A Systematic Review To Identify the Use of Preference Elicitation Methods in Health Care Decision Making

Abstract

Objectives: A Relationship between volume and outcome for complex medical procedures has been used as an argument for regionalization; however, this must be balanced against preferences to have care delivered close to home. The objective of our study was to determine how families trade-off variations in risk against the ability to have complex pediatric care delivered locally. MethOds: Twenty parents of children without serious medical problems seen in an outpatient clinic participated in a probability trade-off experiment involving two scenarios in which they were asked to imagine their child required a complex medical procedure ('lowrisk'= 5% mortality, 'high-risk'= 30% mortality) available locally or at an alternate large center 2.5 hours away by air. Numeric and graphic representations of mortality risk were reduced in a stepwise fashion for procedures performed at the alternate center. Thresholds at which participants chose to travel were identified. Participant's decisions were then challenged by increasing the costs incurred by travelling to the alternate center. Results: In the low-risk scenario, participants chose not to travel until absolute risk was reduced by 2±0.2% (relative risk reduction of 39±3%). In the high-risk scenario, a larger absolute risk reduction (5.1±0.8%, p= 0.0001) but smaller relative risk reduction (17±3%, p= 0.0001) triggered a decision to travel. In the low-risk scenario, only 2 of 8 participants with household income > $100,000/ yr changed their decision to travel when faced with additional costs; however 8 of 12 with lower income changed their decision (p= 0.07). In the high-risk scenario, 1 of 8 in the high income group changed their decision compared to 7 of 12 in the low income group (p= 0.04). cOnclusiOns: Many families would trade substantially higher risk to have complex pediatric care delivered locally. These results have implications for policy development related to delivery of complex care at smaller children's hospitals located far from large urban centers.

A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study

“…DCE is a method that allows a number of characteristics to be traded off against each another. 96,97 Janus et al 97 report a systematic review of preference elicitation studies, defining categories for studies that informed clinical decision-making, supported reimbursement decisions (as in health technology assessments) or elicited the perceived benefits and risks of health innovation for the market authorisation of drugs; in all of these types of decision, DCEs were adopted.…”

Use of Patient Preference Information in Benefit–Risk Assessment, Health Technology Assessment, and Pricing and Reimbursement Decisions: A Systematic Literature Review of Attempts and Initiatives

“…HTAs are centered around the evaluation of evidence and reimbursement decisions of new therapies. HTAs typically require clinical evidences as well as pharmacoeconomic studies, including cost-effectiveness analysis, budget impact analysis, and/or cost utility analysis (CUA) (13). By evaluating this evidence, HTA bodies are able to make their reimbursement decisions.…”

“…Recently, health technology assessment (HTA) organizations, regulatory agencies, and decision-making bodies largely have started to explore opportunities for incorporation of patients' perspective in their decisions (1,3,11,12). Furthermore, patients are claiming this greater role in healthcare decision making (3,5,12,13).…”

“…In response to the growing interest of patient involvement, two trends, not mutually exclusive, have emerged: the first trend is "direct involvement" of patients in decision making, which is in favor of patients participating in discussions, such as through committees, advisory groups, or just testimonies, while the second trend is "indirect patient involvement" through studies allowing for the assessment of patient preferences (PPs) in a more systematic way (7,10,13). Moreover, researchers and policymakers have developed tools to assess PPs and initiated a variety of efforts and attempts to better include these PPs in benefit-risk assessment (BRA) and HTA decisions.…”

The Role of Patients inMarket Access

“…Patient Preference Studies: building on the insights from qualitative research, patient preference studies can be important as a form of patient-based evidence for highlighting the needs in a quantitative form [37][38][39]. A task force of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) has started to define best practices for some of the quantitative methods such as conjoint analysis and discrete choice experiments [40,41] and this is also the subject of the IMI PREFER project [31].…”