Discrete choice experiment to investigate preferences for psychological intervention in cardiac rehabilitation

Abstract

ObjectiveCardiac rehabilitation (CR) is offered to people who recently experienced a cardiac event, and often comprises of exercise, education and psychological care. This stated preference study aimed to investigate preferences for attributes of a psychological therapy intervention in CR.MethodsA discrete choice experiment (DCE) was conducted and recruited a general population sample and a trial sample. DCE attributes included the modality (group or individual), healthcare professional providing care, information provided prior to therapy, location and the cost to the National Health Service (NHS). Participants were asked to choose between two hypothetical designs of therapy, with a separate opt-out included. A mixed logit model was used to analyse preferences. Cost to the NHS was used to estimate willingness to pay (WTP) for aspects of the intervention design.ResultsThree hundred and four participants completed the DCE (general public sample (n=262, mean age 47, 48% female) and trial sample (n=42, mean age 66, 45% female)). A preference for receiving psychological therapy was demonstrated by both samples (general population WTP £1081; 95% CI £957 to £1206). The general population appeared to favour individual therapy (WTP £213; 95% CI £160 to £266), delivered by a CR professional (WTP £48; 9% % CI £4 to £93) and with a lower cost (β=−0.002; p<0.001). Participants preferred to avoid options where no information was received prior to starting therapy (WTP −£106; 95% CI −£153 to −£59). Results for the location attribute were variable and challenging to interpret.ConclusionsThe study demonstrates a preference for psychological therapy as part of a programme of CR, as participants were more likely to opt-in to therapy. Results indicate that some aspects of the delivery which may be important to participants can be tailored to design a psychological therapy. Preference heterogeneity is an issue which may prevent a ‘one-size-fits-all’ approach to psychological therapy in CR.

Cost-effectiveness of home-based cardiac rehabilitation: a systematic review

“…However, despite an increased prevalence of anxiety and depression among people with CVD, none of the interventions explicitly featured psychological care. A preference for receiving psychological therapy (vs no psychological therapy) as a component of CR has been demonstrated 44 45. Future research is needed to determine whether different forms of home-based psychological care are cost-effective among people receiving CR.…”