CHE seminar - Assessing the Value of Equity Concerns: Results of a discrete choice experiment in Alberta, Canada and use in cost-effectiveness analysis

Event details

Abstract:

Objectives

To understand trade-offs between health and equity and provide a framework to incorporate equity in funding decisions.

Methods

We developed a discrete choice experiment using attributes and levels of importance to the local decision maker. Attributes were based on health provided, life-expectancy and quality-of-life, whether the treatment had the potential for conflict with patients’ beliefs, population characteristics, the average time with disease, whether the population had experienced unfair treatment by society, and whether it was a rare disease. 

We contacted 1,445 respondents between May and July 2021 using probability sampling of adults in Alberta, Canada. The main survey consisted of 10 questions. The specific levels shown to each respondent were determined by a balanced overlap fractional factorial experimental design. Validity was tested, and a multinomial logit model was used.

Results

Of those contacted, 891 (62%) opened the survey, and of those 574 (64%) completed it. Straight lining and attribute dominance did not appear to be a concern. 539 (94%) of respondents chose the dominant warm-up scenario. Baseline life-expectancy or quality-of-life, time with disease and whether the disease was rare did not have a statistically significant effect on utility. Gain in life-expectancy increased utility by 0.21 per year gained, utility increased by 0.05 for each 0.01 improvement in quality-of-life, treatments for patients that had been treated unfairly by society increased utility by 0.09 and treatments that respected all patients’ beliefs increased utility by 0.17. These preferences were used to develop a calculator to combine the health, cost and equity impacts of interventions and compare them to an opportunity cost threshold.

Conclusions

This research demonstrates the willingness of respondents to trade off health maximization for treatments that respect all patients’ beliefs and populations that have been treated unfairly by society, and allows decision makers to incorporate equity impacts into their decision making.

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