What outcomes are important to patients with long term conditions? A discrete choice experiment.
OBJECTIVE
To assess how much patients with long-term conditions value self-efficacy (i.e., confidence in their ability to manage their condition) compared with other health outcomes, including measures of quality of life, and process outcomes including access to General Practitioners.


METHODS
Discrete Choice Experiment (DCE) set in UK community settings.


METHODS
367 patients (mean age 57.5) living in the community with a wide range of self-defined long-term conditions.


METHODS
The relative value that individuals place on four specific outcomes, namely, self-efficacy, Health Related Quality of Life (HRQoL), access to General Practitioners, and level of isolation.


RESULTS
Most responders completed their questionnaire in a consistent manner. Most valuations of outcomes were in the expected direction and were statistically significant. A substantial minority of responders exhibited counter-intuitive preferences. The existence of a significant constant in all models raised concerns about model misspecification. Nevertheless, all models showed that participants were willing to trade substantial reductions in their HRQoL for improvements in their self-efficacy.


CONCLUSIONS
The majority of patients with chronic conditions were able to complete the DCE questionnaires. However, the existence of counter-intuitive preferences and evidence of model misspecification require further investigation. These issues are largely overlooked in the health economics literature. Self-efficacy is an important outcome for this group and is not included explicitly in conventional HRQoL measures. This is potentially important where decisions are made on the basis of cost-effectiveness using Quality Adjusted Life Years as the metric. Exclusion of these outcomes may lead to the cost-effectiveness of these interventions being understated.
Richardson
Gerry
G
Centre for Health Economics, University of York, Heslington, York, UK. gar2@york.ac.uk
Bojke
Chris
C
Kennedy
Anne
A
Reeves
David
D
Bower
Peter
P
Lee
Victoria
V
Middleton
Elizabeth
E
Gardner
Caroline
C
Gately
Claire
C
Rogers
Anne
A
D000223:Adaptation, Psychological; D002755:Choice Behavior; D002908:Chronic Disease; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care / Q000191:economics*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011594:Psychometrics; D036301:Qualitative Research; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D020377:Self Efficacy; D012934:Social Isolation; D013315:Stress, Psychological; D011795:Surveys and Questionnaires / Q000592:standards; D006113:United Kingdom