Prioritising health service innovation investments using public preferences: a discrete choice experiment

Abstract

BackgroundPrioritising scarce resources for investment in innovation by publically funded health systems is unavoidable. Many healthcare systems wish to foster transparency and accountability in the decisions they make by incorporating the public in decision-making processes. This paper presents a unique conceptual approach exploring the public’s preferences for health service innovations by viewing healthcare innovations as ‘bundles’ of characteristics. This decompositional approach allows policy-makers to compare numerous competing health service innovations without repeatedly administering surveys for specific innovation choices.MethodsA Discrete Choice Experiment (DCE) was used to elicit preferences. Individuals chose from presented innovation options that they believe the UK National Health Service (NHS) should invest the most in. Innovations differed according to: (i) target population; (ii) target age; (iii) implementation time; (iv) uncertainty associated with their likely effects; (v) potential health benefits; and, (vi) cost to a taxpayer. This approach fosters multidimensional decision-making, rather than imposing a single decision criterion (e.g., cost, target age) in prioritisation. Choice data was then analysed using scale-adjusted Latent Class models to investigate variability in preferences and scale and valuations amongst respondents.ResultsThree latent classes with considerable heterogeneity in the preferences were present. Each latent class is composed of two consumer subgroups varying in the level of certainty in their choices. All groups preferred scientifically proven innovations, those with potential health benefits that cost less. There were, however, some important differences in their preferences for innovation investment choices: Class-1 (54%) prefers innovations benefitting adults and young people and does not prefer innovations targeting people with ‘drug addiction’ and ‘obesity’. Class- 2 (34%) prefers innovations targeting ‘cancer’ patients only and has negative preferences for innovations targeting elderly, and Class-3 (12%) prefers spending on elderly and cancer patients the most.ConclusionsDCE can help policy-makers incorporate public preferences for health service innovation investment choices into decision making. The findings provide useful information on the public’s valuation and acceptability of potential health service innovations. Such information can be used to guide innovation prioritisation decisions by comparing competing innovation options. The approach in this paper makes, these often implicit and opaque decisions, more transparent and explicit.

Community views on factors affecting medicines resource allocation: cross-sectional survey of 3080 adults in Australia

“…Further, findings from the present study resonate with previous studies, 11,17,19,21,22 which have shown that members of the general public give higher priority to medicines used for the treatment of severe illness and for those with no available alternatives. The finding of support for prioritising anticancer medicines is also generally consistent with existing evidence 23,24 and could explain the current focus both in Australia and internationally on achieving timely access to such treatments. 25 However, because cancer medicines were the only disease-specific medicines explored in the present study, this finding should be interpreted with caution.…”

Application of discrete choice experiments to enhance stakeholder engagement as a strategy for advancing implementation: a systematic review

“…In terms of application type (Fig. 5 ), 32 studies were classified as characterizing demand for therapies and treatment technologies [ 12 – 42 ] (16 of 32 [50%] had a primary focus on implementation) [ 13 , 15 , 17 – 19 , 21 , 22 , 25 , 26 , 29 , 33 – 37 , 43 ]; 22 studies compared implementation strategies [ 44 – 65 ] (22 of 22 [100%] had a primary focus on implementation) [ 44 – 65 ]; 11 studies were concerned with incentivizing workforce participation [ 66 – 76 ] (6 of 11 [55%] had a primary focus on implementation) [ 66 , 68 , 71 , 74 – 76 ]; and 10 studies involved prioritizing health-related interventions [ 77 – 86 ] (4 of 10 [40%] had a primary focus on implementation) [ 80 , 82 , 83 , 85 ]. Overall, 48 of the 75 studies (64%) had a primary focus on implementation.…”

“…However, prioritizing healthcare services on the basis of cost-effectiveness alone overlooks other important factors. Among the 10 studies in this category, 4 were conducted at the health system level [ 79 , 82 – 84 ] and 6 were in the primary care setting [ 77 , 78 , 80 , 81 , 85 , 86 ]. In terms of stakeholder engagement, 5 studies involved providers [ 77 , 78 , 80 , 85 , 86 ], 4 involved administrators [ 77 – 79 , 84 ], and 3 involved patients [ 81 – 83 ].…”

Does the Public Prefer Health Gain for Cancer Patients? A Systematic Review of Public Views on Cancer and its Characteristics

“…By including cost as one of the parameters, the authors estimated WTP for the preferred characteristic, and, in the case of cancer, this was approximately £40 per month in extra taxation. This was consistently the highest among the conditions tested, across all latent groups, although the absolute value of this estimate should be treated with caution because it can be sensitive to the framing of the question; for example, framing as a monthly cost may overestimate WTP compared to a one-off fee [18], and WTP can differ for introduction of a service compared to its retention [19]. …”