Biomedical subjects

Mandy Ryan

Publications and source records attributed to Mandy Ryan.

24 records · Page 2Linked to original sources

PubMed2003

Evidence-based consumer choice: a case study in colorectal cancer screening.

OBJECTIVES: To elicit community preferences for colorectal cancer (CRC) screening by faecal occult blood test (FOBT) using discrete choice modeling (DCM). To provide policymakers with information that would assist them in designing the future national screening program. METHODS: 301 participants in central Sydney, aged 50 to 70 years, at 'average' risk of CRC, participated in a face-to-face discrete choice study interview in which screening profiles were posed to derive estimates for preferences for CRC FOBT screening. RESULTS: Three characteristics were varied in our screening profiles, namely: benefit (CRC deaths prevented); potential harm (false positive induced colonoscopy); and notification policy (of test result). Ninety-four respondents (32%) did not trade off CRC deaths prevented for any reduction in harms. Twelve per cent always chose no screening. The remaining 56% traded benefits and harms. These latter respondents (n = 164) were willing to accept 853 (false positive induced) colonoscopies for one CRC death prevented. CONCLUSIONS: While survival was all that mattered for just over one-third of the sample and 12% would choose no screening, the remaining individuals were prepared to trade CRC deaths prevented against other characteristics. CRC screening will not receive unqualified community support, irrespective of harms. IMPLICATIONS: In any future national CRC screening program, consideration of these insights about community assessment of benefits, harms, costs and other characteristics of CRC screening is warranted.

Aged↗

PubMed2003

Using discrete choice experiments to value health care programmes: current practice and future research reflections.

There has been growing interest in discrete choice experiments (DCEs) in health economics over the last few years. This paper identifies and describes applications conducted during 1990-2000. From this basis some important areas for future research are reflected upon. These include: having a better understanding of how respondents interpret price, risk and time attributes; strengthening designs and analysis; investigating decision making heuristics employed when completing DCEs, and the extent these are related to the complexity of the task; external validity, reliability and generalisability. Collaborative work with statistical design experts, psychologists, sociologists and qualitative researchers will prove useful when investigating these issues. It is also critical to link, more generally, the research agenda to work being carried out in marketing, transport and environmental economics and health economics benefit assessment.

Attitude to Health↗

PubMed2003

Valuing food safety improvements using willingness to pay.

Food safety policies are coming under increasing scrutiny. A challenging issue when devising food policies is to assess the 'intangible' benefits such as a reduction in suffering from food-related illness. Here, contingent valuation is used to elicit individuals' willingness to pay (WTP) for the elimination of the risk of poultry-borne illness through irradiation and a hypothetical treatment. Two hundred members of the general public were interviewed and the results show that people are willing to pay extra for food safety. WTP is found to be sensitive to the elicitation format.

Adolescent↗

PubMed2002

Willingness to pay for complete symptom relief of gastroesophageal reflux disease.

BACKGROUND: Over $6 billion per year is spent on prescription medication for gastroesophageal reflux disease (GERD). This study is an economic analysis of patients' willingness to pay for a prescription medication that offers complete relief of GERD symptoms. METHODS: The study was a cross-sectional, nonrandomized design recruiting patients from 5 clinical sites. A computer-administered discrete-choice questionnaire was used to explore patients' willingness to pay for various attributes (time to relief, amount of relief, side effects, and out-of-pocket cost) associated with GERD treatment. Patients chose between 2 different combinations of attributes by indicating which scenario they preferred. Data were gathered on health status, health-related quality of life, and sociodemographic characteristics. RESULTS: Two hundred five patients completed the discrete-choice questionnaire with a consistency rate of 99.5%. All attributes were relevant to patient decision making. Respondents were willing to pay up to $182 to obtain complete relief in a short period of time without side effects. Patients with less severe GERD symptoms were willing to pay more to avoid side effects ($58.25 vs $38.43). Older patients were less willing to pay for better relief than younger patients. CONCLUSIONS: Results demonstrate that patients are willing to pay more per month for a medication that provides more complete and faster relief from GERD symptoms. This information can guide clinicians and formulary committees in evaluating optimal treatment for GERD.

Adult↗

PubMed2002

Establishing patient preferences for gastroenterology clinic reorganization using conjoint analysis.

OBJECTIVE: The Department of Health states that patients with suspected cancer should be seen within 2 weeks, and the Patients' Charter suggests that patients should not wait for more than 30 min in outpatients. Decisions such as these are often made with little assessment of patient preferences. We have elicited patient preferences for the optimal use of time in the outpatient clinic. DESIGN: Questionnaire survey eliciting preference between different clinic scenarios evaluated using discrete choice conjoint analysis. SETTING AND PARTICIPANTS: Patients attending a teaching hospital gastroenterology outpatient clinic. MAIN OUTCOME MEASURES: The relative importance of time spent on the waiting list, time waiting in the clinic, time spent with the specialist, and time waiting for investigation was assessed using a logit model. RESULTS: Patients placed a similar value on waiting for investigation and time spent on the waiting list. A clinic that had a 2-month waiting list but offered immediate investigations would therefore be more popular than a clinic that had a 2-week waiting list but whose investigations were deferred for 3 months. Patients would be prepared to spend an extra 30 min in the waiting room if they spent 1 month less on the waiting list or waiting for investigation. Time spent with a specialist is valued, and patients would be prepared to spend an extra 3 min waiting in the clinic for every extra minute spent with the doctor. CONCLUSIONS: The present Department of Health recommendations and the Patients' Charter are too simplistic and do not take into account patient preferences.

Adolescent↗

PubMed1998

Using conjoint analysis to elicit the views of health service users: an application to the patient health card.

OBJECTIVE: To demonstrate the application of conjoint analysis (CA) for eliciting the views of health service users. METHODS: A CA study was conducted alongside a randomized controlled trial evaluating the introduction of a patient health card (PHC). The PHC was evaluated with respect to three other aspects of general practice: number of days between making a non-urgent appointment and seeing a doctor; waiting time in reception between the time of the appointment and seeing a doctor; and whether the patient is usually seen by the doctor of their choice. A postal questionnaire was sent to 100 individuals from a general practice in Inverurie, Scotland. RESULTS: Seventy-five individuals returned the questionnaire, of whom 51 answered the CA section. The PHC was the least important of the attributes considered. The number of days between making a non-urgent appointment and seeing a doctor was considered to be the most important. A 1-day reduction in the number of days to appointment was four and a half times more important than having a PHC; a 1-minute reduction in waiting time in the reception area was three and a half times more important than having a PHC; and seeing a doctor of choice was over three times more important than having a PHC. Satisfaction or utility scores for different ways of providing a general practice service also indicated that priority should be given to reducing waiting time to see a doctor or reducing waiting time in reception. CONCLUSIONS: While the PHC is a significant and positive predictor of satisfaction in general practice, it is less important than the other three attributes considered. More generally, CA appears to be a potentially useful instrument for eliciting the views of health service users.

Journal Article↗