RESUMO

BACKGROUND: In many countries, methods of economic evaluation and Health Technology Assessment are used to inform healthcare resource allocation decisions. These approaches often require EQ-5D health outcomes measures. This study aimed to create an EQ-5D-3L value set for Bermuda from which EQ-5D-5L Crosswalk values could be obtained. METHODS: Respondents in Bermuda were recruited locally. A team of Trinidad-based interviewers with prior EQ-5D-3L valuation experience conducted valuation interviews on-line using the EQ-VT protocol. Respondents completed composite time-trade off (cTTO) and discrete choice experiment (DCE) tasks. A hybrid model that included both the cTTO and DCE data was estimated. An EQ-5D-5L crosswalk value set was then created from the EQ-5D-3L index values. Coefficients in the resulting crosswalk model were compared with those of crosswalk and valuation studies from other countries. RESULTS: The valuation tasks were completed by a near-representative sample of 366 adult Bermuda citizens. Half of the respondents reported being in state 11111. The lowest EQ VAS and EQ-5D-3L index values were 20 and - 0.120 respectively. The hybrid model produced all logically consistent and statistically significant coefficients that in turn produced index values that were very similar to those obtained in a preliminary model (MAD of 0.027). DISCUSSION: The on-line EQ-VT valuation study was successfully conducted in Bermuda and the values therein can now be used for economic analysis in Bermuda. The Bermuda values differed considerably from those of the other countries against which they were compared. Challenges were encountered with recruitment for an on-line survey in a small population.

RESUMO

Microplastics, an emerging pollutant, have garnered widespread attention due to potential repercussions on human health and the environment. Given the critical role of seafood in food security, growing concerns about microplastics might be detrimental to meeting future global food demand. This study employed a discrete choice experiment to investigate Chilean consumers' preferences for technology aimed at mitigating microplastic levels in mussels. Using a between-subjects design with information treatments, we examined the impact of informing consumers about potential human health and environmental effects linked to microplastics pollution on their valuation for the technology. We found that the information treatments increased consumers' willingness to pay for mussels. Specifically, consumers were willing to pay a premium of around US$ 4 for 250 g of mussel meat with a 90 % depuration efficiency certification. The provision of health impact information increased the price premium by 56 %, while the provision of environmental information increased it by 21 %. Furthermore, combined health and environmental information significantly increased the probability of non-purchasing behavior by 22.8 % and the risk perception of microplastics for human health by 5.8 %. These results emphasized the critical role of information in shaping consumer preferences and provided evidence for validating investment in research and development related to microplastic pollution mitigation measures.

Assuntos

Comportamento do Consumidor , Microplásticos , Alimentos Marinhos , Humanos , Microplásticos/análise , Alimentos Marinhos/análise , Feminino , Adulto , Masculino , Contaminação de Alimentos , Animais , Poluentes Químicos da Água/análise , Chile , Pessoa de Meia-Idade , Adulto Jovem , Bivalves , Comportamento de Escolha

RESUMO

While seawater desalination technologies can improve drinking water supply, they can also generate significant environmental externalities. A choice experiment was implemented to investigate household preferences for potential trade-offs between improved water services and environmental impacts from seawater desalination in the Galápagos Islands. Our results indicate that households are willing to pay for water quality improvements, and for protection of coastal ecosystems and marine organisms. In contrast, households seem indifferent regarding water availability and potential impacts on air quality. Our findings also suggest that respondents who consistently reject the proposed desalination project tend to be less affluent and have stronger environmental preferences than those who support it. It is concluded that stated-preference studies on improved water services should also elicit preferences for potential environmental effects of the proposed water technology.

Assuntos

Ecossistema , Purificação da Água , Equador , Características da Família , Água do Mar , Abastecimento de Água

RESUMO

Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV but requires sustained adherence. Conditional economic incentives (CEIs) can improve medication-taking behaviors, yet preferences for programs that employ CEIs to increase PrEP use among male sex workers (MSWs) have not been investigated. We conducted a discrete choice experiment in Mexico City to elicit stated preferences for a CEI-based PrEP adherence program among MSWs. Respondents expressed their preferences for different program characteristics: incentive amount; incentive format; incentive type; and adherence-verification method. We used a random utility logit model to estimate the relative importance of each attribute and estimated willingness-to-pay. MSWs preferred a higher, fixed incentive, with PrEP adherence measured via hair sampling. MSWs were willing to forego up to 21% of their potential maximum CEI amount to ensure receipt of a fixed payment. MSWs are highly willing to accept a CEI-based intervention for PrEP adherence, if offered along with fixed payments.

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RESUMEN: La profilaxis previa a la exposición (PrEP) es muy eficaz para prevenir el VIH, pero requiere una adherencia sostenida. Los incentivos económicos condicionales (IEC) pueden mejorar los comportamientos de toma de medicamentos, sin embargo, no se han investigado las preferencias por los programas que emplean IEC para aumentar el uso de PrEP entre los trabajadores sexuales masculinos (TSM). Realizamos un experimento de elección discreta con TSM en la Ciudad de México para obtener preferencias declaradas para un programa de adherencia a la PrEP basado en IEC. Los participantes expresaron sus preferencias en cuanto a diferentes características: monto del incentivo; formato del incentivo; tipo de incentivo; y método de verificación de la adherencia. Utilizamos un modelo logit de utilidad aleatoria para estimar la importancia relativa de cada atributo y la disposición a pagar estimada (DAP). Los TSM prefirieron un incentivo fijo más alto, con la adherencia a la PrEP medida a través de muestras de cabello. Los TSM estaban dispuestos a renunciar hasta el 21% de su monto máximo potencial de IEC para garantizar la recepción de un pago fijo. Los TSM están muy dispuestos a aceptar una intervención basada en IEC para la adherencia a la PrEP, si se ofrece junto con pagos fijos.

Assuntos

Infecções por HIV , Profilaxia Pré-Exposição , Profissionais do Sexo , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , México , Motivação

RESUMO

OBJECTIVES: (1) To produce Peruvian general population EQ-5D-5L value sets on a quality-adjusted life-year scale, (2) to investigate the feasibility of a "Lite" protocol less reliant on the composite time trade-off (cTTO), and (3) to compare cTTO and discrete choice experiment (DCE) value sets. METHODS: A random sample of adults (N = 1000) in Lima, Arequipa, and Iquitos did a home interview; 300 were randomly selected to complete 11 cTTOs first. All respondents completed a DCE, including 10 latent-scale pairs (A/B) with 5 EQ-5D-5L attributes, and 12 matched pairs (A/B and B/C) with 5 EQ-5D-5L and one lifespan attributes. We estimated a cTTO heteroscedastic tobit (N = 300) model and 3 DCE Zermelo-Bradley-Terry models (N = 300, 700, and 1000). RESULTS: Each model produced a consistent value set (20 positive incremental parameters). Nevertheless, their lowest quality-adjusted life-year values differed greatly (cTTO: -1.076 [N = 300]; DCE: -0.984 [300], 0.048 [700], -0.213 [1000]). Compared with the cTTO, the DCE (N = 300) produced different parameters (Pearson's correlation = 0.541), fewer insignificant parameters (0 vs 8), and fewer values less than 0 (26% vs 44%). Compared with the DCE (N = 300), the DCE (N = 700) produced higher values but similar parameters (Pearson's correlation = 0.800). CONCLUSIONS: Besides producing EQ-5D-5L value sets for Peru, the results casts doubt about the feasibility of a Lite protocol like the one in this study. Additionally, fundamental differences between cTTO and DCE-without the existence of a gold standard-need further clarification. The choice between the two rational value sets produced in the current study is a matter of judgment and may have substantial policy implications.

Assuntos

Comportamento de Escolha , Modelos Teóricos , Anos de Vida Ajustados por Qualidade de Vida , Inquéritos e Questionários , Adulto , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Qualidade de Vida , Fatores de Tempo

RESUMO

PURPOSE: Teriparatide is used to treat patients with established osteoporosis but is often reserved for patients who have inadequate response to antiresorptive therapy. Biosimilar teriparatide, which is believed to have efficacy and safety similar to the originator product, is now available in Colombia. However, little is known about patients' preferences for originator biologic and biosimilar treatments. Our objective was to quantify the relative importance that patients in Colombia place on features of injectable osteoporosis treatments including whether the treatment is an originator biologic or a biosimilar. PATIENTS AND METHODS: We used a discrete choice experiment (DCE) to elicit preferences of patients with osteoporosis treatment devices in Colombia. The survey was completed by 200 respondents at high risk of fracture, with or without teriparatide experience. Each treatment alternative within the DCE was characterized by five attributes: type of medicine (originator biologic, biosimilar), needle length, angle of injection, how to measure the medicine dose, and how long the medicine can be left unrefrigerated. A random parameters logit regression was used to estimate preferences and conditional relative attribute importance, while controlling for preference heterogeneity. RESULTS: A total of 200 patients (mean age = 58.3 years) completed the survey. Most were female (84.5%) and married (54.5%); 50.5% had secondary education or less, 21% had current teriparatide exposure. The attribute with the highest conditional relative importance estimate (standard error) was biologic versus biosimilar (10 [1.11]), followed by needle length (8.06 [1.11]), dose measurement (6.38 [0.87]), refrigeration (3.81 [1.18]), and angle of injection (1.30 [0.66]). Unobserved preference heterogeneity was present and controlled for in the analyses. CONCLUSION: Despite the availability of biosimilar teriparatide in Colombia, patients expressed a strong preference for an originator biologic osteoporosis medicine over a biosimilar osteoporosis medicine, when the efficacy, safety, and cost of the two options were assumed to be the same.

RESUMO

Aim: To elicit patients' preferences for HIV treatment of the rural population in Colombia.Methods: A discrete choice experiment (DCE), conducted in a HIV clinic in Bogotá, was used to examine the trade-off between five HIV treatment attributes: effect on life expectancy, effect on physical activity, risk of moderate side-effects, accessibility to clinic, and economic costs to access controls. Attributes selection was based on literature review, expert consultation and a focus group with six patients. An efficient experimental design was used to define two versions of the questionnaire with each of 12 choice sets and a dominance task was added to check reliability. A mixed logit model was then used to analyse the data and sub-group analyses were conducted on the basis of age, gender, education, and sexual preference.Results: A total of 129 HIV patients were included for analysis. For all treatment attributes, significant differences between at least two levels were observed, meaning that all attributes were significant predictors of choice. Patients valued the effect on physical activity (conditional relative importance of 27.5%) and the effect on life expectancy (26.0%) the most. Sub-group analyses regard age and education showed significant differences: younger patients and high educated patients valued the effect on physical activity the most important, whereas older patients mostly valued the effect on life expectancy and low educated patients mostly valued the accessibility to clinic.Limitations: One potential limitation is selection bias, as only patients from one HIV clinic were reached. Additionally, questionnaires were partly administered in the waiting rooms, which potentially led to noise in the data.Conclusions: This study suggests that all HIV treatment characteristics included in this DCE were important and that HIV patients from rural Colombia valued short-term efficacy (i.e. effect on physical activity) and long-term efficacy (i.e. effect on life expectancy) the most.

Assuntos

Fármacos Anti-HIV/uso terapêutico , Tomada de Decisões , Infecções por HIV/tratamento farmacológico , Preferência do Paciente , População Rural , Adulto , Fatores Etários , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/economia , Comportamento de Escolha , Colômbia , Custos e Análise de Custo , Escolaridade , Exercício Físico , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes

RESUMO

Aim: This study aimed to assess patients' preferences for HIV treatment in an urban Colombian population.Methods: A Discrete Choice Experiment (DCE) was conducted. Urban Colombian HIV patients were asked to repetitively choose between two hypothetical treatments that differ in regard to five attributes 'effect on life expectancy', 'effect on physical activity', 'risk of moderate side effects, 'accessibility to clinic' and 'economic cost to access controls'. Twelve choice sets were made using an efficient design. A Mixed Logit Panel Model was used for the analysis and subgroup analyses were performed according to age, gender, education level and sexual preference.Results: A total of 224 HIV patients were included. All attributes were significant, indicating that there were differences between at least two levels of each attribute. Patients preferred to be able to perform all physical activity without difficulty, to have large positive effects on life expectancy, to travel less than 2 h, to have lower risk of side-effects and to have subsidized travel costs. The attributes 'effect on physical activity' and 'effects on life expectancy' were deemed the most important. Sub-analyses showed that higher educated patients placed more importance on the large positive effects of HIV treatment, and a more negative preference for subsidized travel cost (5% level).Limitations: A potential limitation is selection bias as it is difficult to make a systematic urban/rural division of respondents. Additional, questionnaires were partly administered in the waiting rooms, which potentially led to some noise in the data.Conclusions: Findings suggests that short-term efficacy (i.e. effect on physical activity) and long-term efficacy (i.e. effect on life expectancy) are the most important treatment characteristics for HIV urban patients in Colombia. Preference data could provide relevant information for clinical and policy decision-making to optimize HIV care.

Assuntos

Fármacos Anti-HIV/uso terapêutico , Tomada de Decisões , Infecções por HIV/tratamento farmacológico , Preferência do Paciente , População Urbana , Adolescente , Adulto , Fatores Etários , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/economia , Comportamento de Escolha , Colômbia , Custos e Análise de Custo , Escolaridade , Exercício Físico , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto Jovem

RESUMO

INTRODUCTION: There is a renewed global interest in improving community health worker (CHW) programmes. For CHW programmes to be effective, key intervention design factors which contribute to the performance of CHWs need to be identified. The recent WHO guidelines recommends the combination of financial and non-financial incentives to improve CHW performance. However, evidence gaps remain as to what package of incentives will improve their performance in different country contexts. This study aims to evaluate CHW incentive preferences to improve performance and retention which will strengthen CHW programmes and help governments leverage limited resources appropriately. METHODS AND ANALYSIS: A discrete choice experiment (DCE) will be conducted with CHWs in Bangladesh, Haiti, Kenya and Uganda with different levels of maturity of CHWs programmes. This will be carried out in two phases. Phase 1 will involve preliminary qualitative research including focus group discussions (FGDs) and key informant interviews to develop the DCE design which will include attributes relevant to the CHW country settings. Phase 2 will involve a DCE survey with CHWs, presenting them with a series of job choices with varying attribute levels. An orthogonal design will be used to generate the choice sets for the surveys. The surveys will be administered in locally-appropriate languages to at least 150 CHWs from each of the cadres in each country. Conditional and mixed multinomial logit (MMNL) models will be used for the estimation of stated preferences. ETHICS AND DISSEMINATION: This study has been reviewed and approved by the Population Council's Institutional Review Board in New York, and appropriate ethics review boards in Kenya, Uganda, Bangladesh and Haiti. The results of the study will be disseminated through in-country dissemination workshops, meetings with country-level stakeholders and policy working groups, print media, online blogs and peer-reviewed journals.

Assuntos

Agentes Comunitários de Saúde , Planos para Motivação de Pessoal/organização & administração , Formulação de Políticas , Saúde Pública , Participação dos Interessados , Bangladesh , Agentes Comunitários de Saúde/economia , Agentes Comunitários de Saúde/psicologia , Agentes Comunitários de Saúde/provisão & distribuição , Grupos Focais , Haiti , Humanos , Quênia , Motivação , Saúde Pública/economia , Saúde Pública/métodos , Saúde Pública/normas , Pesquisa Qualitativa , Melhoria de Qualidade/organização & administração , Uganda , Voluntários/psicologia

RESUMO

BACKGROUND: To assess patients' preferences for HIV testing in Colombia. METHODS: A discrete choice experiment was used to assess preferences of patients diagnosed with HIV, for HIV testing in two HIV clinics in Bogotá, Colombia. Patients were asked to choose repeatedly between two hypothetical HIV testing options that varied with respect to five attributes: distance to testing site, confidentiality, testing days, sample collection method, and the services if HIV positive. A random parameter model was used to analyze the data. RESULTS: A total of 249 questionnaires were eligible for data analysis. Respondents showed a preference for testing on weekdays, nobody being aware, a sample taken from the arm, and receiving medications through a referral. The respondents showed a high negative preference for many people being aware, followed by testing during the weekend and home testing. Subgroup analyses by gender and prior testing history did not reveal significant differences. CONCLUSION: This study suggests that patients' preferences for HIV testing focused especially on confidentiality, availability during weekdays, and using a sample from the arm. This information could be useful to improve uptake of HIV testing in Bogotá, Colombia.

Assuntos

Comportamento de Escolha , Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Preferência do Paciente , Adulto , Colômbia , Confidencialidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem

RESUMO

Previous studies that addressed factors influencing junior doctors' career decisions have failed to consider that the market for medical specialty is regulated and doctors are not always able to pursue their career of choice. There is the concern that the National Medical Exam that doctors have to take in many countries conditions their career choices and is behind the low efficacy of policies for retaining doctors in rural areas. In this paper, we use data from a Discrete Choice Experiment applied to a large sample of Portuguese junior doctors (N = 503) who had already taken their Medical Exam but had not chosen their medical specialty yet. We show that the exam score is de facto a strong predictor for (different) job preferences, but only for doctors who are amongst the highest and the lowest exam scores. For all others-almost half of our sample-geographical attachment (having lived or studied in rural areas or in metropolis) is more relevant in determining specialization decisions. Having a good work-life balance, specially amongst female physicians, is also an important determinant of specialty choice. Using latent-class analysis may help policymakers profiling different groups of doctors and tailoring incentive packages according to their characteristics.

Assuntos

Escolha da Profissão , Avaliação Educacional , Médicos , Especialização , Adulto , Atenção à Saúde , Feminino , Humanos , Masculino , Modelos Econométricos , Portugal , População Rural , Inquéritos e Questionários

RESUMO

Many urban settlements in developing countries still lack access to sanitation services, which puts the environment and population health at risk. The lack of knowledge on household preferences for improved sanitation has been an impediment to extending conventional and onsite sanitation infrastructure. This study implemented a choice experiment to elicit households' willingness to pay for the disposal of different types of waste (i.e. wastewater, excreta, and rainwater) in an urban settlement in Nicaragua. Generalized multinomial logit models were estimated to account for heterogeneity among respondents in both choice behavior and preferences for specific attributes. Findings indicate that households are willing to pay a considerable amount of money for improved disposal of wastewater, excreta, and rainwater. However, households have stronger preferences for wastewater and excreta removal than for disposal of rainwater.

Assuntos

Países em Desenvolvimento , Saneamento , Comportamento de Escolha , Características da Família , Humanos , Nicarágua

RESUMO

As in many developing countries, the eutrophication of lakes has become one of the most severe environmental problems in Brazil. We implemented a choice experiment to investigate local preferences for the restoration of five lakes in the city of Campos dos Goytacazes, Brazil. This study focuses on two attributes of the proposed environmental project: 1) the delay in reaching the targeted level of water quality and 2) the institution that would manage the lakes restoration project. Choice responses are analyzed using a mixed logit model to control for potential heterogeneity among respondents. Results show that the willingness to pay for lakes restoration decays with restoration time in a non-linear fashion. Findings also indicate that respondents would prefer an interinstitutional, non-governmental committee over the municipal government to manage the lakes restoration project.

RESUMO

Economic benefits are derived from sea turtle tourism all over the world. Sea turtles also add value to underwater recreation and convey non-use values. This study examines the non-market value of sea turtles in Tobago. We use a choice experiment to estimate the value of sea turtle encounters to recreational SCUBA divers and the contingent valuation method to estimate the value of sea turtles to international tourists. Results indicate that turtle encounters were the most important dive attribute among those examined. Divers are willing to pay over US$62 per two tank dive for the first turtle encounter. The mean WTP for turtle conservation among international visitors to Tobago was US$31.13 which reflects a significant non-use value associated with actions targeted at keeping sea turtles from going extinct. These results illustrate significant non-use and non-consumptive use value of sea turtles, and highlight the importance of sea turtle conservation efforts in Tobago and throughout the Caribbean region.

Assuntos

Conservação dos Recursos Naturais , Tartarugas , Animais , Comportamento de Escolha , Mergulho , Trinidad e Tobago

RESUMO

There are nowadays over 1 million Portuguese who lack a primary care physician. By applying a discrete choice experiment to a large representative sample of Portuguese junior doctors (N = 503) in 2014, we provide an indication that this shortage may be addressed with a careful policy design that mixes pecuniary and non-pecuniary incentives for these junior physicians. According to our simulations, a policy that includes such incentives may increase uptake of general practitioners (GPs) in rural areas from 18% to 30%. Marginal wages estimated from our model are realistic and close to market prices: an extra hour of work would require an hourly wage of 16.5€; moving to an inland rural setting would involve an increase in monthly income of 1.150€ (almost doubling residents' current income); a shift to a GP career would imply an 849€ increase in monthly income. Additional opportunities to work outside the National Health Service overcome an income reduction of 433€. Our simulation predicts that an income increase of 350€ would lead to a 3 percentage point increase in choice probability, which implies an income elasticity of 3.37, a higher estimation compared to previous studies.

Assuntos

Escolha da Profissão , Medicina , Salários e Benefícios , Comportamento de Escolha , Humanos , Fatores Socioeconômicos

RESUMO

BACKGROUND: Resource allocation decision making in the Caribbean can be greatly enhanced by the introduction of cost per quality-adjusted life-year (QALY) analysis on the basis of local preferences. In the valuation literature there have been recommendations for the elicitation methods of the EuroQol five-dimensional questionnaire (EQ-5D) that combine discrete-choice experiment (DCE) for bulk valuation with a time trade-off component for rescaling. OBJECTIVES: To create a three-level EQ-5D value set for Trinidad and Tobago using an elicitation method that takes into account the local constraints, and that can be easily deployed in other Caribbean islands. METHODS: A D-efficient DCE was completed by a representative sample of 307 adults. A time trade-off procedure was used to obtain values for rescaling the DCE model on a scale anchored at 0 (dead) and 1 (full health). RESULTS: A mixed logit analysis of the DCE data produced an internally valid model that is similar to the results obtained in earlier pilot studies. CONCLUSIONS: This EQ-5D value set allows cost per QALY analyses to be carried out on the basis of preferences from Trinidad and Tobago, and the approach to the DCE design can be taken for similar value sets to be created in the small, resource-constrained health systems of the Caribbean. Some guidelines for the initial application and introduction of cost per QALY analysis into the Trinidad and Tobago health system are also presented.

Assuntos

Nível de Saúde , Qualidade de Vida , Alocação de Recursos , Região do Caribe , Humanos , Inquéritos e Questionários , Trinidad e Tobago

RESUMO

Many low-income individuals from around the world rely on local food vendors for daily sustenance. These small vendors quickly provide convenient, low-priced, tasty foods, however, they may be low in nutritional value. These vendors serve as an opportunity to use established delivery channels to explore the introduction of healthier products, e.g. fresh salad and fruits, to low-income populations. We sought to understand preferences for items prepared in Comedores Populares (CP), government-supported food vendors serving low-income Peruvians, to determine whether it would be feasible to introduce healthier items, specifically fruits and vegetables. We used a best-worst discrete choice experiment (DCE) that allowed participants to select their favorite and least favorite option from a series of three hypothetical menus. The characteristics were derived from a series of formative qualitative interviews conducted previously in the CPs. We examined preferences for six characteristics: price, salad, soup, sides, meat and fruit. A total of 432 individuals, from two districts in Lima, Peru responded to a discrete choice experiment and demographic survey in 2012. For the DCE, price contributed the most to individual's utility relative to the other attributes, with salad and soup following closely. Sides (e.g. rice and beans) were the least important. The willingness to pay for a meal with a large main course and salad was 2.6 Nuevos Soles, roughly a 1 Nuevo Sol increase from the average menu price, or USD $0.32 dollars. The willingness to pay for a meal with fruit was 1.6 Nuevo Soles. Overall, the perceived quality of service and food served in the CPs is high. The willingness to pay indicates that healthier additions to meals are feasible. Understanding consumer preferences can help policy makers design healthier meals in an organization with the potential to scale up to reach a considerable number of low-income families.

Assuntos

Comportamento de Escolha , Comportamento do Consumidor/economia , Preferências Alimentares/psicologia , Alimentos/economia , Pobreza , Adulto , Feminino , Humanos , Masculino , Peru , Inquéritos e Questionários , População Urbana

RESUMO

OBJECTIVE: No country can afford to provide all necessary healthcare for its citizens, so prioritization among interventions must feature in all health systems. Resources in health should be allocated among interventions/facilities/patients in such a way as to be in line with the objectives of the health system. To achieve this, resource allocation decisions must be informed by the relative contributions that prospective interventions will make to societal health and to costs. Internationally, the EQ-5D based quality adjusted life year (QALY) now dominates this kind of analysis. This paper reports on a pilot study to develop an EQ-5D-3L value set for Trinidad and Tobago based on a protocol that avoids some of the issues that are associated with other approaches to developing such value sets such as the complex elicitation tasks that respondents must carry out, and the large respondent samples required for collecting multiple valuation subset values using blocked designs. METHODS: An orthogonal discrete choice experiment design was used to elicit a set of choices from a sample of respondents. RESULTS: The choice data were analysed using mixed multinomial logistic regression to produce an internally valid model that predicts well. CONCLUSION: This paper marks an important milestone in the development of health resource allocation in the Caribbean. It sets out the importance of incorporating the impact of health interventions to inform health resource allocation decisions, describes the elicitation and analysis methods used in the pilot and provides an illustration ofthe use ofthe EQ-5D value set.

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OBJETIVO: Ningún país puede permitirse ofrecer toda la atención a la salud necesaria para sus ciudadanos, de modo que la necesidad de establecer prioridades en las intervenciones constituye un rasgo característico de todos los sistemas de salud. Los recursos de salud deben asignarse entre las intervenciones/instalaciones/pacientes de tal manera que se correspondan con los objetivos del sistema de salud. Para lograr esto, las decisiones en cuanto a la asignación de recursos deben reportarse en términos de las contribuciones relativas que las intervenciones prospectivas representarán para la salud social y los costos. Internacionalmente, el EQ - 5D basado en el año de vida ajustado por calidad (AVAC), domina ahora este tipo de análisis. El presente trabajo reporta un estudio piloto para desarrollar un conjunto de valores EQ - 5D - 3L para Trinidad y Tobago, basado en un protocolo que evite algunos de los problemas asociados con otros enfoques usados para desarrollar estos conjuntos de valores, tales como tareas complejas de obtención de datos, que los encuestados tienen que llevar a cabo, y las grandes muestras de respuestas requeridas para recoger varios subconjuntos de valoración múltiple utilizando diseños bloqueados. MÉTODOS: Un diseño de experimento de elección discreta ortogonal se utiliza para obtener un conjunto de opciones de una muestra de encuestados. RESULTADOS: Los datos de la elección se analizaron mediante regresión logística multinomial mixta para producir un modelo internamente válido que predice bien. CONCLUSION: Este documento marca un hito importante en el desarrollo de la asignación de recursos de salud en el Caribe. El mismo establece la importancia de incorporar el impacto de las intervenciones de salud para informar las decisiones de asignación de recursos de salud, describe los métodos de obtención y análisis utilizados en el programa piloto, y proporciona una ilustración del uso del conjunto de valores EQ - 5D.

Assuntos

Humanos , Alocação de Recursos para a Atenção à Saúde , Anos de Vida Ajustados por Qualidade de Vida , Alocação de Recursos , Trinidad e Tobago , Projetos Piloto , Modelos Estatísticos

RESUMO

OBJECTIVE: To evaluate patients' preferences for various attributes of insulin treatment, including route of insulin delivery. METHODS: We used a discrete choice experiment (DCE) to quantify patients' preferences. The attributes (and levels) included in the DCE questionnaire were: glucose control, frequency of hypoglycemic events, weight gain, route of administration for the long-acting and the short-acting insulin, and out-of-pocket cost. Data were analyzed using conditional logit regression and segmented models were also developed to evaluate differences in preferences between subgroups. RESULTS: Two hundred and seventy-four questionnaires were completed. The mean age (SD) of participants was 56.7 (12.9) years. Forty-nine percent of participants were insulin users, and 17% had type 1 diabetes. Overall, patients' ideal insulin treatment would provide better glucose control, result in fewer adverse reactions, have the lowest cost, and be administered orally. Overall, there was a strong positive preference for better glucose control relative to the other attributes. Segmented analyses by insulin use and type of diabetes suggest that there may be an important psychosocial barrier to initiating insulin therapy but that patients tend to adjust to subcutaneous administration once they initiate therapy. CONCLUSIONS: This study illustrates the importance that patients with diabetes place on glucose control and how preferences for insulin therapy differ between subgroups. Specifically, efforts need to be made to overcome the psychosocial barriers to initiating insulin therapy which may lead to improved control through improved treatment acceptance and ultimately improve patients' quality of life and reduce the economic burden of the disease.