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. 2025 Feb 25;8(1):63-78.
doi: 10.3138/canlivj-2024-0050. eCollection 2025 Feb.

Discrete Choice Experiments and Conjoint Analyses in Health Screening Programs for Type 2 Diabetes and Liver Disease: A Scoping Review

Felice Cinque  1   2   3 , Clara Long  1   2 , Duy A Dinh  4 , Genevieve Gore  5 , Mark Swain  6 , Alnoor Ramji  7 , Keyur Patel  8 , Michael Betel  9 , Harpreet S Bajaj  10 , Kaberi Dasgupta  11   12 , Thomas G Poder  13   14 , Sahar Saeed  15 , Giada Sebastiani  1   2
Affiliations

Discrete Choice Experiments and Conjoint Analyses in Health Screening Programs for Type 2 Diabetes and Liver Disease: A Scoping Review

Felice Cinque et al. Can Liver J. .

Abstract

Background: We aimed to summarize the evidence on the use of discrete choice experiments (DCEs) and conjoint analyses to quantify stakeholders' preferences for screening programs for type 2 diabetes (T2D) and liver diseases, with a specific focus on metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods: For this scoping review, five databases (MEDLINE [PubMed], PubMed Central, EMBASE [Ovid], Europe PMC, Google Scholar) were searched with the assistance of a librarian, and deduplicated records were screened by two independent reviewers. Inclusion criteria: using DCE/CA, addressing screening programs for T2D and liver disease, published in English, French, or Spanish after January 1990.

Results: Among 2,282 studies, 9 (7 from high- and 2 from low-income countries) elicited preferences for screening for liver disease (n = 1), hepatitis C (n = 1), hepatitis B (n = 1), hepatocellular carcinoma (n = 2), noncommunicable diseases (n = 2), diabetic retinopathy (n = 1), and cardiovascular diseases (n = 1). No studies addressed MASLD screening in T2D. Stakeholders included patients (n = 3), health care providers (n = 1), patients plus health care providers (n = 1), and the general population (n = 3). Studies used 18 structure, 6 process, and 4 outcome attributes. Screening sensitivity, setting, duration, provider, and cost were the most important structure attributes in participant choices. Physician support for treatment was the preferred process attribute. Outcome attributes were the least used, but of major importance (screening adherence followed by treatment) when considered.

Conclusions: With no study focusing on MASLD screening in T2D, our scoping review highlights the need to develop a DCE addressing this topic to better design a patient-centred continuum of care.

Keywords: DCE; continuum of care; metabolic dysfunction-associated steatotic liver disease; patient-centred care; preferences; stakeholder preferences.

Plain language summary

Lay Summary: This study aimed to review existing research that uses discrete choice experiments (DCEs) to understand stakeholder preferences for health screening programs, particularly focusing on type 2 diabetes (T2D) and liver disease. These methods are designed to capture how people prioritize different aspects of health care services, such as the setting, provider, or cost, which can help design better programs. Our research team searched five major databases and reviewed 2,282 studies. Nine studies met the inclusion criteria, coming from both high- and low-income countries. These studies focused on screening programs for liver disease, hepatitis B and C, hepatocellular carcinoma, diabetic retinopathy, cardiovascular diseases, and other noncommunicable diseases. However, none specifically addressed screening for metabolic dysfunction-associated steatotic liver disease in people with T2D—a growing public health concern. The studies included various groups, such as patients, health care providers, and the general population. Key factors influencing preferences included the sensitivity of screening, where and by whom the screening was provided, how long it took, and the associated cost. Participants particularly valued physician involvement in supporting treatment decisions. Although outcome-related factors (such as adherence to screening and treatment effectiveness) were less frequently studied, they were found to be highly important when included. Our study highlights a significant gap in research on metabolic dysfunction-associated steatotic liver disease screening for individuals with T2D. Future work should develop a DCE focused on this area to inform patient-centred care strategies that align with stakeholder preferences.

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Conflict of interest statement

M Swain has acted as a speaker for Gilead and Abbott, served as an advisory board member for Ipsen, Pfizer, Novo Nordisk, GSK, and Advanz, and received clinical research grants from Gilead, BMS, CymaBay, Intercept, Pfizer, Novartis, Astra Zeneca, GSK, Novo Nordisk, Axcella Health Inc., Merck, Galectin Therapeutics, Calliditas Therapeutics, Madrigal, AbbVie, Altimmune, Roche, Kowa, Ipsen, and Allergan. A Ranji has acted as speaker for AbbVie, Amgen, Advanz, Gilead, and Novo Nordisk, served as an advisory board member for AbbVie, Advanz, Gilead, and Novo Nordisk, and received clinical research grants from AbbVie, Amgen, Advanz, Gilead, Novo-Nordisc, and GSK. M Betel has served as an advisory board member for Roche. S Saeed has served as an advisory board member for Novo Nordisk. G Sebastiani has acted as a speaker for Merck, Gilead, AbbVie, Novo Nordisk, and Pfizer, served as an advisory board member for Pfizer, Merck, Novo Nordisk, and Gilead, and has received unrestricted research funding from Theratecnologies Inc. F Cinque, C Long, DA Dinh, G Gore, HS Bajaj, TG Poder, K Dasgupta, and K Patel have no competing interests.

Figures

Figure 1:
Figure 1:. PRISMA flow diagram showing the process of study selection for inclusion, with the search conducted on August 18, 2023
Figure 2:
Figure 2:. Summary of the multistep process developed by De Brún et al. for the selection of attributes and levels in a DCE, with the included studies that met each step
See this image and copyright information in PMC

References

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