A labelled discrete choice experiment adds realism to the choices presented: preferences for surveillance tests for Barrett esophagus

Abstract

Background: Discrete choice experiments (DCEs) allow systematic assessment of preferences by asking respondents to choose between scenarios. We conducted a labelled discrete choice experiment with realistic choices to investigate patients' trade-offs between the expected health gains and the burden of testing in surveillance of Barrett esophagus (BE).

Methods: Fifteen choice scenarios were selected based on 2 attributes: 1) type of test (endoscopy and two less burdensome fictitious tests), 2) frequency of surveillance. Each test-frequency combination was associated with its own realistic decrease in risk of dying from esophageal adenocarcinoma. A conditional logit model was fitted.

Results: Of 297 eligible patients (155 BE and 142 with non-specific upper GI symptoms), 247 completed the questionnaire (84%). Patients preferred surveillance to no surveillance. Current surveillance schemes of once every 1-2 years were amongst the most preferred alternatives. Higher health gains were preferred over those with lower health gains, except when test frequencies exceeded once a year. For similar health gains, patients preferred video-capsule over saliva swab and least preferred endoscopy.

Conclusion: This first example of a labelled DCE using realistic scenarios in a healthcare context shows that such experiments are feasible. A comparison of labelled and unlabelled designs taking into account setting and research question is recommended.

Figure 1

Example of a choice scenario as presented in the questionnaire.

Figure 2

Utility of endoscopic surveillance by test and frequency (reference = no surveillance, the x-axis).

Figure 3

A. Utility of endoscopic surveillance tests by patient type. B. Utility of endoscopic surveillance tests by gender. C. Utility of endoscopic surveillance test by age-group. BE: patients with Barrett esophagus. NS: patients with non-specific upper GI symptoms.