title: The monetary value of patient-centred care: results from a discrete choice experiment in Dutch fertility care.
abstract: OBJECTIVE
  What are patients and insurers willing to pay for different aspects of fertility care, with a particular focus on patient-centredness?
  
  
  CONCLUSIONS
  In fertility care, both patients and health insurers place a high value on patient-centred factors, also when taking into account the effectiveness of fertility care. WHAT IS KNOWN ALREADY?: The benefit patients derive from fertility treatment may arise from several aspects of their care, such as the effectiveness, safety or patient-centred factors. Patient-centredness is recognized as an important, multi-dimensional concept, including domains on the organizational level (e.g. information provision) and on the human level (e.g. patient involvement).
  
  
  METHODS
  We performed a discrete choice experiment (DCE) within 32 Dutch fertility clinics and five large health insurance companies in the Netherlands. A total of 996 infertile patients who underwent at least one treatment cycle for their fertility problem and 84 healthcare insurers participated in the study which was executed in the summer of 2012.
  
  
  METHODS
  All participating patients and health insurers completed a DCE about their preferences in fertility care regarding the effectiveness, patient-centredness of care and additional costs. Logistic regression analysis was subsequently used to determine what both patients and health insurers were willing to pay for a one-step increase in patient-centred care and 1% higher pregnancy rates.
  
  
  RESULTS
  Five hundred and fifty patients (55.2%) and 45 healthcare insurers (53.6%) completed the DCE questionnaire. Patients were willing to pay a median amount of €463 for a relevant one-step increase in patient-centred care and €107 for 1% increase in pregnancy rates. Healthcare insurers' valuations were lower: €191 for more patient-centred care and €60 for 1% increase in pregnancy rates. The willingness-to-pay values depended on patients' age, patients' ethnicity, income, and treatment type and on health insurers' age.
  
  
  CONCLUSIONS
  An important limitation of a DCE study is that other attributes, that were not included in our study, are relevant as well. Therefore, our study participants might make other choices in real life compared with our hypothetical DCE scenarios. We tried to prevent this potential bias by selecting the most important attributes from the literature, using the input of an expert panel and performing a pilot study to test the validity of our questionnaire.
  
  
  CONCLUSIONS
  This study emphasizes the importance of patient-centredness aspects of care for both infertile patients and their insurers. Therefore, efforts by policymakers and clinicians to improve these aspects of care would increase the overall value patients derive from their fertility treatment. Moreover, although insurers placed a lower monetary value on patient-centredness aspects than patients, it is arguable that insurers' purchasing decisions should be guided by patient rather than insurer preferences. Finally, given the relatively high monetary value patients place on patient-centred aspects of their fertility care, there may be a willingness to allow for some optional co-payments for this quality of care dimension.
  
  
  BACKGROUND
  This work was supported by Merck Sharp and Dohme, the Netherlands. No competing interests declared.
  
  
  BACKGROUND
  Clinical Trials NCT01834313.
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands dana.huppelschoten@radboudumc.nl.
authors.forename: Aleida G
authors.initials: AG
authors.lastname: Huppelschoten
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Eva W
authors.initials: EW
authors.lastname: Verkerk
authors.affiliation: The King's Fund, 11-13 Cavendish Square, London W1G 0AN, UK.
authors.forename: John
authors.initials: J
authors.lastname: Appleby
authors.affiliation: Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Groenewoud
authors.affiliation: Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Eddy M M
authors.initials: EM
authors.lastname: Adang
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Willianne L D M
authors.initials: WL
authors.lastname: Nelen
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Jan A M
authors.initials: JA
authors.lastname: Kremer
mesh_terms: D000367:Age Factors; D005260:Female; D017048:Health Care Costs; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D009426:Netherlands; D018802:Patient-Centered Care / Q000191:economics* / Q000379:methods / Q000639:trends; D011247:Pregnancy; D018873:Pregnancy Rate; D018456:Reproductive Medicine / Q000191:economics*; D012959:Socioeconomic Factors
keywords: discrete choice experiment; health insurers; patient-centredness; preferences; willingness-to-pay