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BackgroundIn U.S. states that legalized and commercialized recreational cannabis, cannabis sales in illegal markets are still sizable or even larger than those in legal markets. This study aimed to assess cannabis consumers' preferences for purchasing cannabis from legal and illegal markets and estimate the trade-offs under various policy scenarios.Methods963 adults were recruited, who used cannabis in the past year and lived in a state with recreational cannabis legalization. In a discrete choice experiment, participants chose purchasing cannabis from a legal dispensary or an illegal dealer with varying levels in product attributes including quality, safety, accessibility, potency, and price. Mixed logit models were used to analyze preferences.ResultsThe likelihood of choosing legal cannabis increased with a higher quality, the presence of lab test, a shorter distance to seller, a higher tetrahydrocannabinol level, and a lower price. The likelihood of choosing illegal cannabis increased with a higher quality, a shorter distance to seller, and a lower price. Among product attributes, quality and accessibility were perceived to be the most important for legal cannabis and price was perceived to be the most important for illegal cannabis. Policy simulations predicted that improving quality, ensuring safety, allowing delivery services, increasing dispensary density, and lowering prices/taxes of legal cannabis may reduce illegal cannabis market share.ConclusionsIn the U.S., cannabis consumers' preferences for illegal cannabis were associated with both legal and illegal cannabis product attributes. Policies regulating legal cannabis markets should consider potential spillover effects to illegal markets.

Background: Evidence suggests that coordination of care for people affected by rare diseases is poor. In order to improve the way that care is coordinated it is necessary to understand the preferences of people affected by these conditions, and providers. The aim of this study was to examine patient, parent and carer, and health care professional preferences for different attributes of care coordination for people affected by rare diseases. We conducted a discrete choice experiment using online surveys. There were no restrictions on participants in terms of rare conditions, demographic factors other than age, or geographical location within the UK. Choice scenarios were based on the following attributes: annual cost of attending appointments; access to health records; access to clinical expertise; support of a care coordinator; access to a specialist centre; and, the existence of a documented plan for emergency care. Data were analysed using alternative-specific conditional logit regression models. Results: Valid responses were obtained from 996 individuals (528 patients, 280 carers, 188 health care professionals) between August and December 2019. All attributes significantly influenced the type of service respondents preferred. Patients, carers and health professionals' preferences for care coordination were influenced by: the cost of attending appointments; access to health records; clinical expertise; role of care coordinators; access to specialist centres; and the existence of plan for emergency care. There were no statistically significant differences in the preferences between patients and carers. Preferences of health professionals differed to those of patients and carers. Both patients and carers selected responses which granted them a greater degree of autonomy in relation to the role of care coordinators, whereas health professionals preferred services where care coordinators had more autonomy. Health care professionals also expressed a stronger preference for a documented formal emergency plan to be in place. Conclusions: The findings highlight that people value better coordinated care, in line with policy documents emphasising commitments to coordinated care for people affected by rare diseases. This study highlights the factors that could be included in service provision as ways of improving the coordination of care for people affected by rare diseases. [ABSTRACT FROM AUTHOR]

Conservation literature addresses a broad spectrum of interdisciplinary questions and benefits. Conservation science benefits most when a diverse range of authors are represented, particularly those from countries where much conservation work is focused. In other disciplines, it is well known that barriers and biases exist in the academic publishing sphere, which can affect research dissemination and an author's career development. We used a discrete choice experiment to determine how 7 journal attributes affect authors’ choices of where to publish in conservation. We targeted authors directly by contacting authors published in 18 target journals and indirectly via communication channels for conservation organizations. We only included respondents who had previously published in a conservation‐related journal. We used a multinomial logit model and a latent class model to investigate preferences for all respondents and distinct subpopulations. We identified 3 demographic groups across 1038 respondents (older authors from predominantly middle‐income countries, younger authors from predominantly middle‐income countries, and younger authors from high‐income countries) who had published in conservation journals. Each group exhibited different publishing preferences. Only 2 attributes showed a consistent response across groups: cost to publish negatively affected journal choice, including authors in high‐income countries, and authors had a consistent preference for double‐blind review. Authors from middle‐income countries were willing to pay more for society‐owned journals, unlike authors from high‐income countries. Journals with a broad geographical scope that were open access and that had relatively high impact factors were preferred by 2 of the 3 demographic groups. However, journal scope and open access were more important in dictating journal choice than impact factor. Overall, different demographics had different preferences for journals and were limited in their selection based on attributes such as open access policy. However, the scarcity of respondents from low‐income countries (2% of respondents) highlights the pervasive barriers to representation in conservation research. We recommend journals offer double‐blind review, reduce or remove open access fees, investigate options for free editorial support, and better acknowledge the value of local‐scale single‐species studies. Academic societies in particular must reflect on how their journals support conservation and conservation professionals. [ABSTRACT FROM AUTHOR]

Informal care represents a significant cost driver in dementia but monetizing informal care hours to inform cost-of-illness or economic evaluation studies remains a challenge. This study aimed to use a discrete choice experiment to estimate the value of informal care time provided to people with dementia in Australia accounting for positive and negative impacts of caregiving. Attributes and levels were derived from a literature review, interviews with carers, and advice received from an advisory group. Attributes included 4 positive and negative caregiving experiences, in addition to "hours of care provided" and the "monetary compensation from the government." A D-efficient design was constructed with 2 generic alternatives that represented hypothetical informal caregiving situations. The discrete choice experiment survey was administered online to a representative sample of the Australian general population and a group of informal carers of people with dementia. The willingness to accept estimates were calculated for the 2 samples separately using the mixed logit model in the willingness to pay space. Based on 700 respondents included in the analysis (n = 488 general public, n = 212 informal carers), the mean willingness to accept for an additional hour of informal care, corrected for the positive and negative impacts of informal care, was $21 (95% CI 18-23) for the general public and $20 (95% CI 16-25) for the informal carers sample. The estimates generated in this study can be used to inform future cost-of-illness studies and economic evaluations, ensuring that informal care time is considered in future policy and funding decisions. • Informal care represents a significant cost driver in dementia but monetizing informal care hours to inform cost-of-illness or economic evaluation studies remains a challenge. • This study estimated a monetary value of informal care time of $21 per hour, corrected for the positive and negative impacts of caring for a person with dementia. • This estimate can be used to inform future cost-of-illness studies and economic evaluations, ensuring that informal care time is considered in future policy and funding decisions. [ABSTRACT FROM AUTHOR]

Financial savings at the household level are vital for poverty alleviation, yet they face social, psychological and institutional obstacles. Over recent years, mobile phones have proven effective in enhancing financial inclusion. However, when individuals decide how to save, their preferences remain unclear. This study investigates the preferences of 421 Malian smallholder farmers for a hypothetical mobile savings application using a discrete choice experiment. Apart from standard savings account features such as transaction charges, interest amount and minimum deposit requirements, it assesses preferences for two innovative features designed to address deviations from rational decision‐making. The first feature allows multiple users to pool their savings, utilising social dynamics and peer pressure to encourage responsible savings behaviour and enhance commitment. The second feature offers users the ability to manage their finances more effectively by dividing them into purpose‐specific sub‐accounts. The findings reveal a strong overall preference for saving via the application rather than keeping cash on hand. As anticipated, farmers favour lower costs and deposits and higher interest amounts. Generally, individual saving is preferred over group saving, and the option to compartmentalise is valued, albeit not statistically significantly so. However, the analysis of underlying heterogeneity reveals substantial differences in respondents' preferences for these commitment‐enhancing features. These findings underscore the need for customised approaches that align with farmers' unique preferences and constraints. Such approaches can inform the development of bespoke mobile savings solutions for farming households, thereby boosting their resilience and financial well‐being. [ABSTRACT FROM AUTHOR]

There is scope for improving the sustainability of intensive dairy farms through the uptake of sustainable production practices such as more grass‐based feeding systems. Such feeding systems can reduce feed‐food competition and the environmental impacts of feed production, among other farm‐level and societal benefits. However, empirical research on how farmers' feed choices mis(align) with sustainability transitions and the associated drivers is limited. This paper explores the trade‐offs that farmers make between the environmental, social and economic sustainability impacts of grass‐based feeding systems based on data from Swedish dairy farmers. Using an identity‐based utility framework and a hybrid latent class model, we find substantial heterogeneity in dairy farmers' trade‐offs between feed‐related sustainability attributes: greenhouse gas emissions, biodiversity, animal welfare, feed self‐sufficiency, feed cost and milk yield. Furthermore, our findings demonstrate that farmers who are strongly interested in the environmental and social sustainability impacts of their dairy feeding systems, beyond economic gains, are motivated mainly by their pro‐environmental and pro‐social identities. Overall, our findings imply that identity‐enhancing interventions are promising policy instruments for encouraging the uptake of more grass‐based feeding systems. [ABSTRACT FROM AUTHOR]

Introduction: Invasive meningococcal disease (IMD) is a severe and life-threatening disease. In the United States (US), vaccine coverage with MenACWY and MenB meningococcal vaccines is suboptimal among adolescents/young adults aged 16–23 years. A combined meningococcal vaccine (MenABCWY) could increase convenience (e.g., fewer injections) and improve coverage. The objective was to quantify preferences for hypothetical meningococcal vaccine profiles among adolescents/young adults and parents. Methods: An online discrete choice experiment was conducted among 16- to 23-year-olds, and parents of 16- to 18-year-olds. Attributes (3 × 4) and levels (1 × 2) were based on the literature and focus groups. Participants made ten pair-wise forced trade-off choices, systematically varied using a D-optimal design. Random parameter logit quantified the relative importance of vaccination attributes and estimated the trade-offs. Differences in preferences by subgroups were assessed. Results: Totals of 300 adolescents and young adults (median age 20 years) and 300 parents (median age 46 years) completed the survey. Overall, 89.6% of 16- to 23-year-olds and 69.1% of parents preferred a simplified hypothetical meningococcal vaccination profile, e.g., with fewer injections (3 vs. 4) and fewer healthcare provider (HCP) visits (2–3 vs. 4). Having HCP advice and clear Centers for Disease Control and Prevention recommendations impacted vaccination choice, with both groups reporting high trust in HCP information (83.3% among 16- to 23-year-olds; 98.7% among parents). Barriers to vaccination included lack of HCP advice or awareness of meningococcal vaccines, and income level and out-of-pocket costs for parents. Conclusions: Adolescents/young adults and parents demonstrated a significant preference for a meningococcal vaccine that is more convenient (such as combined MenABCWY). Parents' vaccination preferences differed by income level and out-of-pocket costs, suggesting financial barriers to vaccination may exist which could result in IMD prevention inequalities. Findings from this study provide important information to support patient-facing informed policy discussions. A simplified vaccination schedule and strong recommendation could help improve vaccine uptake, schedule compliance, disease prevention, and reduce inequalities in IMD risk and prevention. A graphical abstract is available with this article. [ABSTRACT FROM AUTHOR]

This study uses choice experiment data to explore the role of program attributes and farmer characteristics in explaining differences in farmers' behavior toward carbon payment programs. Results show that most farmers in the study prefer the status quo over carbon payment programs for switching to carbon-sequestering conservation practices. Farmers have negative preferences toward contract length and positive preferences toward government or not-for-profit organizations as governing entities. Besides program attributes, farmers' climate consciousness and adverse weather experiences influence their choices and willingness to accept carbon payments. The results suggest the potential for targeting carbon payments to specific groups of farmers. [ABSTRACT FROM AUTHOR]

Existing research qualitatively explores consumer preferences for stroke rehabilitation interventions. However, it remains unclear which intervention characteristics are most important to consumers, and how these preferences may influence uptake and participation. Discrete choice experiments (DCE) provide a unique way to quantitatively measure preferences for health and health care. This study aims to explore how DCEs have been used in stroke rehabilitation and to identify reported consumer preferences for rehabilitation interventions. A systematic review of published stroke rehabilitation DCEs was completed (PROSPERO registration: CRD42021282578). Six databases (including CINAHL, MEDLINE, EconLIT) were searched from January 2000-March 2023. Data extracted included topic area, sample size, aim, attributes, design process, and preference outcomes. Descriptive and thematic analyses were conducted, and two methodological checklists applied to review quality. Of 2,446 studies screened, five were eligible. Studies focused on exercise preference (n = 3), the structure and delivery of community services (n = 1), and self-management programs (n = 1). All had small sample sizes (range 50–146) and were of moderate quality (average score of 77%). Results indicated people have strong preferences for one-to-one therapy (over group-based), light-moderate intensity of exercise, and delivery by qualified therapists (over volunteers). Few DCEs have been conducted in stroke rehabilitation, suggesting consumer preferences could be more rigorously explored. Included studies were narrow in the scope of attributes included, limiting their application to practice and policy. Further research is needed to assess the impact of differing service delivery models on uptake and participation. [ABSTRACT FROM AUTHOR]

South African subsistence livestock farmers rely heavily on traditional mitigation and coping mechanisms to deal with the effects of drought. However, these methods have proven ineffective in managing the full impact of drought. Consequently, policymakers are increasingly interested in promoting Index-based Pasture Insurance (IBPI). This paper aims to assess subsistence livestock farmers' preferences for IBPI. A simple random sampling method was used to select 110 subsistence livestock farmers for data collection. A discrete choice experiment—Conditional Logit and Latent Class models and incentivized lottery games were used to elicit preferences for insurance contracts and loss aversion. The findings indicate that subsistence livestock farmers have a favourable attitude toward IBPI contracts that protect against drought-related pasture degradation. The Conditional Logit model shows that farmers prefer transparent contracts that reimburse with feed and vouchers rather than cash. However, they derive negative marginal utility from basis risk and premium. However, the Latent Class model reveals heterogeneous preferences for IBPI among farmers. Farmers are also loss-averse, but loss aversion did not influence their preference for IBPI. Therefore, the primary recommendation for insurance providers is to consider customizing IBPI attributes to increase adoption among subsistence farmers. [ABSTRACT FROM AUTHOR]

Background: Understanding patient preferences for treatments may facilitate shared decision-making. This study assessed adult patient preferences for attention-deficit/hyperactivity disorder (ADHD) treatments in a sample of 600 patients in the United States (US). Methods: A web-based discrete choice experiment (DCE) survey was conducted among treated adults with ADHD. Participants were recruited from Dynata's US panel (06/22/2023-07/06/2023). Attributes and levels, identified based on clinical inputs and published data, included efficacy and safety. Participants' preferences were estimated using conditional logistic regression. Willingness to trade-off and attributes' relative importance were calculated. Overall preferences for treatment profiles approximating centanafadine, lisdexamfetamine, atomoxetine, and viloxazine were estimated using adjusted total utilities. Results were stratified by current treatment status. Sensitivity analyses including participants who passed validity tests were conducted. Results: Among the 600 participants (mean age 37.9 years; 66.2% female; 50.8% treated), all attributes had a statistically significant impact on preferences for ADHD treatments (p < 0.001); the most important attribute was improvement in ADHD symptoms (36%), followed by risks of nausea (25%), insomnia (20%), anxiety (8%), dry mouth (6%), and feeling jittery (5%). Together, safety attributes accounted for > 60% of relative importance in decision-making. Participants were willing to forgo 0.59, 0.57, 0.49, 0.32, and 0.17 percentage points of symptom improvement to achieve one-percentage-point reduced risk of insomnia, nausea, anxiety, feeling jittery, and dry mouth, respectively. Centanafadine profile had consistently higher adjusted total utilities than its comparators. Similar results were obtained in the subgroup and sensitivity analyses. Conclusion: Efficacy was the most important attribute for patients when making treatment decision, but taken together, AEs had greater relative importance than efficacy alone. Accordingly, a profile resembling that of centanafadine would be preferred by an average patient compared to key competitors due to its favorable safety profile. These findings may help improve treatment decision-making, enhance treatment satisfaction, and foster adherence. [ABSTRACT FROM AUTHOR]

Objective response rate (ORR), and duration of response (DOR) were of lesser importance. Conclusion: In this study, patients highlighted that improving survival time was the most important and that QoL is also an important consideration. Discussions during treatment decision-making may benefit from broader conversations around treatment characteristics, including impacts on QoL and convenience of the regimen. [ABSTRACT FROM AUTHOR]

Purpose: Discrete choice experiment (DCE) and profile case (case 2) best-worst scaling (BWS) present uncertainties regarding the acceptability of quantifying individual healthcare preferences, which may adversely affect the validity of responses and impede the reflection of true healthcare preferences. This study aimed to assess the acceptability of these two methods from the perspective of patients with type 2 diabetes mellitus (T2DM) and examine their association with specific characteristics of the target population. Patients and Methods: This cross-sectional study was based on a nationally representative survey; data were collected using a multistage stratified cluster-sampling procedure between September 2021 and January 2022. Eligible adults with confirmed T2DM voluntarily participated in this study. Participants completed both the DCE and case 2 BWS (BWS-2) choice tasks in random order and provided self-reported assessments of acceptability, including task completion difficulty, comprehension of task complexity, and response preference. Logistic regression and random forest models were used to identify variables associated with acceptability. Results: In total, 3286 patients with T2DM were included in the study. Respondents indicated there was no statistically significant difference in completion difficulty between the DCE and BWS-2, although the DCE scores were slightly higher (3.07 ± 0.68 vs 3.03 ± 0.67, P = 0.06). However, 1979 (60.2%) respondents found the DCE easier to comprehend. No significant preferences were observed between the two methods (1638 (49.8%) vs 1648 (50.2%)). Sociodemographic factors, such as residence, monthly out-of-pocket costs, and illness duration were significantly associated with comprehension complexity and response preference. Conclusion: This study yielded contrasting results to most of previous studies, suggesting that DCE may be less cognitively demanding and more suitable for patients with T2DM from the perspective of self-reported acceptability of DCE and BWS. This study promotes a focus on patient acceptability in quantifying individual healthcare preferences to inform tailored optimal stated-preference method for a target population. Plain Language Summary: Stated preference methodologies such as the discrete choice experiment (DCE) and case 2 best-worst scaling (BWS-2) are gaining popularity as methods for quantifying individual preferences in healthcare. However, the acceptability of the two methods to participants must be considered in practice to reduce cognitive burden and ensure the validity of preference elicitation.DCE was perceived to be less cognitively burdensome than BWS-2. In contrast to patients who thought that DCE was more acceptable, BWS-2 was more accepted by rural patients, patients who lived with the disease for a longer period, and those who had lower monthly out-of-pocket costs.These findings demonstrate potential differences in the acceptability of DCE and BWS-2 for patients with type 2 diabetes mellitus. To improve efficiency, it would be useful for researchers to consider the optimal stated preference method for identifying target populations according to sociodemographic and disease-related characteristics. [ABSTRACT FROM AUTHOR]

Understanding visitors' willingness to pay (WTP) for natural ecosystems can assist policymakers in managing the environmental assets that form the foundation of nature-based tourism. To earn the highest economic return from limited budgetary resources, tourist-dependent destinations must identify sustainable sources of conservation funding and prioritize spending across ecosystems and initiatives. The purpose of this study is to assess the potential for visitor donations to serve as a source of conservation funding and investigate preferences and willingness to pay for multiple ecosystems concurrently, using data from a stated preference survey administered in Grenada, a small island state in the southern Caribbean that relies on nature-based tourism. Results from a discrete choice experiment and a contingent valuation exercise reveal a reluctance to donate to conservation initiatives by more than half of respondents. Visitors place the highest value on improvements to coral reefs, followed by rainforests, mangroves, and beaches. Average willingness to donate to a conservation trust fund ranged from US $8.00 to US $15.00, and from US $17.00 to US $52.00 for conservation plans targeting improvements to specific ecosystems. Few factors are found to be associated with willingness to pay. Scale heterogeneity may be a more significant source of variation than preference heterogeneity. [ABSTRACT FROM AUTHOR]

Context: Risk stratification has been suggested as a strategy for improving cancer screening. Any changes to existing programmes must be acceptable to the public. Objective: This study aimed to explore the preferences and considerations of individuals relating to the introduction of different risk‐based strategies to determine eligibility for colorectal cancer (CRC) screening. Study Design: Participants completed a discrete choice experiment (DCE) within online interviews. Nine conjoint‐analysis tasks were created, each with two potential CRC screening programmes. The attributes included personal risk of CRC, screening invitation strategy and impact. Participants chose between programmes while thinking aloud and sharing their thoughts. Transcripts were analysed using codebook thematic analysis. Participants: Twenty participants based in England aged 40–79 years without previous cancer history or medical expertise. Results: When choosing between programmes, participants first and primarily looked to prioritise saving lives. The harms associated with screening were viewed as a surprise but also felt by most to be inevitable; the benefits frequently outweighed, therefore, harms were considered less important. Risk stratification using individual characteristics was considered a nuanced approach to healthcare, which tended to be preferred over the age‐alone model. Detailed personal risk information could be taken more seriously than non‐personalised information to motivate behaviour change. Although it had minimal impact on decision‐making, not diverting resources for screening from elsewhere was valued. Individuals who chose not to provide health information were considered irresponsible, while it was important that those with no information to provide should not lose out. Conclusion: Risk‐stratified CRC screening is generally aligned with public preferences, with decisions between possible stratification strategies dominated by saving lives. Even if attributes including risk factors, risk stratification strategy and risk communication contributed less to the overall decision to select certain programmes, some levels more clearly fulfilled public values; therefore, all these factors should be taken into consideration when redesigning and communicating CRC screening programmes. Patient or Public Contribution: The primary data source for this study is interviews with 20 members of the public (current, past or future CRC screening invitees). Two public representatives contributed to planning this study, particularly the DCE. [ABSTRACT FROM AUTHOR]

Farmers can counteract global warming by drawing carbon dioxide from the air into agricultural soils by building up humus. Humus programs were developed to motivate farmers for even more humus formation (= carbon sequestration) through an additional financial incentive. These programs are still at an early stage of development, which is why the number of participating farmers and research work is still low. This study is the first to analyze the willingness of German farmers to participate in hypothetical humus programs. The results of a discrete choice experiment show that a (higher) threshold for the payout of the premium, regional (rather than field-specific) reference values, and the risk of repayment clearly discourage farmers from participating. Program providers must more than double the premium (set at around 240 € per hectare and 0.1% humus increase) to maintain farmers' willingness to participate despite a payout threshold. Regional reference values and an additional premium/repayment system would lead to an increase in the premium of around 20 € per hectare in order to keep the willingness to participate at the same level. The motivation to build up humus, the desire to maximize subsidies, and a higher livestock density have a positive influence on farmers' decision to participate. Farm size and risk attitude have an impact on farmers' preferences for program design. The study is relevant for policymakers and non-governmental organizations concerned with carbon management, as our findings highlight pathways for efficient, targeted designs of humus programs and carbon sequestration policies. [ABSTRACT FROM AUTHOR]

Introduction: Despite decades of research on risk-communication approaches, questions remain about the optimal methods for conveying risks for different outcomes across multiple time points, which can be necessary in applications such as discrete choice experiments (DCEs). We sought to compare the effects of 3 design factors: 1) separated versus integrated presentations of the risks for different outcomes, 2) use or omission of icon arrays, and 3) vertical versus horizontal orientation of the time dimension. Methods: We conducted a randomized study among a demographically diverse sample of 2,242 US adults recruited from an online panel (mean age 59.8 y, s = 10.4 y; 21.9% African American) that compared risk-communication approaches that varied in the 3 factors noted above. The primary outcome was the number of correct responses to 12 multiple-choice questions asking survey respondents to identify specific numbers, contrast options to recognize dominance (larger v. smaller risks), and compute differences. We used linear regression to test the effects of the 3 design factors, controlling for health literacy, graph literacy, and numeracy. We also measured choice consistency in a subsequent DCE choice module Results: Mean comprehension varied significantly across versions (P < 0.001), with higher comprehension in the 3 versions that provided separated risk information for each risk. In the multivariable regression, separated risk presentation was associated with 0.58 more correct responses (P < 0.001; 95% confidence interval: 0.39, 0.77) compared with integrated risk information. Neither providing icon arrays nor using vertical versus horizontal time formats affected comprehension rates, although participant understanding did correlate with DCE choice consistency. Conclusions: In presentations of multiple risks over multiple time points, presenting risk information separately for each health outcome appears to increase understanding. Highlights: When conveying information about risks of different outcomes at multiple time points, separate presentations of single-outcome risks resulted in higher comprehension than presentations that combined risk information for different outcomes. We also observed benefits of presenting single-outcome risks separately among respondents with lower numeracy and graph literacy. Study participants who scored higher on risk understanding were more internally consistent in their responses to a discrete choice experiment. [ABSTRACT FROM AUTHOR]

Purpose: Agriculture education promotes farmers and societal welfare through a more efficient use of resources and the adoption of sustainable farming practices. Nevertheless, farmers' educational attainment is limited across countries. This study explores farmers' intention to participate in formal agriculture education. Design/methodology/approach: A discrete choice experiment survey with 363 farmers exploring their preferences for different specifications within a diploma in agriculture was employed. We focus on Northern Ireland, a country with a relatively large agricultural sector and were farmers have a low level of formal education. Findings: Our results show that farmers exhibited a preference for short courses delivered in the evenings, with 75% of the teaching time delivered online, favouring educational topics linked to farm performance against those related to socio-environmental outcomes. Part-time younger farmers, operating in small farms located in less favoured areas, reported the highest willingness to pay for the course. However, farmers that had previously participated in a Young Farmer Payment Scheme reported the lowest interest in undertaking the course. Practical implications: The study provides useful information to education providers in relation to the design of agriculture courses to better meet farmers' preferences and therefore encourage levels of uptake. Secondly, the study can help policymakers to make informed decisions about policy instruments incentivising farmers to engage in education. Theoretical implications: By drawing from random parameter choice models, the study highlights that the heterogeneity of farmers' preferences should be considered when modelling their decision to engage in agriculture education. Originality/value: This is the first study that elicits farmers' preferences towards agriculture education via a discrete choice experiment. Secondly, the study explores preference heterogeneity based on farmers and farms' characteristics. [ABSTRACT FROM AUTHOR]

Purpose: The calculation of aggregated composite measures is a widely used strategy to reduce the amount of data on hospital report cards. Therefore, this study aims to elicit and compare preferences of both patients as well as referring physicians regarding publicly available hospital quality information Methods: Based on systematic literature reviews as well as qualitative analysis, two discrete choice experiments (DCEs) were applied to elicit patients' and referring physicians' preferences. The DCEs were conducted using a fractional factorial design. Statistical data analysis was performed using multinomial logit models Results: Apart from five identical attributes, one specific attribute was identified for each study group, respectively. Overall, 322 patients (mean age 68.99) and 187 referring physicians (mean age 53.60) were included. Our models displayed significant coefficients for all attributes (p < 0.001 each). Among patients, "Postoperative complication rate" (20.6%; level range of 1.164) was rated highest, followed by "Mobility at hospital discharge" (19.9%; level range of 1.127), and "The number of cases treated" (18.5%; level range of 1.045). In contrast, referring physicians valued most the "One-year revision surgery rate" (30.4%; level range of 1.989), followed by "The number of cases treated" (21.0%; level range of 1.372), and "Postoperative complication rate" (17.2%; level range of 1.123) Conclusion: We determined considerable differences between both study groups when calculating the relative value of publicly available hospital quality information. This may have an impact when calculating aggregated composite measures based on consumer-based weighting. [ABSTRACT FROM AUTHOR]

Objective: Despite being primary beneficiaries of human papillomavirus (HPV) vaccines, female university students in China exhibit low vaccination rates. This study aimed to assess their preferences for HPV vaccination services and evaluate the relative importance of various factors to inform vaccination strategy development. Methods: Through a literature review and expert consultations, we identified five key attributes for study: effectiveness, protection duration, waiting time, distance, and out-of-pocket (OOP) payment. A D-efficient design was used to create a discrete choice experiment (DCE) questionnaire. We collected data via face-to-face interviews and online surveys from female students across seven universities in China, employing mixed logit and latent class logit models to analyze the data. The predicted uptake and compensating variation (CV) were used to compare different vaccination service scenarios. Results: From 1178 valid questionnaires, with an effective response rate of 92.9%, we found that effectiveness was the most significant factor influencing vaccination preference, followed by protection duration, OOP payment and waiting time, with less concern for distance. The preferred services included a 90% effective vaccine, lifetime protection, a waiting time of less than three months, a travel time of more than 60 min, and low OOP payment. Significant variability in preferences across different vaccination service scenarios was observed, affecting potential market shares. The CV analysis showed female students were willing to spend approximately CNY 5612.79 to include a hypothetical 'Service 5' (a vaccine with higher valency than the nine-valent HPV vaccine) in their prevention options. Conclusions: The findings underscore the need for personalized, need-based HPV vaccination services that cater specifically to the preferences of female university students to increase vaccination uptake and protect their health. [ABSTRACT FROM AUTHOR]

Background: Generic substitution policies have been widely implemented worldwide to enhance the accessibility of medications. Nevertheless, certain patients have voiced discontent with these policies. This study aimed to evaluate the patient preferences for generic substitution policies and explore the potential for optimization to enhance patient acceptance. Methods: A discrete choice experiment (DCE) was conducted to estimate the relative importance (RI) of five attributes, including generic consistency evaluation (GCE), reimbursement rate, medication use control, information disclosure, and post-marketing surveillance. Respondents were recruited among inpatients and outpatients in three cities and surveys were conducted face-to-face. Preference coefficients, RI of attributes, and the uptake rate of various policies were computed using a mixed logit model. The interaction effects were also included to examine preference heterogeneity. Results: A total of 302 patients completed the survey. All five attributes significantly impacted policy acceptance. GCE held the highest RI value at 56.64%, followed by reimbursement rate (RI = 12.62%), information disclosure (RI = 12.41%), post-marketing surveillance (RI = 9.54%), and medication use control (RI = 8.80%). Patient preferences varied depending on their gender and income. The patient uptake rate of China's current policy was only 68.56%. If all generics were to pass GCE without altering the other attributes, the uptake rate of policies would rise to 82.63%. Similarly, implementing information disclosure without changing other attributes would result in a 78.67% uptake rate, which is comparable to the effect of a 10% increase in reimbursement rate for generics (78.81%). Combining these policies could mitigate the adverse effects of mandatory substitution on patient. Conclusion: Chinese patient preferences for generic substitution policies were mainly influenced by GCE. China's current generic substitution policy has room for further optimization to enhance patient acceptance. [ABSTRACT FROM AUTHOR]

Objective Background Methods Results Conclusions To evaluate preferences for key attributes of injected or infused preventive migraine treatments and assess heterogeneity in preferences among Canadian participants with migraine.Current treatment options for migraine prevention differ in their attributes, including mode of administration, efficacy, and dosing frequency; preferences for such attributes can vary among patients. With the advent of new therapies, evidence demonstrating patient preferences for injected or infused preventive migraine treatments is necessary.Canadian adults self‐reporting a diagnosis of migraine completed a cross‐sectional, internet‐based survey that included a discrete choice experiment. Participants were presented with attributes of preventive migraine treatments, including speed of onset, durability of efficacy, mode of administration, administration setting, and dosing frequency. Latent class analysis (LCA) was used to identify subgroups of patients who differed in their treatment preferences.In total, 200 participants completed the survey. Participants’ treatment preferences were most sensitive to improvements in the durability of effectiveness from “wears off 2 weeks before next dose” to “does not wear off before the next dose” (absolute difference in weights = |−0.95 to 1.07| = 2.02) and improvements from “cranial injections” to “intravenous infusions” (|−1.04 to 0.58| = 1.62); participants equally preferred self‐injection and intravenous infusion from a health‐care provider (mean weight = 0.58 and 0.47, respectively) as a route of administration over cranial injections (mean weight = −1.04). Three subgroups were identified with LCA: group one (n = 103) prioritized fast‐acting and durable therapies, group two (n = 54) expressed aversion to cranial injections, and group three (n = 43) favored treatments administered in a health‐care provider setting.In this sample of Canadian adults with migraine, we showed that durability of effectiveness and mode of administration are key attributes influencing patient preferences for preventive migraine treatments; however, certain groups of patients may differ in their treatment priorities. Our results highlight the need for patient–provider discussions regarding treatment attributes and consideration of patients’ preferences when selecting a preventive migraine treatment. [ABSTRACT FROM AUTHOR]

Background: Listening to patient voices is critical, in terms of how people experience their condition as well as their treatment preferences. This research explored the patient journey, therapy attributes and goals among treatment experienced adults with chronic lymphocytic leukemia (CLL). We sought to understand patient experiences, needs and expectations to identify areas for improvement of treatment and care delivery. Methods: Two online surveys were developed for completion by CLL patients. In Stage 1, participants completed a best-worst scaling (BWS) task to evaluate eleven previously validated healthcare journey moments that matter (MTM). Responses were used to generate the patient experience index (PEI) score. In Stage 2, participants completed a survey that included both a discrete choice experiment (DCE) to assess drivers of treatment preferences by evaluating the relative attribute importance (RAI) of seven features and a BWS exercise which explored long-term treatment goals. Results: Twenty-five patients completed Stage 1 and thirty patients Stage 2. Treatment experience was balanced between oral and intravenous medication. The most important/least satisfied MTM were treatment effectiveness, access to support and other treatments as well as monitoring progress. The median PEI score was 66.2 (out of 100). DCE results demonstrated that patients most value treatments for CLL that are associated with prolonged progression free survival (PFS; RAI: 24.6%), followed by treatments that have a lower risk of severe side effects and lower out-of-pocket costs (RAI: 19.5%, 17.4%, respectively). The remainder of the weight in decision making (38.5%) was split between the remaining attributes, namely 'mild to moderate side effects' (13.4%), 'long-term risks' (12.2%), type of treatment (i.e., oral, IV or a combination of oral and IV; 8.7%) and treatment duration (i.e., ongoing versus fixed; 4.2%). Patients preferred oral to intravenous therapy. The most valued long-term treatment goal was to be physically healthy, followed by living a long life, spending time with family/friends, and avoiding hospitalization. Conclusion: Treatment experienced patients with CLL are focused on receiving effective, safe therapies and value long PFS. Consideration and discussion of other attributes, such as once daily dosing, oral only medication, out-of-pocket costs and access to support services may affect patient treatment choices and ultimately enhance their healthcare experience and outcomes. [ABSTRACT FROM AUTHOR]

AbstractThe overall value of treatments for chronic lymphocytic leukemia (CLL) depends on several factors, including preferences of the general population, who contributes to the financing of health systems. This study investigated societal preferences for attributes of CLL treatments in Italy. An online large-scale survey was designed using a discrete choice experiment (DCE) methodology and delivered to the Italian adult general population. Ten treatment attributes were identified, covering efficacy, safety, operational aspects and (hypothetical) out-of-pocket cost. DCE data were analyzed using a mixed logit regression model, estimating the willingness-to-pay for attribute levels’ change. The general population significantly preferred more effective treatments, with shorter duration, administered orally rather than orally + intravenously. Changes in therapy duration, frequency of checkups and organ damage risk had the greatest impact on preferences. The integration of societal preferences in the value judgments of CLL therapies may help health authorities in establishing priority setting and taking pricing-reimbursement decisions. [ABSTRACT FROM AUTHOR]

Plastic pollution is a global issue that endangers both human health and the ecosystem. Although interest in sustainable alternatives to single-use plastics has grown, their adoption has been insufficient, and menstrual products are no exception. Disposable menstrual products, such as sanitary napkins, continue to dominate over sustainable options like menstrual cups (MCs). Although studies on women's perceptions and attitudes toward menstrual hygiene management have abounded, there is a lack of research on the development of promotional strategies for sustainable menstrual products. This study aims to fill this research gap by investigating consumers' decision-making process in the face of a real-life option regarding menstruation products. In this comparative study, we conducted a labeled discrete choice experiment on consumers in Japan (n = 1,929), Indonesia (n = 2,031), and France (n = 2,067) to reveal their preferences for sanitary napkins, tampons, and MCs. The respondents from each country were divided into three groups (one control group and two treatment groups with information provided). The results showed that in all countries, the information regarding the costeffectiveness of MCs (i.e., per-use cost) was unequivocally significant, whereas information about their health and environmental benefits was not. Access to free MCs can contribute to their adoption and alleviation of period poverty in all countries, with a relatively moderate acceptance in Japan. The results also showed variations across countries in consumer characteristics (attitude toward menstruation, innovation-friendliness, and green consumption) and the use and perceptions of MCs. Hence, tailored promotional strategies should be considered for each market. [ABSTRACT FROM AUTHOR]

Introduction: The popularity of video consultations in healthcare has accelerated during the COVID-19 pandemic. Despite increased availability and obvious benefits, many patients remain hesitant to use video consultations. This study investigates the relative importance of the consultation mode compared to other attributes in patients' appointment choices in Germany. Methods: A discrete choice experiment was conducted to examine the influence of appointment attributes on preferences for video over in-clinic consultations. A total of 350 participants were included in the analysis. Results: The level of continuity of care (46%) and the waiting time until the next available appointment (22%) were shown to have higher relative importance than consultation mode (18%) and other attributes. Participants with fewer data privacy concerns, higher technology proficiency, and more fear of COVID-19 tended to prefer video over in-clinic consultations. The predicted choice probability of a video over a typical in-clinic consultation and opting out increased from <1% to 40% when the video consultation was improved from the worst-case to the best-case scenario. Conclusion: This study provides insight into the effect of the consultation mode on appointment choice at a time when telemedicine gains momentum. The results suggest that participants preferred in-clinic over video consultations. Policymakers and service providers should focus on increasing the level of continuity of care and decreasing the time until the next available appointment to prompt the adoption of video consultations. Although participants preferred to talk to their physician in person over consulting via video per se, the demand for video consultations can be increased significantly by improving the other appointment attributes of video consultations such as the level of continuity of care. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop a Japanese value set for the EORTC QLU-C10D, a multi-attribute utility measure derived from the cancer-specific health-related quality-of-life (HRQL) questionnaire, the EORTC QLQ-C30. The QLU-C10D contains ten HRQL dimensions: physical, role, social and emotional functioning, pain, fatigue, sleep, appetite, nausea, and bowel problems. Methods: Quota sampling of a Japanese online panel was used to achieve representativeness of the Japanese general population by sex and age (≥ 18 years). The valuation method was an online discrete choice experiment. Each participant considered 16 choice pairs, randomly assigned from 960 choice pairs. Each pair included two QLU-C10D health states and life expectancy. Data were analyzed using conditional logistic regression, parameterized to fit the quality-adjusted life-year framework. Preference weights were calculated as the ratio of each dimension-level coefficient to the coefficient for life expectancy. Results: A total of 2809 eligible panel members consented, 2662/2809 (95%) completed at least one choice pair, and 2435/2662 (91%) completed all choice pairs. Within dimensions, preference weights were generally monotonic. Physical functioning, role functioning, and pain were associated with the largest utility weights. Intermediate utility weights were associated with social functioning and nausea; the remaining symptoms and emotional functioning were associated with smaller utility decrements. The value of the worst health state was − 0.221, lower than that seen in most other existing QLU-C10D country-specific value sets. Conclusions: The Japan-specific QLU-C10D value set is suitable for evaluating the cost and utility of oncology treatments for Japanese health technology assessment and decision-making. [ABSTRACT FROM AUTHOR]

Background: The second version of the Short-Form 6-Dimension (SF-6Dv2) classification system has recently been developed. The objective of this study was to develop a value set for SF-6Dv2 based on the societal preferences of a general population in the capital of Iran. Methods: A representative sample of the capital of Iran (n = 3061) was recruited using a stratified multistage quota sampling technique. Face-to-face interviews were conducted using binary choice sets from the international valuation protocol of the discrete choice experiment with duration. The conditional logit was used to estimate the final value set, and a latent class model was employed to assess heterogeneity of preferences. Results: Coefficients generated from the models were logically consistent and significant. The best model was the one that included an additional interaction term for cases where one or more dimensions reached their most severe levels. It provides a value set with logical consistent coefficients and the lowest percentage of worse than death health states. Predicted values for the SF-6Dv2 were within the range of − 0.796–1. Pain dimension had the largest impact on utility decrement, whereas vitality had the least impact. The presence of preference heterogeneity was evident, and the Bayesian Information Criterion indicated the optimal fit for a latent class model with two classes. Conclusion: This study provided the SF-6Dv2 value set for application in the context of Iran. This value set will facilitate the use of the SF-6Dv2 instrument in health economic evaluations and clinical settings. [ABSTRACT FROM AUTHOR]

Objectives: Cannabis use is common in people with early-phase psychosis (EP) and is associated with worse treatment outcomes. Few targeted interventions for cannabis use behaviour in this population exist, most focusing on abstinence, none focusing on harm reduction. Many people with EP will not seek treatment for their cannabis use with current therapeutic options. Understanding preferences for cannabis-focused harm reduction interventions may be key to improving outcomes. This study aimed to determine preferences of young adults with EP who use cannabis for cannabis-focused harm reduction interventions. Methods: Eighty-nine young adults across Canada with EP interested in reducing cannabis-related harms were recruited. An online questionnaire combining conventional survey methodology and two unique discrete choice experiments (DCEs) was administered. One DCE focused on attributes of core harm reduction interventions (DCE 1) and the second on attributes of boosters (DCE 2). We analysed these using mixed ranked-ordered logistic regression models. Preference questions using conventional survey methodology were analysed using summary statistics. Results: Preferred characteristics for cannabis-focused harm reduction interventions (DCE 1) were: shorter sessions (60 min vs. 10 min, odds ratio (OR): 0.72; P < 0.001); less frequent sessions (daily vs. monthly, OR: 0.68; P < 0.001); shorter interventions (3 months vs. 1 month, OR: 0.80; P < 0.01); technology-based interventions (vs. in-person, OR: 1.17; P < 0.05). Preferences for post-intervention boosters (DCE 2) included opting into boosters (vs. opting out, OR: 3.53; P < 0.001) and having shorter boosters (3 months vs. 1 month, OR: 0.79; P < 0.01). Nearly half of the participants preferred to reduce cannabis use as a principal intervention goal (vs. using in less harmful ways or avoiding risky situations). Conclusions: Further research is required to see if technology-based harm reduction interventions for cannabis featuring these preferences translate into greater engagement and improved outcomes in EP patients. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to survey and analyze the preferences for pharmacist-managed clinic among urban residents in China. Materials and Methods: A discrete choice experiment was conducted in Nanjing, China. A D-efficient fractional factorial design was used to generate the questionnaire. Three models were used to investigate each patient's strength of preference and preference heterogeneity. The relative importance for each treatment attribute was also determined. Results: 156 usable questionnaires (of 228 questionnaires sent out) were received. Respondents preferred pharmacist-managed clinics with the following characteristics: good pharmacists' knowledge and clinical medication practice competency, lower consultation fees, a dedicated consultation room, physician-pharmacist joint clinic, with pharmacists' knowledge competency receiving the highest priority. Latent class analysis revealed three classes (Experiential Type, Content Type and Economic Type) were identified based on respondents' preferences for pharmacist-managed clinics. Conclusion: The respondents were willing to choose a PMC relative to the current situation. When deciding on a pharmacist-managed clinic, residents are driven by pharmacists' competency, consultation fee, availability of consultation rooms and collaborative care or independent pharmacist service. Differences in patients' preferences identified in the study provide information on pharmacist-managed clinics that meet residents' expectations. [ABSTRACT FROM AUTHOR]

Reducing free-riding is an important challenge for educators who use group projects. In this study, we measure students' preferences for group project characteristics and investigate if characteristics that better help to reduce free-riding become more important for students when stakes increase. We used a discrete choice experiment based on 12 choice tasks in which students chose between two group projects that differed on five characteristics of which each level had its own effect on free-riding. A different group project grade weight was presented before each choice task to manipulate how much there was at stake for students in the group project. Data of 257 student respondents were used in the analysis. Based on random parameter logit model estimates we find that students prefer (in order of importance) assignment based on schedule availability and motivation or self-selection (instead of random assignment), the use of one or two peer process evaluations (instead of zero), a small team size of three or two students (instead of four), a common grade (instead of a divided grade), and a discussion with the course coordinator without a sanction as a method to handle free-riding (instead of member expulsion). Furthermore, we find that the characteristic team formation approach becomes even more important (especially self-selection) when student stakes increase. Educators can use our findings to design group projects that better help to reduce free-riding by (1) avoiding random assignment as team formation approach, (2) using (one or two) peer process evaluations, and (3) creating small(er) teams. [ABSTRACT FROM AUTHOR]

As health care moves away from volume-based to value-based delivery, the role of the patient in determining value in health care is now paramount. Thus, health care should be aligned with what matters most to patients. Ascertaining patient preferences is therefore critical if we are to provide patients with care that is meaningful to them. However, preferences are difficult to measure and traditional methods of preference measurement in physical therapy face challenges when attempting to measure such. This perspective makes a case for greater use of the discrete choice experiment (DCE) in physical therapy as a research method to measure patient preferences. The DCE is a research method used to elicit preferences for services or goods. This article addresses the importance of eliciting patient preferences as part of person-centered care in the value-based space, the challenges faced in preference measurement in physical therapy, and how the DCE can alleviate some of those challenges. It also provides examples of the DCE in health care and suggests ways in which it can be effectively used in physical therapist practice to improve the delivery of meaningful rehabilitation services to patients. Implementing greater use of the DCE in physical therapy can improve person-centered physical therapist service delivery and inform policy development that creates cost-effective care which is meaningful to patients. It can further help to highlight the value of physical therapy to population health, and to policy makers as health care moves toward more value-based models. [ABSTRACT FROM AUTHOR]

* OBJECTIVE: To identify the smallest worthwhile effect (SWE) of exercise therapy for people with nonspecific chronic low back pain (CLBP). * DESIGN: Discrete choice experiment * METHODS: The SWE was estimated as the lowest reduction in pain that participants would consider exercising worthwhile, compared to not exercising, ie, effects due to natural history and other components (eg, regression to the mean). We recruited English-speaking adults in Australia with nonspecific CLBP to our online survey via e-mail obtained from a registry of previous participants and advertisements on social media. We used discrete choice experiment to estimate the SWE of exercise compared to no exercise for pain intensity. We analyzed the discrete choice experiment using a mixed logit model and mitigated hypothetical bias through certainty calibration, with sensitivity analyses performed with different certainty calibration thresholds. * RESULTS: Two hundred and thirteen participants completed the survey. The mean age (±standard deviation [SD]) was 50.7±16.5, median (interquartile range) pain duration 10 years (5-20), and mean pain intensity (±SD) was 5.8±2.3 on a 0-to-10 numerical rating scale. For people with CLBP, the SWE of exercise was a between-group reduction in pain of 20%, compared to no exercise. In the sensitivity analyses, the SWE varied with different levels of certainty calibration, from 0% without certainty calibration to 60% with more extreme certainty calibration. * CONCLUSION: This patient-informed threshold of clinical importance could guide the interpretation of findings from randomized trials and meta-analyses of exercise therapy compared to no exercise. [ABSTRACT FROM AUTHOR]

Because of increasing customer awareness and government regulations, apparel organisations are inclined to adopt social sustainability practices (SSPs) into their working environment. There is a lack of scientific literature examining the interaction between social and economic sustainability within the apparel industry from the employee perspective. This study aims to assess the preferences of blue and white‐collar employees in the apparel supply chain to implement SSPs. The SSPs were identified through a literature study and a deductive approach was taken to conduct a discrete choice experiment. The experiment revealed that blue‐collar employees prioritised maternity leaves and proper sanitary facilities, whereas white‐collar employees preferred corporate social responsibility initiatives and providing proper sanitary facilities when designing the jobs for blue‐collar employees. The study also identified willingness to pay for the identified practices highlighting the importance of providing maternity leaves and proper sanitary facilities to enhance economic and social sustainability. This research contributes to bridging the gap between the expectations of blue‐collar and white‐collar employees towards SSPs and provide an understanding of the interaction between the social and economic pillars of sustainability in the global apparel supply chain. [ABSTRACT FROM AUTHOR]

Background: Systemic family interventions for adolescents with problems of substance use and/or delinquency are increasingly focused subject of economic evaluations. Treatment effects go beyond improvements in commonly measured health-related quality of life (HRQOL). The Teen-Addiction Severity Index (T-ASI) was identified as capable of capturing these broad outcomes. However, it lacks preference-based scores. An abbreviated self-completion version (ASC T-ASI) was created and validated, covering the T-ASI domains substance use, school, work, family, social relationships, justice, and mental health. This study aimed to obtain societal preference scores for the ASC T-ASI. Methods: Preferences were elicited in a sample of the Dutch general adult population (n = 1500), using a web-based Discrete Choice Experiment. Choice tasks included two unlabeled alternatives with attributes and levels corresponding to the domains and levels of the ASC T-ASI. A pilot study (n = 106) informed priors, optimal presentation, and number of choice tasks applied in the main study. Data were analyzed using a mixed multinomial logit model. Results: Preference scores were logically ordered, with lower scores for worse ASC T-ASI states. Scores were most influenced by reductions in problems concerning the domains substance use, mental health, justice, and family. Tariffs were calculated for each ASC T-ASI state, ranging from 0 (worst situation) to 1 (best situation). Conclusions: The tariffs enable preference-based assessments of the broad effects of systemic family interventions for adolescents with problems of substance use and/or delinquency. The outcome reflects addiction-related rather than health-related utility and can be used next to generic HRQOL instruments in relevant economic evaluations. Given the source used for the preferences, interpretations and valuation of scores require attention. [ABSTRACT FROM AUTHOR]

Objective: The EORTC QLU-C10D is a new preference-based measure derived from the EORTC QLQ-C30. Country-specific value sets are required to support the cost-utility analysis of cancer-related interventions. This study aimed to generate an EORTC QLU-C10 value set for Hong Kong (HK). Methods: A HK online panel was quota-sampled to achieve an adult general population sample representative by sex and age. Participants were invited to complete an online discrete choice experiment survey. Each participant was asked to complete 16 choice-pairs, randomly assigned from a total of 960 choice-pairs, each comprising two QLU-C10D health states and a duration attribute. Conditional and mixed logistic regression analyses were used to analyse the data. Results: The analysis included data from 1041 respondents who had successfully completed the online survey. The distribution of sex did not differ from that of the general population, but a significant difference was found among age groups. A weighting analysis for non-representative variable (age) was used. Utility decrements were generally monotonic, with the largest decrements for physical functioning (− 0.308), role functioning (− 0.165), and pain (− 0.161). The mean QLU-C10D utility score of the participants was 0.804 (median = 0.838, worst to best = − 0.169 to 1). The value of the worst health state was − 0.223, which was sufficiently lower than 0 (being dead). Conclusions: This study established HK utility weights for the QLU-C10D, which can facilitate cost-utility analyses across cancer-related health programmes and technologies. [ABSTRACT FROM AUTHOR]

Background: The value of a Quality-Adjusted Life-Year (QALY) is of great importance for the healthcare system. It helps when it comes to defining a cost-effectiveness threshold for the evaluation of health technologies. No willingness-to-pay value for a QALY exists in the province of Quebec, Canada. Objectives: In this paper, we empirically investigated the monetary value of a QALY for the population of Quebec. Methods: Based on the Short-Form 6-Dimension version 2 (SF-6Dv2), we conducted an online survey with a representative adult sample living in Quebec. We used a time trade-off (TTO) combined with contingent valuation (CV), and a discrete choice experiment (DCE) to assess both the population's willingness to pay (WTP) for one QALY and the marginal WTP for health attributes. A health utility algorithm using hybrid regression was developed to determine a preference-based value set for health states. Results: Main analysis was conducted on 993 answers for the CV and 2143 answers for the DCE. The willingness-to-pay per QALY varied from CA$ 47,048.84 (CI: 21,554.38; 72,543.30) for CV to CA$ 73,936.87 (CI: 63,105.40; 84,768.35) for DCE. Among the 6 dimensions of the SF-6Dv2, marginal WTP varied from CA$ 4499.15 (CI: 2975.06; 6023.25) for more role accomplishment in daily activities to CA$ 15,867.12 (CI: 13,825.75; 17,908.49) for less pain. Robustness check with multiple alternative samples, as well as alternative health utility algorithms, showed that the results were robust and the DCE method provided 50% larger results than the CV method, although confidence intervals overlap. Conclusion: This paper provides useful information for decision-makers on the monetary value of a QALY in Quebec. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Despite the great importance of supplementary health insurance, one of the obstacles to its expansion is that the willingness to pay for it is not known. The disregard for insurance calculations in the law and the supportive views of policy makers in this area have meant that premiums have been set by the insurer and for this reason may not match the costs incurred. With this in mind, the main objective of this article is to identify the factors that influence consumers’ willingness to pay for supplementary health insurance and to estimate their willingness to pay. METHODS: To achieve these objectives, the library study, expert panel, and discrete choice experiment methods were used along with the common analysis technique. FINDINGS: Based on the results of the qualitative part, eight features were extracted for the health insurance package at four levels. The results of the quantitative part also showed that people in Tehran derive the most benefit from insurance coverage for inpatient services. This benefit is greater for inpatient services in the private sector than in the public sector. In addition, coverage of outpatient services carries more weight in people’s preferences than other characteristics. Also, the desirability and willingness to pay for coverage of dental services was significant and for coverage of long-term care, paraclinical services and rehabilitation was rated as moderate. Medical devices have the least benefit to people and the presence of this feature in the supplementary health insurance package has the least impact on people’s willingness to pay. The insurance premium also has a negative influence on the choice of supplementary insurance. The results also show that the demographic (topical) and socioeconomic characteristics of the insured can influence people’s preferences. CONCLUSION: People are most willing to pay for “dental services”, “home care” and “numerous medical centers under contract”, which should be considered by insurers when drafting policies. [ABSTRACT FROM AUTHOR]

Background and Aims: There has been hesitancy among people with regard to accepting vaccines, especially that of coronavirus disease‐2019 (COVID‐19). This hesitancy is aggravated by the different vaccine alternatives available and what one considers before choosing a particular vaccine. The aim of this article was to investigate some driving factors that can influence an individual's COVID‐19 vaccine preference in the presence of other alternatives, using some specific vaccine characteristics. Methods: Discrete choice questionnaire was designed using the attributes and their corresponding levels to collect data on participants' preference for a COVID vaccine over a period of 12 Weeks in Sunyani, Ghana, with the help of an observational study design. A total of 150 participants receiving Covid‐19 vaccines at the University of Energy and Natural Resources Hospital were systematically selected and interviewed. Factors considered included: Efficacy of the vaccine, credibility of the manufacturing company, side effects of the vaccine, and availability of the vaccine. Data was analyzed using the conditional probit of the discrete choice experiment (DCE). Results: Results from the study using the conditional probit of the discrete choice experiment (DCE) showed efficacy, side effects, and availability as significant attributes for preference. However, there was no preference with respect to the credibility of the manufacturing company. In addition, vaccine availability was not a dis‐utility in comparison to the alternatives that are readily available. This disutility was however higher among males than females. Conclusion: From the study, most respondents preferred a COVID‐19 vaccine that is highly efficacious or a vaccine with milder side effect or a vaccine that may not necessarily be readily available. It was also observed that dis‐utility is higher among males when it comes to vaccine not being readily available than females as the odds of a female choosing a vaccine that is readily available is much higher compared to their males counterparts. [ABSTRACT FROM AUTHOR]

Abstract Background In U.S. states that legalized and commercialized recreational cannabis, cannabis sales in illegal markets are still sizable or even larger than those in legal markets. This study aimed to assess cannabis consumers’ preferences for purchasing cannabis from legal and illegal markets and estimate the trade-offs under various policy scenarios. Methods 963 adults were recruited, who used cannabis in the past year and lived in a state with recreational cannabis legalization. In a discrete choice experiment, participants chose purchasing cannabis from a legal dispensary or an illegal dealer with varying levels in product attributes including quality, safety, accessibility, potency, and price. Mixed logit models were used to analyze preferences. Results The likelihood of choosing legal cannabis increased with a higher quality, the presence of lab test, a shorter distance to seller, a higher tetrahydrocannabinol level, and a lower price. The likelihood of choosing illegal cannabis increased with a higher quality, a shorter distance to seller, and a lower price. Among product attributes, quality and accessibility were perceived to be the most important for legal cannabis and price was perceived to be the most important for illegal cannabis. Policy simulations predicted that improving quality, ensuring safety, allowing delivery services, increasing dispensary density, and lowering prices/taxes of legal cannabis may reduce illegal cannabis market share. Conclusions In the U.S., cannabis consumers’ preferences for illegal cannabis were associated with both legal and illegal cannabis product attributes. Policies regulating legal cannabis markets should consider potential spillover effects to illegal markets.

Jie Jia,1,&ast; Tao Sun,1,&ast; Jiamin Tang,1 Kaidi Sun,1 Zhengnan Meng,1 Hailong Zhu,2 Xianhong Huang1 1Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, 311121, People’s Republic of China; 2Department of Sociology, School of Public Administration, Hangzhou Normal University, Hangzhou, 311121, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xianhong Huang, Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, 311121, People’s Republic of China, Tel/Fax +86-571-2886-5627, Email hxh974291@163.comPurpose: Healthcare professionals’ participation is crucial for the efficient implementation of multidisciplinary team (MDT) collaboration models. We identified the key factors influencing healthcare professionals’ preference to participate in MDTs in tertiary hospitals.Methods: To clarify the attributes and levels of the discrete choice experiment (DCE), we conducted a targeted literature review and conducted in-depth interviews with MDT service providers. Following this, a DCE was designed to evaluate healthcare professionals’ preferences for MDT participation, and the influence of factors such as salary subsidies, leadership attention, patient participation, quality assessment, working intensity, and case complexity. A conditional logit model estimated the utility of each attribute. Willingness-to-pay estimates were derived by taking the negative ratio of the coefficients of non-economic and economic attributes. A series of policy simulation analyses were conducted.Results: Two hundred healthcare professionals completed the questionnaire, with 180 valid responses used for analysis. All attributes were statistically significant. Leadership attention and working intensity were the primary factors influencing staff willingness to participate in MDTs, followed by quality assessment and salary subsidies. Significant preference differences were observed between respondents; compared with mid-level staff, senior-level healthcare professionals believed patient engagement would be more helpful in boosting participation. The policy simulation showed that changing leadership attention from “neglect” to “emphasis” would increase the probability of staff choosing to participate in MDTs from 24.4% to 66.98%.Conclusion: Leadership attention was the primary concern for healthcare professionals in MDTs. To effectively motivate staff participation in MDTs, policymakers should adopt a holistic approach that considers work motivation and individual backgrounds, including competitive salary packages and a positive work environment. They should concurrently introduce MDT case complexity measurement tools to optimize resource allocation. Addressing staff members’ unique needs and career aspirations by creating targeted training programs, pathways for advancement, and personalized career development plans are also crucial.Keywords: multidisciplinary medical services, participation motivation, health services research, discrete choice experiment

Background Using discrete choice experiment (DCE) to study the employment preference of health personnel to choose jobs can provide scientific and efficient basis for the formulation of policies related to the attraction and retention of health personnel in rural and remote areas. Objective To review, summarize and generalize the researches on the application of DCE to the field of human resources for health, so as to provide reference for future research. Methods Web of Science, PubMed, CNKI, Wanfang and VIP were systematically searched for literature related to DCE application to the field of health human resources from February to April in 2022. The data of included studies such as study objectives, data analysis models, the choice item settings and results were extracted. Results A total of 44 papers published from 2000 to 2020 were finally included. The study objects were mainly health workers in service and students; six studies were labeled and others were unlabeled in the included papers; the number of working attributes ranged from 4 to 8; the number of levels of working attributes was predominantly 2 to 4 (88.6%, 39/44). The teamwork of general practitioners and workload were used as working attributes in the studies in high-income countries; the most frequently selected working attribute in studies from low-and middle-income countries was housing (21 times), followed by essential equipment such as facilities and medications (19 times), and learning/training opportunities (16 times). Income (salary) was incorporated into the working attributes across the literature. Furthermore, we formulated a framework of working attributes containing four aspects: social aspects, including the hospital volume, social support/respect, identification (establishment or becoming a permanent employee) ; working aspects, including working location, working conditions, workload, working (management) atmosphere, teamwork, mentoring by supervisors (for primary health workers) ; career development aspects, including years of promotion, training (continuing education) opportunities, academic and research opportunities; life aspects, including income, housing, traffic, and children's education. Mixed Logit Model was the frequently used analytical model (19 times), followed by Conditional Logit Model (9 times), Generalized Multinomial Logit Model (3 times) . Conclusion The heterogeneity of research findings in this field is large, making it difficult to draw uniform conclusions. Moreover, the application of DCE in the field of human resources for health still needs to be promoted globally. Relevant studies are very limited and the evidence obtained needs to be confirmed by further research.

Abstract Introduction Invasive meningococcal disease (IMD) is a severe and life-threatening disease. In the United States (US), vaccine coverage with MenACWY and MenB meningococcal vaccines is suboptimal among adolescents/young adults aged 16–23 years. A combined meningococcal vaccine (MenABCWY) could increase convenience (e.g., fewer injections) and improve coverage. The objective was to quantify preferences for hypothetical meningococcal vaccine profiles among adolescents/young adults and parents. Methods An online discrete choice experiment was conducted among 16- to 23-year-olds, and parents of 16- to 18-year-olds. Attributes (3 × 4) and levels (1 × 2) were based on the literature and focus groups. Participants made ten pair-wise forced trade-off choices, systematically varied using a D-optimal design. Random parameter logit quantified the relative importance of vaccination attributes and estimated the trade-offs. Differences in preferences by subgroups were assessed. Results Totals of 300 adolescents and young adults (median age 20 years) and 300 parents (median age 46 years) completed the survey. Overall, 89.6% of 16- to 23-year-olds and 69.1% of parents preferred a simplified hypothetical meningococcal vaccination profile, e.g., with fewer injections (3 vs. 4) and fewer healthcare provider (HCP) visits (2–3 vs. 4). Having HCP advice and clear Centers for Disease Control and Prevention recommendations impacted vaccination choice, with both groups reporting high trust in HCP information (83.3% among 16- to 23-year-olds; 98.7% among parents). Barriers to vaccination included lack of HCP advice or awareness of meningococcal vaccines, and income level and out-of-pocket costs for parents. Conclusions Adolescents/young adults and parents demonstrated a significant preference for a meningococcal vaccine that is more convenient (such as combined MenABCWY). Parents’ vaccination preferences differed by income level and out-of-pocket costs, suggesting financial barriers to vaccination may exist which could result in IMD prevention inequalities. Findings from this study provide important information to support patient-facing informed policy discussions. A simplified vaccination schedule and strong recommendation could help improve vaccine uptake, schedule compliance, disease prevention, and reduce inequalities in IMD risk and prevention. A graphical abstract is available with this article. Graphical Abstract

Abstract Background Listening to patient voices is critical, in terms of how people experience their condition as well as their treatment preferences. This research explored the patient journey, therapy attributes and goals among treatment experienced adults with chronic lymphocytic leukemia (CLL). We sought to understand patient experiences, needs and expectations to identify areas for improvement of treatment and care delivery. Methods Two online surveys were developed for completion by CLL patients. In Stage 1, participants completed a best-worst scaling (BWS) task to evaluate eleven previously validated healthcare journey moments that matter (MTM). Responses were used to generate the patient experience index (PEI) score. In Stage 2, participants completed a survey that included both a discrete choice experiment (DCE) to assess drivers of treatment preferences by evaluating the relative attribute importance (RAI) of seven features and a BWS exercise which explored long-term treatment goals. Results Twenty-five patients completed Stage 1 and thirty patients Stage 2. Treatment experience was balanced between oral and intravenous medication. The most important/least satisfied MTM were treatment effectiveness, access to support and other treatments as well as monitoring progress. The median PEI score was 66.2 (out of 100). DCE results demonstrated that patients most value treatments for CLL that are associated with prolonged progression free survival (PFS; RAI: 24.6%), followed by treatments that have a lower risk of severe side effects and lower out-of-pocket costs (RAI: 19.5%, 17.4%, respectively). The remainder of the weight in decision making (38.5%) was split between the remaining attributes, namely ‘mild to moderate side effects’ (13.4%), ‘long-term risks’ (12.2%), type of treatment (i.e., oral, IV or a combination of oral and IV; 8.7%) and treatment duration (i.e., ongoing versus fixed; 4.2%). Patients preferred oral to intravenous therapy. The most valued long-term treatment goal was to be physically healthy, followed by living a long life, spending time with family/friends, and avoiding hospitalization. Conclusion Treatment experienced patients with CLL are focused on receiving effective, safe therapies and value long PFS. Consideration and discussion of other attributes, such as once daily dosing, oral only medication, out-of-pocket costs and access to support services may affect patient treatment choices and ultimately enhance their healthcare experience and outcomes.

Background: The advent of biologics and janus kinase inhibitors has revolutionized treatment of atopic dermatitis (AD). Objective: To investigate preferences of patients with AD for attributes of currently approved systemic treatments and assess influencing factors. Methods: An online discrete choice experiment was conducted in patients with AD throughout Germany to analyze preferences for outcome (probability of (almost) clear skin at week 16, probability of significant itch improvement, time to onset of itch relief and type of side effects) and process attributes (application method and frequency of laboratory tests). Results: Participants (n=182, 75.3% female) considered side effects (Relative Importance Score (RIS): 31.2), (almost) clear skin (RIS: 24.2) and probability of itch improvement (RIS: 16.0) most important. Application method (RIS: 14.4), time to onset of itch relief (RIS: 7.4) and frequency of laboratory tests (RIS: 6.8) were less relevant. Preferences were significantly influenced by sex, age, psychiatric comorbidity, current therapy and health-related quality of life according to multivariate regression analysis. Conclusions: Participants attached great importance to safety and symptom control. However, preferences were also dependent on individual characteristics, underscoring the importance of personal counseling. Conjoined with medical considerations, patients’ preferences have fundamental impact on shared decisions for treatment of AD. [ABSTRACT FROM AUTHOR]

Purpose: Evidence on treatment preferences of patients with moderate-to-severe atopic dermatitis (AD) in the United States (US) is limited and an assessment of treatment preferences in this group is warranted. Materials and methods: An online discrete choice experiment survey was conducted (June 2023) among US adults with self-reported moderate-to-severe AD or experience with systemic therapy who had inadequate response to topical treatments. Preference weights estimated from conditional logistic regression models were used to calculate willingness to trade off and attributes’ relative importance (RI). Results: Participants (N=300; mean age: 45years; 70% females; 52% systemic therapy experienced) preferred treatments with higher efficacy, lower risk of adverse events (AEs), and less frequent blood tests (p<.05). Treatment attributes, from high to low RI, were itch control (38%), risk of cancer (23%), risk of respiratory infections (18%), risk of heart problems (11%), sustained improvement in skin appearance (5%), blood test frequency (3%), and frequency and mode of administration (2%); together, AE attributes accounted for more than half of the RI. Conclusions: Participants preferred AD treatments that maximize itch control while minimizing AE risks, whereas mode of administration had little impact on preferences. Understanding patients’ preferences may help improve shared decision-making, potentially leading to enhanced patient satisfaction with treatment, increased engagement, and better clinical outcomes. [ABSTRACT FROM AUTHOR]