Emily Lancsar
Newcastle University
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PharmacoEconomics | 2008
Emily Lancsar; Jordan J. Louviere
Discrete choice experiments (DCEs) are regularly used in health economics to elicit preferences for healthcare products and programmes. There is growing recognition that DCEs can provide more than information on preferences and, in particular, they have the potential to contribute more directly to outcome measurement for use in economic evaluation. Almost uniquely, DCEs could potentially contribute to outcome measurement for use in both cost-benefit and cost-utility analysis.Within this expanding remit, our intention is to provide a resource for current practitioners as well as those considering undertaking a DCE, using DCE results in a policy/commercial context, or reviewing a DCE. We present the fundamental principles and theory underlying DCEs. To aid in undertaking and assessing the quality of DCEs, we discuss the process of carrying out a choice study and have developed a checklist covering conceptualizing the choice process, selecting attributes and levels, experimental design, questionnaire design, pilot testing, sampling and sample size, data collection, coding of data, econometric analysis, validity, interpretation and welfare and policy analysis.In this fast-moving area, a number of issues remain on the research frontier. We therefore outline potentially fruitful areas for future research associated both with DCEs in general, and with health applications specifically, paying attention to how the results of DCEs can be used in economic evaluation. We also discuss emerging research trends.We conclude that if appropriately designed, implemented, analysed and interpreted, DCEs offer several advantages in the health sector, the most important of which is that they provide rich data sources for economic evaluation and decision making, allowing investigation of many types of questions, some of which otherwise would be intractable analytically. Thus, they offer viable alternatives and complements to existing methods of valuation and preference elicitation.
Expert Review of Pharmacoeconomics & Outcomes Research | 2002
Rosalie Viney; Emily Lancsar; Jordan J. Louviere
To investigate the impact of health policies on individual well-being, estimate the value to society of new interventions or policies, or predict demand for healthcare, we need information about individuals’ preferences. Economists usually use market-based data to analyze preferences, but such data are limited in the healthcare context. Discrete choice experiments are a potentially valuable tool for elicitation and analysis of preferences and thus, for economic analysis of health and health programs. This paper reviews the use of discrete choice experiments to measure consumers’ preferences for health and healthcare. The paper provides an overview of the approach and discusses issues that arise when using discrete choice experiments to assess individuals’ preferences for health and healthcare.
Health Technology Assessment | 2010
Rachel Baker; Ian J. Bateman; Cam Donaldson; Michael Jones-Lee; Emily Lancsar; Graham Loomes; Helen Mason; M. Odejar; J.L. Pinto Prades; Angela Robinson; Mandy Ryan; Phil Shackley; Richard Smith; Robert Sugden; John Wildman
OBJECTIVESnTo identify characteristics of beneficiaries of health care over which relative weights should be derived and to estimate relative weights to be attached to health gains according to characteristics of recipients of these gains (relativities study); and to assess the feasibility of estimating a willingness-to-pay (WTP)-based value of a quality-adjusted life-year (QALY) (valuation study).nnnDESIGNnTwo interview-based surveys were administered - one (for the relativities study) to a nationally representative sample of the population in England and the other (for the valuation study) to a smaller convenience sample.nnnSETTINGnThe two surveys were administered by the National Centre for Social Research (NatCen) in respondents homes.nnnPARTICIPANTSn587 members of the public were interviewed for the relativities study and 409 for the valuation study.nnnMETHODSnIn the relativities study, in-depth qualitative work and considerations of policy relevance resulted in the identification of age and severity of illness as relevant characteristics. Scenarios reflecting these, along with additional components reflecting gains in QALYs, were presented to respondents in a series of pairwise choices using two types of question: discrete choice and matching. These questions were part of a longer questionnaire (including attitudinal and sociodemographic questions), which was administered face to face using a computer-assisted personal interview. In the valuation study, respondents were asked about their WTP to avoid/prevent different durations of headache or stomach illness and to value these states on a scale (death = 0; full health = 1) using standard gamble (SG) questions.nnnRESULTSnDiscrete choice results showed that age and severity variables did not have a strong impact on respondents choices over and above the health (QALY) gains presented. In contrast, matching showed age and severity impacts to be strong: depending on method of aggregation, gains to some groups were weighted three to four times more highly than gains to others. Results from the WTP and SG questions were combined in different ways to arrive at values of a QALY. These vary from values which are in the vicinity of the current National Institute for Health and Clinical Excellence (NICE) threshold to extremely high values.nnnCONCLUSIONSnWith respect to relative weights, more research is required to explore methodological differences with respect to age and severity weighting. On valuation, there are particular issues concerning the extent to which noise and error in peoples responses might generate extreme and unreliable figures. Methods of aggregation and measures of central tendency were issues in both weighting and valuation procedures and require further exploration.
Health Economics, Policy and Law | 2009
Jordan J. Louviere; Emily Lancsar
Compared to many applied areas of economics, health economics has a strong tradition in eliciting and using stated preferences (SP) in policy analysis. Discrete choice experiments (DCEs) are one SP method increasingly used in this area. Literature on DCEs in health and more generally has grown rapidly since the mid-1990s. Applications of DCEs in health have come a long way, but to date few have been best practice, in part because best practice has been somewhat of a moving target. The purpose of this paper is to briefly survey the history of DCEs and the state of current knowledge, identify and discuss knowledge gaps, and suggest potentially fruitful areas for future research to fill such gaps with the aim of moving the application of DCEs in health economics closer to best practice.
BMC Health Services Research | 2011
Cam Donaldson; Rachel Baker; Helen Mason; Michael Jones-Lee; Emily Lancsar; John Wildman; Ian J. Bateman; Graham Loomes; Angela Robinson; Robert Sugden; José Luis Pinto Prades; Mandy Ryan; Phil Shackley; Richard Smith
BackgroundSince the inception of the National Institute for Health and Clinical Excellence (NICE) in England, there have been questions about the empirical basis for the cost-per-QALY threshold used by NICE and whether QALYs gained by different beneficiaries of health care should be weighted equally. The Social Value of a QALY (SVQ) project, reported in this paper, was commissioned to address these two questions. The results of SVQ were released during a time of considerable debate about the NICE threshold, and authors with differing perspectives have drawn on the SVQ results to support their cases. As these discussions continue, and given the selective use of results by those involved, it is important, therefore, not only to present a summary overview of SVQ, but also for those who conducted the research to contribute to the debate as to its implications for NICE.DiscussionThe issue of the threshold was addressed in two ways: first, by combining, via a set of models, the current UK Value of a Prevented Fatality (used in transport policy) with data on fatality age, life expectancy and age-related quality of life; and, second, via a survey designed to test the feasibility of combining respondents answers to willingness to pay and health state utility questions to arrive at values of a QALY. Modelling resulted in values of £10,000-£70,000 per QALY. Via survey research, most methods of aggregating the data resulted in values of a QALY of £18,000-£40,000, although others resulted in implausibly high values. An additional survey, addressing the issue of weighting QALYs, used two methods, one indicating that QALYs should not be weighted and the other that greater weight could be given to QALYs gained by some groups.SummaryAlthough we conducted only a feasibility study and a modelling exercise, neither present compelling evidence for moving the NICE threshold up or down. Some preliminary evidence would indicate it could be moved up for some types of QALY and down for others. While many members of the public appear to be open to the possibility of using somewhat different QALY weights for different groups of beneficiaries, we do not yet have any secure evidence base for introducing such a system.
Respirology | 2007
Emily Lancsar; Jane Hall; Madeleine King; Patricia Kenny; Jordan J. Louviere; Denzil G. Fiebig; Ishrat Hossain; Francis Thien; Helen K. Reddel; Christine Jenkins
Background and objective:u2003 Long‐term adherence to inhaled corticosteroids is poor despite the crucial role of preventer medications in achieving good asthma outcomes. This study was undertaken to explore patient preferences in relation to their current inhaled corticosteroid medication, a hypothetical preventer or no medication.
Evaluation Review | 2004
Marian Shanahan; Emily Lancsar; Marion Haas; Bronwyn Lind; Don Weatherburn; Shuling Chen
In New South Wales, Australia, a cost-effectiveness evaluation was conducted of an adult drug court (ADC) program as an alternative to jail for criminal offenders addicted to illicit drugs. This article describes the program, the cost-effectiveness analysis, and the results. The results of this study reveal that, for the 23-month period of the evaluation, the ADC was as cost-effective as were conventional sanctions in delaying the time to the first offense and more cost-effective in reducing the frequency of offending for those outcome measures selected. Although the evaluation was conducted using the traditional steps of a cost-effectiveness analysis, because of the complexity of the program and data limitations it was not always possible to adhere to textbook procedures. As such, each step involved in undertaking the cost-effectiveness analysis is discussed, highlighting the key issues faced in the evaluation.
Health Economics, Policy and Law | 2011
Rachel Baker; S. M. Chilton; Cam Donaldson; Michael Jones-Lee; Emily Lancsar; Helen Mason; Hugh Metcalf; Mark Pennington; John Wildman
Recently, for many health economics researchers, empirical estimation of the monetary valuation of a quality-adjusted life year (QALY) has become an important endeavour. Different philosophical and practical approaches to this have emerged. On the one hand, there is a view that, with health-care budgets set centrally, decision-making bodies within the system can iterate, from observation of a series of previous decisions, towards the value of a QALY, thus searching for such a value. Alternatively, and more consistent with the approach taken in other public sectors, individual members of the public are surveyed with the aim of directly eliciting a preference-based - also known as a willingness-to-pay-based (WTP-based) - value of a QALY. While the former is based on supply-side factors and the latter on demand, both in fact suffer from informational deficiencies. Sole reliance on either would necessitate an acceptance or accommodation of chronic inefficiencies in health-care resource allocation. On the basis of this observation, this paper makes the case that in order to approach optimal decision making in health-care provision, a framework incorporating and thus, to a degree, reconciling these two approaches is to be preferred.
European Journal of Health Economics | 2005
Emily Lancsar; Cam Donaldson
Bryan and Dolan have offered a critique of the use of discrete choice experiments in health economics. Their call for more open debate on “the relative strengths and limitations of the DCE method, particularly when applied in health settings” is warranted. However, their paper has only added to part of this debate in that it focuses on the application of choice experiments in the health sector but says little on the strengths and limitations of the DCE method in general. We argue that while the criticisms posed by Bryan and Dolan rightly challenge the manner in which DCEs have been applied in health economics, such criticism does not challenge the theoretical/methodological basis of DCEs per se.
Australian and New Zealand Journal of Public Health | 2005
Patricia Kenny; Emily Lancsar; Jane Hall; Madeleine King; Meredyth Chaplin
Objective: To identify the resources used and the costs incurred by people with asthma for health care and non‐health care products and services to manage asthma.