of the reviewed studies was found to be incomplete and inconsistent, making them difficult to assess. Checklists can help to improve standards of reporting; however, existing checklists do not address methodological issues for valuing child HRQoL. Existing checklists also focus on reporting methods and processes used in developing HRQoL values, with less focus on reporting of the values' key characteristics and properties. We aimed to develop a checklist for studies generating values for child HRQoL, including for disease-specific states and value sets for generic child HRQoL instruments. Development: A conceptual model provided a structure for grouping items into five modules. Potential items were sourced from an adult HRQoL checklist review, with additional items specific to children developed using recent reviews. Checklist items were reduced by eliminating duplication and overlap, then refined for relevance and clarity via an iterative process. Long and short checklist versions were produced for different user needs. The resulting long RETRIEVE contains 83 items, with modules for reporting methods (A–D) and characteristics of values (E), for researchers planning and reporting child health valuation studies. The short RETRIEVE contains 14 items for decision makers or researchers choosing value sets. Conclusion: Applying the RETRIEVE checklists to relevant studies suggests feasibility. RETRIEVE has the potential to improve completeness in the reporting of preference-based values for child HRQOL outcomes and to improve assessment of preference-based value sets. [ABSTRACT FROM AUTHOR]
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- 2024
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134. Reviews.
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Capie, Forrest, Levy, David M., Saunders, Peter, Mills, Gordon, Wolfson, Martin H., Lancsar, Emily J., Freebairn, John, Guest, Ross, Qing Zhang, and Chapman, Bruce
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NONFICTION - Abstract
Books reviewed: Peter Bernholz, Monetary Regimes and Inflation: History, Economic and Political Relationships William Oliver Coleman, Economics and Its Enemies: Two Centuries of Anti-Economics Michael Pusey, The Experience of Middle Australia. The Dark Side of Economic Reform Bent Flyvbjerg, Nils Bruzelius and Werner Rothengatter, Megaprojects and Risk: An Anatomy of Ambition Phillip Anthony O’Hara, Marx, Veblen, and Contemporary Institutional Political Economy Joseph P. Newhouse, Pricing the Priceless. A Health Care Conundrum Ian McAllister, Steve Dowrick and Riaz Hassan (eds), The Cambridge Handbook of Social Sciences in Australia Owen Covick (ed), Policies to Boost Australian Saving: How? And Why? Ross Garnaut, Ligang Song, Yang Yao and Xiaolu Wang, Private Enterprise in China Andrew Norton, The Unchained University [ABSTRACT FROM AUTHOR]
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- 2004
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135. Valuing the Quality-of-Life Aged Care Consumers (QOL-ACC) Instrument for Quality Assessment and Economic Evaluation.
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Ratcliffe, Julie, Bourke, Siobhan, Li, Jinhu, Mulhern, Brendan, Hutchinson, Claire, Khadka, Jyoti, Milte, Rachel, and Lancsar, Emily
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Objective: This paper reports on the valuation of the classification system for the Quality-of-Life Aged Care Consumers (QOL-ACC) instrument using a discrete choice experiment (DCE) with duration with a large sample of older people receiving aged care services.Methods: A DCE with 160 choice sets of two quality-of-life state-survival duration combinations blocked into 20 survey versions, with eight choice sets in each version, was designed and administered through an on-line survey to older Australians receiving aged care services in home and via interviewer facilitation with older people in residential aged care settings. Model specifications investigating preferences with respect to survival duration and interactions between QOL-ACC dimension levels were estimated. Utility weights were developed, with estimated coefficients transformed to the 0 (being dead) to 1 (full health) scale to generate a value set suitable for application in quality assessment and for the calculation of quality-adjusted life-years for use in economic evaluation.Results: In total, 953 older people completed the choice experiment with valid responses. The estimation results from econometric model specifications indicated that utility increased with survival duration and decreased according to quality-of-life impairment levels. An Australian value set (range - 0.56 to 1.00) was generated for the calculation of utilities for all QOL-ACC states.Conclusion: The QOL-ACC is unique in its focus on measuring and valuing quality of life from the perspective of older people themselves, thereby ensuring that the preferences of aged care service users are the primary focus for quality assessment and economic evaluation. [ABSTRACT FROM AUTHOR]- Published
- 2022
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136. Views, obstacles, and uncertainties around the inclusion of children and young people's time in economic evaluations: Findings from an international survey of health economists.
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Andronis, Lazaros, Morgan, Cameron, Donaldson, Cam, Lancsar, Emily, and Petrou, Stavros
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EXPERIMENTAL design , *PILOT projects , *INFERENTIAL statistics , *TIME , *RESEARCH methodology , *UNCERTAINTY , *MEDICAL care costs , *INTERVIEWING , *QUANTITATIVE research , *QUALITATIVE research , *EARLY intervention (Education) , *QUESTIONNAIRES , *DESCRIPTIVE statistics , *COST analysis , *SOCIAL attitudes , *THEMATIC analysis - Abstract
People's time is a limited resource and, in economic evaluations that adopt a societal perspective, it is important that it is valued and accounted for. Yet, in economic evaluations of interventions for children and young people (CYP), attempts to take into account the opportunity cost of their time are rare. To understand why this is the case, we need to first understand what views health economists hold in relation to CYP time, and what challenges they face in incorporating this in their evaluations. We planned and carried out an international survey of health economists. We used a combination of approaches to identify potential survey respondents (the survey's sampling frame), we developed a questionnaire that sought to capture respondents' views and practice through close- and open-ended questions, we piloted the questionnaire through a series of cognitive interviews, and we e-mailed unique links to the final version of the questionnaire to 1956 individuals in the sampling frame. We analysed data using quantitative (descriptive and inferential statistics) and qualitative (thematic analysis) methods. We received 274 complete responses. Most respondents (87%) believe CYP time should be considered for inclusion in economic evaluations conducted from a societal perspective. However, they identify a number of obstacles to doing so, most prominently uncertainties around appropriate practice (e.g., when CYP's time should or should not be included in calculations), methodological gaps (e.g., what value to attach to CYP's time), and practical difficulties in measuring displaced time in CYP. Reporting on their own practice, most respondents found it challenging to consider CYP time in their studies, and stressed the need for clear guidance on when, and further research on how, to appropriately account for CYP's time in economic evaluations. We offer our views on how to move the topic forwards and make suggestions further research. • Children and young people's time is rarely accounted for in economic evaluations. • We surveyed health economists to understand their views and practice on the topic. • Respondents pointed out various challenges and gaps in available methods. • Research is needed on how to value and include CYP time in economic evaluations. [ABSTRACT FROM AUTHOR]
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- 2023
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137. 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
138. 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
139. 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
140. 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
141. 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
142. 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
143. 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
144. 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
- Published
- 2013
145. 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
- Published
- 2016
146. 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
147. 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
- Published
- 2014
148. 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
- Published
- 2013
149. 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
150. 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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