title: Should I stay or should I go home? A latent class analysis of a discrete choice experiment on hospital-at-home.
abstract: OBJECTIVE
  This study aimed 1) to quantify the strength of patient preferences for different aspects of early assisted discharge in The Netherlands for patients who were admitted with a chronic obstructive pulmonary disease exacerbation and 2) to illustrate the benefits of latent class modeling of discrete choice data. This technique is rarely used in health economics.
  
  
  METHODS
  Respondents made multiple choices between hospital treatment as usual (7 days) and two combinations of hospital admission (3 days) followed by treatment at home. The latter was described by a set of attributes. Hospital treatment was constant across choice sets. Respondents were patients with chronic obstructive pulmonary disease in a randomized controlled trial investigating the cost-effectiveness of early assisted discharge and their informal caregivers. The data were analyzed using mixed logit, generalized multinomial logit, and latent-class conditional logit regression. These methods allow for heterogeneous preferences across groups, but in different ways.
  
  
  RESULTS
  Twenty-five percent of the respondents opted for hospital treatment regardless of the description of the early assisted discharge program, and 46% never opted for the hospital. The best model contained four latent classes of respondents, defined by different preferences for the hospital and caregiver burden. Preferences for other attributes were constant across classes. Attributes with the strongest effect on choices were the burden on informal caregivers and co-payments. Except for the number of visits, all attributes had a significant effect on choices in the expected direction.
  
  
  CONCLUSIONS
  Considerable segments of respondents had fixed preferences for either treatment option. Applying latent class analysis was essential in quantifying preferences for attributes of early assisted discharge.
authors.affiliation: Institute for Medical Technology Assessment/Institute for Healthcare Policy and Management, Erasmus University, Rotterdam, The Netherlands. Electronic address: goossens@bmg.eur.nl.
authors.forename: Lucas M A
authors.initials: LM
authors.lastname: Goossens
authors.affiliation: Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Cecile M A
authors.initials: CM
authors.lastname: Utens
authors.affiliation: Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Frank W J M
authors.initials: FW
authors.lastname: Smeenk
authors.affiliation: Department of Business Economics, Erasmus School of Economics, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: Donkers
authors.affiliation: Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Onno C P
authors.initials: OC
authors.lastname: van Schayck
authors.affiliation: Institute for Medical Technology Assessment/Institute for Healthcare Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Maureen P M H
authors.initials: MP
authors.lastname: Rutten-van Mölken
mesh_terms: D017028:Caregivers / Q000523:psychology; D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D009426:Netherlands; D010351:Patient Discharge; D057240:Patient Preference; D010865:Pilot Projects; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: COPD; discrete choice experiment; hospital-at-home; latent-class conditional logit