title: What, who and when? Incorporating a discrete choice experiment into an economic evaluation.
abstract: BACKGROUND
  Economic evaluation focuses on Quality-Adjusted-Life-Years (QALYs) as the main valuation method. However, it is well known that factors beyond health related quality of life are important to patients and the public. Whilst discrete-choice-experiments (DCE) have been extensively used to value such factors, their incorporation within an economic evaluation framework is limited. This study is the first to incorporate patient preferences for factors beyond QALYs into an economic evaluation and compare results with the standard cost-per-QALY approach, using randomised-controlled-trial (RCT) participants.
  
  
  METHODS
  Costings, clinical-effectiveness (appropriateness-of-treatment), QALYs and patient satisfaction data were collected at baseline and 12-month follow-up for a new pharmacy-service within a randomised-controlled-trial. Trial participants who replied to the follow-up survey and had not subsequently withdrawn from the study were mailed a DCE questionnaire at 24-months. WTP for the standard and new service was derived from the DCE. Results from QALYs and the DCE were compared.
  
  
  RESULTS
  At 12 months, costs, clinical-effectiveness and QALYs did not differ between the intervention and control; however there was a significant increase in satisfaction in the intervention. The DCE valued this increased satisfaction in the intervention (positive net-benefit). The longer the time patients experienced the new service the greater the reported net-benefit.
  
  
  CONCLUSIONS
  When incorporating a DCE into an economic evaluation a number of questions are raised: what factors should be valued, whose values (trial-groups vs. all-trial-population) and when should they be elicited (still-receiving-the-intervention or afterwards). Consideration should also be given to status quo bias.
authors.affiliation: LSE Health and Social Care, the London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK. m.tinelli@lse.ac.uk.
authors.forename: Michela
authors.initials: M
authors.lastname: Tinelli
authors.affiliation: Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill campus, AB25 2ZD, Aberdeen, Scotland.
authors.forename: Mandy
authors.initials: M
authors.lastname: Ryan
authors.affiliation: Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill campus, AB25 2ZD, Aberdeen, Scotland.
authors.forename: Christine
authors.initials: C
authors.lastname: Bond
keywords: Cost-benefit analysis (CBA); Discrete choice experiment (DCE); Economic evaluation; Quality adjusted life year (QALY); Randomised controlled trial (RCT); Willingness to pay (WTP)