How Do People with Experience of Infertility Value Different Aspects of Assistive Reproductive Therapy? Results from a Multi-Country Discrete Choice Experiment

Abstract

Objectives Assistive reproductive therapies can help those who have difficulty conceiving but different forms of assistive reproductive therapies are associated with different treatment characteristics. We undertook a large, multinational discrete choice experiment to understand patient preferences for assistive reproductive therapies. Methods We administered an online discrete choice experiment with persons who had experience with subfertility or assistive reproductive therapies in the USA, UK, the Nordic region (Denmark, Norway, Sweden, Finland), Spain, and China. Attributes encouraged trade-offs between effectiveness, risk of adverse effects, treatment (dis)comfort, (in)convenience, cost per cycle and shared decision making. We used multinomial logit and mixed-logit models to estimate preferences and attribute importance by country/region, and estimated willingness to pay for changes in attribute levels. Results A total of 7565 respondents participated. Mixed logit had a better fit than multinomial logit across all samples. Preferences moved in expected directions across all samples, but the relative importance of attributes differed between countries. Willingness to pay was greatest for improvements in effectiveness and a greater degree of shared decision making, and we observe a substantial 'option value' independent of treatment characteristics. Unexpectedly, preferences over cost were insignificant in the Chinese sample, limiting the use of willingness to pay in this sample. Conclusions Respondents balanced concerns for effectiveness with other considerations, including the cost and (dis)comfort of treatment, and the degree of shared decision making, but there is also substantial option value independent of treatment characteristics, demonstrating value of assistive reproductive therapies to individuals with experience of subfertility. We hypothesise that price insensitivity in the Chinese sample may reflect a degree of social desirability bias.

What Features of Fertility Treatment do Patients Value? Price Elasticity and Willingness-to-Pay Values from a Discrete Choice Experiment

“…Comparing our results to the broader literature suggests that marginal WTP values for some attributes of fertility treatment are similar across countries. For instance, our study indicated a marginal WTP value of $383-$524 across income categories for a one percentage point increase in the treatment success rate, which is comparable to values reported for European countries [23,29,58]. Given that other studies used different fertility treatment attributes, a direct comparison of the marginal WTP values is often not possible.…”

“…Several stated-preference DCEs that assessed preferences for fertility treatments have been published [19][20][21][22][23][24][25][26][27][28][29][30], of which some elicited marginal willingness-to-pay (WTP) values for different attributes of fertility treatment [21,23,[27][28][29][30] and, notably, one study comparing preferences across countries [29]. We are aware of only one application of DCEs to a fertility treatment context in Australia [28], which elicited taxpayer/societal preferences for fertility treatment and derived marginal WTP values for treatment attributes explored.…”

Driving factors in treatment decision-making of patients seeking medical assistance for infertility: a systematic review

“…The characteristics of included studies are described in Table 1 . Twelve studies had a DCE design ( Musters et al , 2011 ; van Empel et al , 2011 ; Huppelschoten et al , 2014 ; van den Wijngaard et al , 2014 , 2015 ; Weiss et al , 2017 ; Hendriks et al , 2019 ; Braam et al , 2020 ; Abdulrahim et al , 2021 ; Cornelisse et al , 2022 ; Skedgel et al , 2022 ; Keller et al , 2023 ), one study included both a DCE and a survey ( Hendriks et al , 2016 ), one was designed as CAs study ( Palumbo et al , 2011 ), and six were survey and/or interview studies ( Bayram et al , 2005 ; Steures et al , 2005 ; van Weert et al , 2007 ; Sills et al , 2012 ; Duthie et al , 2017 ; Stormlund et al , 2019 ).…”

“…Of the 20 studies, 11 had been conducted in the Netherlands ( Bayram et al , 2005 ; Steures et al , 2005 ; van Weert et al , 2007 ; Musters et al , 2011 ; van Empel et al , 2011 ; Huppelschoten et al , 2014 ; van den Wijngaard et al , 2014 , 2015 ; Weiss et al , 2017 ; Braam et al , 2020 ; Cornelisse et al , 2022 ), two studies were conducted in both the Netherlands and Belgium ( Hendriks et al , 2016 , 2019 ), two studies were carried out in the USA ( Sills et al , 2012 ; Duthie et al , 2017 ), one in Australia ( Keller et al , 2023 ), one in the UK ( Abdulrahim et al , 2021 ), one in Denmark ( Stormlund et al , 2019 ), and one in Spain ( Palumbo et al , 2011 ). The largest study included multiple countries: the USA, the UK, Denmark, Norway, Sweden, Finland, Spain, and China ( Skedgel et al , 2022 ).…”

“…All six survey/interview studies were rated as being at critical risk of bias owing to selection bias, use of unvalidated questionnaires, and not accounting for the lack of independence of the data in the analysis (multiple questions were answered by each participant) ( Bayram et al , 2005 ; Steures et al , 2005 ; van Weert et al , 2007 ; Sills et al , 2012 ; Duthie et al , 2017 ; Stormlund et al , 2019 ). Of the 14 DCE/CA designs, nine had moderate risk of bias ( Palumbo et al , 2011 ; van Empel et al , 2011 ; Huppelschoten et al , 2014 ; van den Wijngaard et al , 2015 ; Hendriks et al , 2016 ; Weiss et al , 2017 ; Braam et al , 2020 ; Abdulrahim et al , 2021 ; Skedgel et al , 2022 ) and four had high risk of bias, for example owing to low participation rates or suboptimal statistical analysis ( Musters et al , 2011 ; van den Wijngaard et al , 2014 ; Hendriks et al , 2019 ; Cornelisse et al , 2022 ). The overall rating of a study was based on the lowest rating in any of the categories.…”