title: A comparison of two experimental design approaches in applying conjoint analysis in patient-centered outcomes research: a randomized trial.
abstract: BACKGROUND
  While the application of conjoint analysis and discrete-choice experiments in health are now widely accepted, a healthy debate exists around competing approaches to experimental design. There remains, however, a paucity of experimental evidence comparing competing design approaches and their impact on the application of these methods in patient-centered outcomes research.
  
  
  OBJECTIVE
  Our objectives were to directly compare the choice-model parameters and predictions of an orthogonal and a D-efficient experimental design using a randomized trial (i.e., an experiment on experiments) within an application of conjoint analysis studying patient-centered outcomes among outpatients diagnosed with schizophrenia in Germany.
  
  
  METHODS
  Outpatients diagnosed with schizophrenia were surveyed and randomized to receive choice tasks developed using either an orthogonal or a D-efficient experimental design. The choice tasks elicited judgments from the respondents as to which of two patient profiles (varying across seven outcomes and process attributes) was preferable from their own perspective. The results from the two survey designs were analyzed using the multinomial logit model, and the resulting parameter estimates and their robust standard errors were compared across the two arms of the study (i.e., the orthogonal and D-efficient designs). The predictive performances of the two resulting models were also compared by computing their percentage of survey responses classified correctly, and the potential for variation in scale between the two designs of the experiments was tested statistically and explored graphically.
  
  
  RESULTS
  The results of the two models were statistically identical. No difference was found using an overall chi-squared test of equality for the seven parameters (p = 0.69) or via uncorrected pairwise comparisons of the parameter estimates (p-values ranged from 0.30 to 0.98). The D-efficient design resulted in directionally smaller standard errors for six of the seven parameters, of which only two were statistically significant, and no differences were found in the observed D-efficiencies of their standard errors (p = 0.62). The D-efficient design resulted in poorer predictive performance, but this was not significant (p = 0.73); there was some evidence that the parameters of the D-efficient design were biased marginally towards the null. While no statistical difference in scale was detected between the two designs (p = 0.74), the D-efficient design had a higher relative scale (1.06). This could be observed when the parameters were explored graphically, as the D-efficient parameters were lower.
  
  
  CONCLUSIONS
  Our results indicate that orthogonal and D-efficient experimental designs have produced results that are statistically equivalent. This said, we have identified several qualitative findings that speak to the potential differences in these results that may have been statistically identified in a larger sample. While more comparative studies focused on the statistical efficiency of competing design strategies are needed, a more pressing research problem is to document the impact the experimental design has on respondent efficiency.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Kinter
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Prior
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Carswell
authors.forename: John F P
authors.initials: JF
authors.lastname: Bridges
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001480:Basal Ganglia Diseases / Q000139:chemically induced; D003071:Cognition; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D057240:Patient Preference; D012008:Recurrence; D015203:Reproducibility of Results; D012107:Research Design; D012559:Schizophrenia / Q000188:drug therapy / Q000628:therapy*
chemical_list: D014150:Antipsychotic Agents