In the field of Health Technology Assessment (HTA), understanding the preferences of patients, healthcare professionals, and other stakeholders is crucial for making informed decisions. One valuable tool for capturing these preferences is the Discrete Choice Experiment (DCE). This article aims to explore what a DCE is, its value in HTA, the main steps involved in implementing a DCE, and best practices when building a DCE. By following these steps, researchers can effectively elicit and analyze preferences, leading to better-informed decision-making processes.

What is a DCE?

A Discrete Choice Experiment (DCE) is a quantitative research method used to assess and measure preferences. It presents participants with a set of hypothetical choices between different health interventions or treatment options, each with different attributes, and asks them to state their preferred option. By analyzing these choices, researchers can determine which attributes are most important to patients and stakeholders and how they weigh the trade-offs between different attributes.

What is the value of DCE?

Patient Preference Studies (PPS) like DCE can be implemented in each step of the medical development process life cycle in various ways. For example, DCE provides valuable insights into patient needs during the discovery phase and can also help with trial design during the clinical development phase. Preferences can also be used to evaluate the value of healthcare interventions and during the HTA phase, stakeholders can use these insights to allocate resources more efficiently and effectively to develop treatments with preferred attributes.

Main steps to implementing a DCE:

Step 1. Define the research question: Clearly articulate the research objectives and the specific preferences to be measured. Identify the target population and relevant attributes that influence decision-making.

Step 2. Design the choice sets-choose the attributes and identify levels: Develop choice sets that represent the alternatives. Define the attributes and their levels based on a thorough literature review, expert input, and stakeholder engagement. Ensure that the combinations of attribute levels are realistic and representative of the decision context. Consider the appropriate number of choices to balance the respondent burden and statistical efficiency.

Step 3. Pilot testing: Before conducting the main study, it is essential to pilot test the DCE design. This helps identify any issues with the questionnaire, refine the attribute descriptions, and ensure that the choice sets are understandable and realistic to respondents.

Step 4. Sampling and data collection: Determine the appropriate sample size and sampling strategy based on the research question and target population. Consider the mode of data collection, such as online surveys, face-to-face interviews, or telephone interviews, based on the target population and available resources. Use the appropriate data collection method to minimize biases and maximize response rates.

Step 5. Data analysis and interpretation: Employ appropriate statistical techniques to analyze the data and estimate preference models. There are three main types of models to choose from. The first is a model to estimate preference weights conditional importance of attributes. The second model identifies groups with similar treatment preferences. The last one is an estimation of willingness to pay. After running the various models, interpret the results in the context of the research question. Provide clear and concise summaries of the findings, including the relative importance of attributes.

Best practices when building a preference study using DCE

  • It is important to involve stakeholders, such as patients, caregivers, and healthcare professionals, in the design process to ensure that the research question and the attributes of interest are relevant and meaningful. This can be achieved through focus groups, interviews, or surveys.
  • The experimental design should be simple, the number of attributes and levels should be kept to a minimum to avoid overwhelming the participants. Generally, the number of attributes to evaluate is between 5 and 8. The main categories of treatment attributes are: Benefits, Risk, and Treatment Modalities.
  • The questions should be written in a way that reduces biases.  For example, there should be neutrality in phrasing the questions and each attribute should show up an equal number of times in the DCE.
  • Clear instructions and guidance should be provided to the participants to ensure that they understand the purpose of the study and how to complete the DCE. It is important to explain the concept of trade-offs and the hypothetical nature of the choices.

Discrete Choice Experiments (DCEs) are valuable tools in the field of Health Technology Assessment (HTA) for eliciting and measuring preferences. By following the main steps outlined above and adhering to best practices, researchers can effectively design and implement preference studies using DCEs. The insights gained from DCEs contribute to evidence-based decision making, helping policymakers allocate resources and make informed choices that align with the preferences of patients, healthcare professionals, and other stakeholders.

EvidentIQ can provide support when conducting DCE studies. From the experimental design stage to implementation and reporting, EvidentIQ can customize a solution that can help you effectively execute your patient preference study. They offer best-in-class Real World Evidence (RWE) methodologies, such as DCE, for patient studies in multiple diseases and geographical areas thanks to their direct access to a global patient platform. Patient studies can focus on treatment preference, quality of life, value of health, disease/treatment burden, unmet needs, etc. EvidentIQ can help generate unique Real World Data (RWD) to significantly help life sciences customers support the value story of their product for HTA submission, pricing and reimbursement as well as their scientific communication within the clinical community.

Sources: 

https://www.youtube.com/watch?v=IPIkIXWOJ5g
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8546533/#:~:text=A%20discrete%20choice%20experiment%20

https://yhec.co.uk/glossary/discrete-choice-experiment-dce/

https://bmjopen.bmj.com/content/11/3/e045803

https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-021-01647-z