Preference, Trial & Evaluation
Cost-Effectiveness of Screening for Primary Aldosteronism in Hypertensive Patients in Australia: A Markov Modelling Analysis
Woode ME, Wong K, Reid CM, Stowasser M, Russell G, Gwini S, Young MJ, Fuller PJ, Yang J & Chen G† . Journal of Hypertension, 2023, 41 (10): 1615-1625. DOI: 10.1097/HJH.0000000000003513.
This study demonstrated that screening all hypertensive patients for PA from age 40 is cost-effective. The findings argue in favour of screening for PA before the development of severe hypertension in the Australian healthcare setting.
Comparison of a Full and Partial Choice Set Design in A Labeled Discrete Choice Experiment
Thai T†, Bliemer M, Chen G, Spinks J, De New S & Lancsar E. Health Economics, 2023, 32 (6): 1284-1304. DOI: 10.1002/hec.4666.
Labelled discrete choice experiments (DCEs) commonly present all alternatives using a full choice set design (FCSD), which could impose a high cognitive burden on respondents. In the setting of employment preferences, this study demonstrated that a partial choice set design (PCSD) reduced cognitive burden whilst maintaining convergent validity compared with a FCSD in labelled DCEs.
Exploring the Preferences of the Australian Public for Antibiotic Treatments: A Discrete Choice Experiment
Degeling C†, Yarwood T, Nettel‑Aguirre A, Mullan J, Reynolds N & Chen G†. Patient, 2023, 16 (5): 555-567. DOI: 10.1007/s40271-023-00640-z.
Despite concerted public awareness raising campaigns, our results suggest that several factors may influence the preferences of Australians when considering antibiotic use. However, for those more likely to be aware of the need to preserve antibiotics, out-of-pocket costs and limiting the contribution to antibiotic resistance are the dominant influence. Delays in starting treatment were not important for any latent class suggesting public tolerance for this measure.
FIT for Purpose: Study Protocol for a Randomized Controlled Trial to Personalize Surveillance Colonoscopy for Individuals at Elevated Risk of Colorectal Cancer
Winter JM†, Cornthwaite KJ, Young GP, Wilson C, Chen G, Woodman R, Coats M, Fraser R, Cock C, Bampton P & Symonds EL. International Journal of Colorectal Disease, 2023, 38: 201. DOI: 10.1007/s00384-023-04493-8.
This multicenter, prospective, randomized controlled trial will determine the safety, cost effectiveness and patient acceptance of using fecal immunochemical test (FIT) to extend surveillance colonoscopy intervals for individuals at elevated risk of colorectal cancer.
Eliciting Primary Healthcare Physicians’ Preferences for Job Characteristics in Rural China: A Discrete Choice Experiment
Bao M, Huang C†, Wang L, Yan G & Chen G. BMJ Open, 2023, 13: e056741. DOI: 10.1136/bmjopen-2021-056741.
This study revealed physicians’ job preferences in rural China based on eight attributes: (1) salary, (2) educational opportunities, (3) transportation, (4) job location, (5) workload, (6) essential equipment, (7) doctor–patient relationship, and (8) ‘bianzhi’ (positions with lifetime job security).
Parents’ Preferences for Respite Care of Children with Medical Complexity
Yamamoto Y†, Aoki A, Fuji H, Chen G, Bolt T, Suto M, Mori R, Uchida K, Takehara K, Gai R. Pediatrics International, 2023, DOI: 10.1111/ped.15703.
7 attributes were included: (1) medical care (medical device related care (like ventilators or parenteral nutrition) or the use of medicines), (2) daily care (the intensity of nurses' allocation and the number of bathing services during their stay), (3) education/nursing, (4) time for their child and space for family, (5) sharing information, (6) emergency care, and (7) cost. There was a strong preference for high-level medical care, especially the management of ventilators, among parents of children with severe disabilities for their overnight respite care service.
Social Interventions to Support People with Disability: A Systematic Review of Economic Evaluation Studies
Ma BH†, Badji S, Petrie D, Llewellyn G & Chen G. PLoS ONE, 2023, 18 (1): e0278930. DOI: 10.1371/journal.pone.0278930.
Social interventions are essential in supporting the health and well-being of people with disability, but there is a critical need to prioritise resources for those that provide the best value for money. This systematic review aims to summarise the current evidence in the economic evaluation of social services for people with disability and to critically compare the methodologies used in conducting the economic evaluations with a focus on the outcomes and costs.
Willingness to Be Tested for A Secondary Cause of Hypertension: A Survey of the Australian General Community
Lai JH, Gwini SM, Chen G, Long KM, Russell G, Schlaich MP, Stowasser M, Young MJ, Fuller PJ, Mori TA, Wolley M, Reid CM & Yang J†. Internal Medicine Journal, 2023, 53 (10): 18261836. DOI: 10.1111/imj.15955.
A high proportion of patients are willing to engage in testing for a secondary cause of hypertension. The top three barriers to testing included fear of a serious underlying condition, lack of belief in further testing and increased stress associated with further testing.
What Constitutes Preferred Long-Term Care Provided in Residential Aged Care Facilities? An Empirical Comparison of the Preferences of the General Population, Residents, and Family Members
Milte R†, Mpundu-Kaambwa C, Chen G, Crotty M & Ratcliffe J. Value in Health, 2022, 25 (2): 257-267. DOI: 10.1016/j.jval.2021.09.001.
This study illustrates that preferences for residential aged care service delivery may vary depending upon perspective and experience. The discrete choice experiments (DCEs) found that preferences for the general population and resident samples were similar, while preferences of family member carers were significantly different from those of the resident and general population samples.
Parental Preference for Influenza Vaccine for Children in China: A Discrete Choice Experiment
Li S, Gong T, Chen G, Liu P, Lai X, Rong H, Ma X, Hou Z & Fang H†. BMJ Open, 2022, 12: e055725. DOI: 10.1136/ bmjopen-2021-055725.
Risk of a severe side effect was the most important attribute, followed by the protection rate and duration of vaccine-induced protection.
Cost-Effectiveness Analysis of Total Laparoscopic Hysterectomy Versus Total Abdominal Hysterectomy for Uterine Fibroids in Western China: A Societal Perspective
Yang J, Fan X†, Gao J†, Li D, Xu Y & Chen G. BMC Health Services Research, 2022, 22: 252. DOI: 10.1186/s12913-022-07644-9.
TLH is cost effective compared with TAH in preventing additional complications based on our estimated conservative threshold in China.
Healthcare Funding Decisions and Real-World Benefits: Reducing Bias by Matching Untreated Patients
Ghijben P†, Petrie D, Zavarsek S, Chen G & Lancsar E. PharmacoEconomics, 2021, 39 (7): 741-756. DOI: 10.1007/s40273-021-01020-x.
Standard matching approaches used for estimating treatment effects with real-world data can give biased estimates when unobserved factors are associated with treatment selection and outcomes. This study proposes a new untreated matching approach that can reduce this bias by using outcomes of the untreated contemporaneous patients to improve matching between treated patients and historical treated-controls.
“Rescue” of Nonparticipants in Colorectal Cancer Screening: A Randomized Controlled Trial of Three Non-Invasive Test Options
Young GP†, Chen G, Wilson CJ, McGrane E, Hughes-Barton DL-A, Flight IHK & Symonds EL. Cancer Prevention Research, 2021, 14 (8): 803-810. DOI: 10.1158/1940-6207.CAPR-21-0080.
There was no clear advantage between a fecal test, blood test or choice of test although, when given a choice, the fecal test was preferred.
Job Preferences of Undergraduate Pharmacy Students in China: A Discrete Choice Experiment
Liu P, Liu S, Gong T, Li Q, Chen G† & Li S†. Human Resources for Health, 2021, 19: 79. DOI: 10.1186/s12960-021-00626-8.
Monthly income and work location were most important to respondents, followed by work unit (which refers to the nature of the workplace) and years to promotion. There was significant preference heterogeneity among respondents.
Shedding Light on Therapeutics in Alopecia and Their Relevance to COVID-19
Fagan N†, Meah N, York K, Bokhari L, Fletcher G, Chen G, Tobin DJ, Messenger A, Irvine AD, Sinclair R & Wall D. Clinics in Dermatology, 2021, 39 (1): 76-83. DOI: 10.1016/j.clindermatol.2020.12.015.
Patients with alopecia are a diverse group, for whom a wide range of systemic therapies are prescribed. They offer a meaningful opportunity to collect real-world data that will better inform the global community, through pooled observations from multinational real-world patient registries, and so not only help inform care of alopecia but also offer a chance to establish risk factors and candidate interventions that may modulate disease course and save lives.
Changes in Public Preferences for Technologically Enhanced Surveillance following the COVID-19 Pandemic: A Discrete Choice Experiment
Degeling C†, Chen G†, Gilbert GL, Brookes V, Thai T, Wilson A & Johnson J. BMJ Open, 2020, 10 (11): e041592. DOI: 10.1136/bmjopen-2020-041592.
As governments attempt to navigate a path out of COVID-19 restrictions, robust evidence is essential to inform requirements for public acceptance of technologically enhanced communicable disease surveillance systems. This study examined the value of core surveillance system attributes to the Australian public, before and during the early stages of the current pandemic. After onset, participants demonstrated greater preference for a surveillance system that could prevent a higher number of illnesses and deaths, and were less concerned about their personal autonomy. They also increased their preference for a system with high data security.
Parental Vaccine Preferences for Their Children in China: A Discrete Choice Experiment
Gong T, Chen G, Liu P, Lai X, Rong H, Ma X, Hou Z, Fang H† & Li S†. Vaccines, 2020, 8: 0687. DOI: 10.3390/vaccines8040687.
With regard to the vaccination decisions for their children, parents in China were mostly driven by vaccination safety, effectiveness and were not affected by the severity of diseases.
Tenofovir Prophylaxis for Preventing Mother-to-Child Hepatitis B Virus Transmission in China: A Cost-Effectiveness Analysis
Yin J, Liang P, Chen G, Wang F, Cui F, Liang X & Zhuang G†. International Journal of Infectious Diseases, 2020, 95: 118-124. DOI: 10.1016/j.ijid.2020.03.036.
Tenofovir prophylaxis for mothers with high viral loads in late pregnancy was more cost-effective than the current active-passive immunoprophylaxis alone.
Ratcliffe J†, Chen G, Khadka J, Kumaran S, Hutchinson C, Milte R, Savvas S & Batchelor F. Royal Commission into Aged Care Quality and Safety Research Paper 20; Commonwealth of Australia; 2021.
Australia’s Aged Care System: Assessing the Views and Preferences of the General Public for Quality of Care and Future Funding
Ratcliffe J†, Chen G, Cleland J, Kaambwa B, Khadka J, Hutchinson C & Milte R. Royal Commission into Aged Care Quality and Safety Research Paper 6; Commonwealth of Australia; 2020.
Cyclosporin for Moderate-to-Severe Alopecia Areata: A Double-blind, Randomized, Placebo-controlled Clinical Trial of Efficacy and Safety
Lai VWY†, Chen G, Gin D & Sinclair R. Journal of the American Academy of Dermatology, 2019, 81 (3): 694-701. DOI: 10.1016/j.jaad.2019.04.053.
The first randomised placebo-controlled trial for evaluating the efficacy of cyclosporin in moderate to severe alopecia areata (AA). Monotherapy cyclosporin is moderately effective at inducing remission in patients with moderate to severe AA. These results will guide clinicians in their choice of second-line agent for AA patients who are steroid-responsive, but steroid-dependent.
A Randomised Controlled Trial Testing Provision of Fecal and Blood Test Options on Participation for Colorectal Cancer Screening
Symonds EL†, Hughes DL, Flight I, Woodman R, Chen G, Ratcliffe J, Pedersen SK, Fraser RJL, Wilson CJ & Young GP. Cancer Prevention Research, 2019, 12 (9): 631-640. DOI: 10.1158/1940-6207.CAPR-19-0089.
In a population familiar with FIT-screening, provision of a blood test either as a rescue of FIT non-participants or as an up-front choice did not increase overall participation. This might reflect a lack of awareness of the blood test for screening compared to FIT.
Preferences for Surveillance of Barrett’s Oesophagus: A Discrete Choice Experiment
Bulamu NB, Chen G†, Bright T, Ratcliffe J, Chung A, Fraser RJL, Törnqvist B & Watson DI. Journal of Gastrointestinal Surgery, 2019, 23: 1309-1317. DOI: 10.1007/s11605-018-4049-6.
Endoscopic surveillance for Barrett’s oesophagus is undertaken to detect dysplasia and early cancer and to facilitate early intervention. Along with the ongoing developments of non-invasive tests that will provide new capabilities for non-invasive early detection and monitoring of cancer and inflammatory disease, it is vital to understand patients’ preferences about these new developments. Furthermore, this study has explicitly investigated whether respondents’ own perceived risk of developing oesophageal adenocarcinoma impacted on their preference to participate in surveillance.
Economic Evaluation of Simulated and Traditional Clinical Placements in Occupational Therapy Education
Gospodarevskaya E†, Carter R, Imms C, Chu EMY, Nicola-Richmond K, Gribble N, Froude E, Guinea S, Sheppard L, Iezzi A & Chen G. Australian Occupational Therapy Journal, 2019, 66 (3): 369-379. DOI: 10.1111/1440-1630.12563.
For universities that procure traditional clinical placements (TCPs) predominately at public health care facilities and sustain high administrative overheads, the simulated clinical placement (SCP) program could be a cost-saving alternative. From a broader value-for-money perspective respondents favoured TCP over SCP, yet placed importance on placement availability and opportunity to demonstrate competence for students during the placement.
Job Preferences of Undergraduate Nursing Students in Eastern China: A Discrete Choice Experiment
Liu T, Li S†, Yang R, Liu S & Chen G. Human Resources for Health, 2019, 17: 1. DOI: 10.1186/s12960-018-0335-3.
Attributes include location, monthly income, bianzhi (which refers to the established posts and can be loosely regarded as state administrative staffing), career development and training opportunity, work environment & working strength.
Preferences for Cervical Cancer Screening Service Attributes in Rural China: A Discrete Choice Experiment
Li S, Liu S, Ratcliffe J, Gray A & Chen G†. Patient Preference and Adherence, 2019, 13: 881-889. DOI: 10.2147/PPA.S201913.
Attributes included the percentage of cervical cancer-related death reduction, screening interval, screening location, screening pain, waiting time for screening results and out-of-pocket costs. When considering a cervical cancer screening program, the screening cost, location and the percentage of cervical cancer-related death reduction were of most concern to women. Among the presented attributes the pain associated with the process of screening was of the least concern.
Job Preferences for Healthcare Administration Students in China: A Discrete Choice Experiment
Liu S, Li S†, Li Y, Wang H, Zhao J & Chen G. PLoS ONE, 2019, 14(1): e0211345. DOI: 10.1371/journal.pone.0211345.
Attributes include location, monthly income, workload, bianzhi (which refers to the established posts and can be loosely regarded as state administrative staffing), working environment and career development opportunity.
Does the Use of Proportional Shortfall Help Align the Prioritisation of Health Services with Public Preferences?
Richardson J†, Iezzi A, Maxwell A & Chen G. European Journal of Health Economics, 2018, 19 (6): 797-806. DOI: 10.1007/s10198-017-0923-5.
It has been proposed that equity may be included in the economic evaluation of health services using the ‘proportional shortfall’ (PS)—the proportion of a person’s QALY expectation that they would lose because of an illness. The present paper reports the results of a population survey designed to test whether PS helped to explain people’s preferences for health services and whether it did this better than the absolute shortfall or the equity related variables that PS seeks to replace. It is concluded that the use of PS is unlikely to improve the alignment of priorities with public preferences.
Job Preferences for Medical Students in China: A Discrete Choice Experiment
Liu S, Li S†, Yang R, Liu T & Chen G. Medicine, 2018, 97, 38: e12358. DOI: 10.1097/MD.0000000000012358.
Attributes include work location, hospital type, monthly income, bianzhi (which can be loosely regarded as state administrative staffing), work environment, Training and career development opportunity.
The Impact of Sample Type and Procedural Attributes on Relative Acceptability of Different Colorectal Cancer Screening Regimens
Osborne JM, Flight I, Wilson C†, Chen G, Ratcliffe J & Young GP. Patient Preference and Adherence, 2018, 12: 1825-1836. DOI: 10.2147/PPA.S172143.
This study investigated population preferences for colorectal cancer (CRC) screening tests that utilise different sample collections (stool, blood, saliva) and the extent to which specific attributes (convenience, performance, cost) impact this preference based on a discrete choice experiment (DCE). Aversion to sample type and perceived inconvenience of sample collection are significant drivers of screening preference. Blood and saliva were both preferable to stool sampling.
Taste, Choice and Timing: Investigating Resident and Carer Preferences for Meals in Aged Care Homes
Milte R†, Ratcliffe J, Chen G & Crotty M. Nursing and Health Sciences, 2018, 20 (1): 116-124. DOI: 10.1111/nhs.12394.
This DCE study found that respondents were willing to pay a premium to receive food which met their expectations of taste, and for a high level of control over serving sizes, which has implications for how food services in residential care are delivered in the future.
Towards More Efficient Surveillance of Barrett’s Esophagus - Identification and Exclusion of Patients at Low Risk of Cancer
Lindblad M, Bright T, Schloithe A, Mayne GC, Chen G, Bull J, Bampton PA, Fraser RJL, Gatenby PA, Gordon LG & Watson DI†. World Journal of Surgery, 2017, 41 (4): 1023-1034. DOI: 10.1007/s00268-016-3819-0.
This study found that individuals with non-dysplastic Barrett’s esophagus (BE) segments less than 2cm in length or no intestinal metaplasia have a very low risk of progression to esophageal cancer and should be considered for removal from endoscopic surveillance programs. A Markov cohort model result suggests that BE surveillance of the higher risk individuals, following exclusion of the lower risk cohort, is considered cost-effective.
Adolescent Values for Immunisation Programs in Australia: A Discrete Choice Experiment
Wang B†, Chen G, Ratcliffe J, Afzali HHA, Giles L & Marshall H. PLoS ONE, 2017, 12 (7): e0181073. DOI: 10.1371/journal.pone.0181073.
Adolescents’ vaccine decisions were driven by disease types, healthcare facilities where vaccines were administered, the severity of side effects and vaccine delivery methods. Vaccine efficacy was selected as an attribute in a number of previous DCE studies, but not included in this DCE survey as it was not reported as a major contributor to vaccine hesitancy or refusal.
Communal Sharing and the Provision of Low-Volume High-Cost Health Services: Results of a Survey
Richardson J†, Iezzi A, Chen G & Maxwell A. PharmacoEconomics - Open, 2017, 1 (1): 13-23. DOI: 10.1007/s41669-016-0002-3.
This study suggests and tests a reason why the public might support the funding of services for rare diseases (SRDs) when the services are effective but not cost effective. It is postulated that the fairness of funding a service is influenced by a comparison of the average patient benefit with the average cost to those who share the cost.
Assessing Knowledge and Attitudes towards Cervical Cancer Screening among Rural Women in Eastern China
Liu T, Li S†, Ratcliffe J & Chen G. International Journal of Environmental Research and Public Health, 2017, 14 (9), 967. DOI: 10.3390/ijerph14090967.
Although the Chinese government provides free cervical cancer screening for rural women aged 35 to 59 years, the screening rate remains low even in the more developed regions of eastern China. Education was the only significant factor associated with a positive attitude. Women who were older, or who had received a formal education were more likely to participate in cervical cancer screening in rural China.
Adolescent, Parent, and Societal Preferences and Willingness to Pay for Meningococcal B Vaccine: A Discrete Choice Experiment
Marshall H†, Chen G, Clarke M & Ratcliffe J. Vaccine, 2016, 34 (5): 671-677. DOI: 10.1016/j.vaccine.2015.11.075.
This study explored adolescent/parental values for a variety of salient vaccine attributes to assess preferences and willingness-to-pay (WTP) for a MenB vaccine using a DCE. Vaccine effectiveness, adverse events, and duration of immunity are important drivers for parental and adolescent decisions about WTP for MenB vaccine.
Novel Application of a Discrete Choice Experiment to Identify Preferences for a National Healthcare-Associated Infection Surveillance Program: A Cross Sectional Study
Russo PL†, Chen G, Cheng AC, Richard M, Graves N, Ratcliffe J & Hall J. BMJ Open, 2016, 6 (5): e011397. DOI: 10.1136/bmjopen-2016-011397.
This study identified key stakeholder preferences and priorities when considering a national healthcare-associated infection (HAI) surveillance programme.
Adolescent Confidence in Immunisation: Assessing and Comparing Attitudes of Adolescents and Adults
Wang B†, Giles L, Afzali HHA, Clarke M, Ratcliffe J, Chen G & Marshall H. Vaccine, 2016, 34 (46): 5595-5603. DOI: 10.1016/j.vaccine.2016.09.040.
Adolescents had less vaccine confidence than adults, and were more likely to seek information from social networks than adults. One-third of adolescents surveyed were eager to be involved in joint decision making. In addition, males showed less confidence in vaccine benefits but less concern about reactions than females.
Investigating Consumers’ and Informal Carers’ Views and Preferences for Consumer Directed Care: A Discrete Choice Experiment
Kaambwa B†, Lancsar E, McCaffrey N, Chen G, Gill L, Cameron ID, Crotty M & Ratcliffe J. Social Science and Medicine, 2015, 140: 81-94. DOI: 10.1016/j.socscimed.2015.06.034.
This study investigated the relative importance to community aged care services (CACS) consumers and informal (family) carers of gradations relating to six salient features of consumer directed care (CDC) using a DCE.
What Sort of Follow-Up Services would Australian Breast Cancer Survivors Prefer if We Could No Longer Offer Long-Term Specialist-Based Care? A Discrete Choice Experiment
Bessen T†, Chen G, Street J, Eliott J, Karnon J, Keefe D & Ratcliffe J. British Journal of Cancer, 2014, 110 (4): 859-867. DOI: 10.1038/bjc.2013.800.
Beyond the first 2 years from diagnosis, in the absence of a specialist led follow-up, women prefer to have their routine breast cancer follow-up by a Breast Physician (or a Breast Cancer Nurse) in a dedicated local breast cancer clinic, rather than with their local General Practitioner. Drop-in clinics for the management of treatment-related side effects and to provide advice to both develop and maintain good health are also highly valued by breast cancer survivors.
Australian Public Preferences for the Funding of New Health Technologies: A Comparison of Discrete Choice and Profile Case Best-Worst Scaling Methods
Whitty JA†, Ratcliffe J, Chen G & Scuffham PA. Medical Decision Making, 2014, 34 (5): 638-654. DOI: 10.1177/0272989X14526640.
The findings from both the BWS and DCE were generally consistent in that respondents exhibited stronger preferences for technologies offering prevention or early diagnosis over other benefit types. Respondents also prioritized technologies that benefit younger people, larger numbers of people, those in rural areas, or indigenous Australians; that provide value for money; that have no available alternative; or that upgrade an existing technology. However, the relative preference weights and consequent preference orderings differed between the DCE and BWS models. Further, poor correlation between the DCE and BWS weights was observed.
Cognitive Overload? An Exploration of the Potential Impact of Cognitive Functioning in Discrete Choice Experiments with Older People in Health Care
Milte R†, Ratcliffe J, Chen G, Lancsar E, Miller M & Crotty M. Value in Health, 2014, 17 (5): 655-659. DOI: 10.1016/j.jval.2014.05.005.
This exploratory study investigated the effect of cognitive functioning on the consistency of individual responses to a DCE study conducted exclusively with older people. Conditional logit, mixed logit, heteroscedastic conditional logit, and generalized multinomial logit regression models were used to analyze the DCE data and to explore the relationship between the level of cognitive functioning and preference and scale heterogeneity. Both the heteroscedastic conditional logit and generalized multinomial logit models indicated that the presence of mild cognitive impairment did not have a significant effect on the consistency of responses to the DCE.
What Factors Influence Older People in the Decision to Relinquish Their Driver's Licence?: A Discrete Choice Experiment
McNamara A†, Chen G, George S, Walker R & Ratcliffe J. Accident Analysis and Prevention, 2013, 55: 178-184. DOI: 10.1016/j.aap.2013.02.034.
Factors pertaining to the individual themselves including advanced old age and low confidence in driving ability may be more influential than environmental factors such as availability of other transport options and the cost of public transport in an older person's decision to relinquish their driving licence.