title: Prioritising patients for bariatric surgery: building public preferences from a discrete choice experiment into public policy.
abstract: OBJECTIVE
  To derive priority weights for access to bariatric surgery for obese adults, from the perspective of the public.
  
  
  METHODS
  Australian public hospital system.
  
  
  METHODS
  Adults (N=1994), reflecting the age and gender distribution of Queensland and South Australia.
  
  
  METHODS
  A discrete choice experiment in which respondents indicated which of two individuals with different characteristics should be prioritised for surgery in repeated hypothetical choices. Potential surgery recipients were described by seven key characteristics or attributes: body mass index (BMI), presence of comorbid conditions, age, family history, commitment to lifestyle change, time on the surgical wait list and chance of maintaining weight loss following surgery. A multinomial logit model was used to evaluate preferences and derive priority weights (primary analysis), with a latent class model used to explore respondent characteristics that were associated with variation in preference across the sample (see online supplementary analysis).
  
  
  RESULTS
  A preference was observed to prioritise individuals who demonstrated a strong commitment to maintaining a healthy lifestyle as well as individuals categorised with very severe (BMI≥50 kg/m2) or (to a lesser extent) severe (BMI≥40 kg/m2) obesity, those who already have obesity-related comorbidity, with a family history of obesity, with a greater chance of maintaining weight loss or who had spent a longer time on the wait list. Lifestyle commitment was considered to be more than twice as important as any other criterion. There was little tendency to prioritise according to the age of the recipient. Respondent preferences were dependent on their BMI, previous experience with weight management surgery, current health state and education level.
  
  
  CONCLUSIONS
  This study extends our understanding of the publics' preferences for priority setting to the context of bariatric surgery, and derives priority weights that could be used to assist bodies responsible for commissioning bariatric services.
authors.affiliation: Faculty of Health and Behavioural Sciences, School of Pharmacy, The University of Queensland, St Lucia, Queensland, Australia.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Whitty
authors.affiliation: Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Ratcliffe
authors.affiliation: Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kendall
authors.affiliation: Urban Research Program, Griffith School of Environment, Griffith University, Southport, Queensland, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Burton
authors.affiliation: Menzies Centre for Health Policy, University of Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
authors.affiliation: Faculty of Life Sciences and Medicine, King's College London, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Littlejohns
authors.affiliation: School of Human Services and Social Work, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Harris
authors.affiliation: Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.
authors.forename: Rachael
authors.initials: R
authors.lastname: Krinks
authors.affiliation: Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Scuffham
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D057240:Patient Preference; D011640:Public Policy; D011793:Queensland; D013021:South Australia
keywords: HEALTH ECONOMICS; obesity