Domenico Moro

Discrete Choice Experiments in Health Economics: A Review of the Literature

BackgroundDiscrete choice experiments (DCEs) are increasingly used in health economics to address a wide range of health policy-related concerns.ObjectiveBroadly adopting the methodology of an earlier systematic review of health-related DCEs, which covered the period 2001–2008, we report whether earlier trends continued during 2009–2012.MethodsThis paper systematically reviews health-related DCEs published between 2009 and 2012, using the same database as the earlier published review (PubMed) to obtain citations, and the same range of search terms.ResultsA total of 179 health-related DCEs for 2009–2012 met the inclusion criteria for the review. We found a continuing trend towards conducting DCEs across a broader range of countries. However, the trend towards including fewer attributes was reversed, whilst the trend towards interview-based DCEs reversed because of increased computer administration. The trend towards using more flexible econometric models, including mixed logit and latent class, has also continued. Reporting of monetary values has fallen compared with earlier periods, but the proportion of studies estimating trade-offs between health outcomes and experience factors, or valuing outcomes in terms of utility scores, has increased, although use of odds ratios and probabilities has declined. The reassuring trend towards the use of more flexible and appropriate DCE designs and econometric methods has been reinforced by the increased use of qualitative methods to inform DCE processes and results. However, qualitative research methods are being used less often to inform attribute selection, which may make DCEs more susceptible to omitted variable bias if the decision framework is not known prior to the research project.ConclusionsThe use of DCEs in healthcare continues to grow dramatically, as does the scope of applications across an expanding range of countries. There is increasing evidence that more sophisticated approaches to DCE design and analytical techniques are improving the quality of final outputs. That said, recent evidence that the use of qualitative methods to inform attribute selection has declined is of concern.

Does volunteering improve employability? Insights from the British Household Panel Survey and beyond

Policy interest in the role of volunteering as a route to employment is enduring, with an assumption that links between volunteering, employability and employment are positive and straightforward. This has largely been supported by existing evidence, although there have been few longitudinal studies testing the theory. Analysing data from the British Household Panel Survey, we used multivariate techniques to explore the effects of volunteering on moves from being out of work into work; and on retention and wage progression for people in employment. We suggest that the relationship is complex: volunteering may have a positive effect on the labour market position of some individuals in some circumstances; for others it may have a negative, or no, effect. We offer some suggestions for the variations we found: the limitations of the dataset and our analysis; a limited concept of employability; and too narrow a view of volunteering and its impact.

Who should be prioritized for renal transplantation?: Analysis of key stakeholder preferences using discrete choice experiments

BackgroundPolicies for allocating deceased donor kidneys have recently shifted from allocation based on Human Leucocyte Antigen (HLA) tissue matching in the UK and USA. Newer allocation algorithms incorporate waiting time as a primary factor, and in the UK, young adults are also favoured. However, there is little contemporary UK research on the views of stakeholders in the transplant process to inform future allocation policy. This research project aimed to address this issue.MethodsDiscrete Choice Experiment (DCE) questionnaires were used to establish priorities for kidney transplantation among different stakeholder groups in the UK. Questionnaires were targeted at patients, carers, donors / relatives of deceased donors, and healthcare professionals. Attributes considered included: waiting time; donor-recipient HLA match; whether a recipient had dependents; diseases affecting life expectancy; and diseases affecting quality of life.ResultsResponses were obtained from 908 patients (including 98 ethnic minorities); 41 carers; 48 donors / relatives of deceased donors; and 113 healthcare professionals. The patient group demonstrated statistically different preferences for every attribute (i.e. significantly different from zero) so implying that changes in given attributes affected preferences, except when prioritizing those with no rather than moderate diseases affecting quality of life. The attributes valued highly related to waiting time, tissue match, prioritizing those with dependents, and prioritizing those with moderate rather than severe diseases affecting life expectancy. Some preferences differed between healthcare professionals and patients, and ethnic minority and non-ethnic minority patients. Only non-ethnic minority patients and healthcare professionals clearly prioritized those with better tissue matches.ConclusionsOur econometric results are broadly supportive of the 2006 shift in UK transplant policy which emphasized prioritizing the young and long waiters. However, our findings suggest the need for a further review in the light of observed differences in preferences amongst ethnic minorities, and also because those with dependents may be a further priority.

A dimming of the 'warm glow'? Are non-profit workers in the UK still more satisfied with their jobs than other workers?

Research has long shown that employees working for non-profit organisations report a higher level of job satisfaction than workers in other sectors. This chapter investigates trends in job satisfaction using longitudinal data from the British Household Panel Survey (1992–2008/2009), through models which contain detailed information on individual, job and organisational characteristics. We use fixed-effects ordered-logit models to investigate job satisfaction taking account of our panel structure and the nature of the job satisfaction dependent variable. The results suggest an important, non-profit premium in job satisfaction which, contradicting the apparent bivariate evidence, is not changing over time (in appropriate models) – the warm glow of higher job satisfaction remains.