Using discrete choice experiments to go beyond clinical outcomes when evaluating clinical practice

• Published in: Journal of evaluation in clinical practice Vol. 11; no. 4; pp. 328 - 338
• Main Authors: Ryan, Mandy, Major, Kirsten, Skåtun, Diane
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.08.2005
• Subjects: Clinical Medicine - organization & administration; discrete choice experiments; Female; Financing, Personal; Humans; Male; Middle Aged; patient preferences; Patient Satisfaction; Referral and Consultation; Rheumatology; State Medicine - organization & administration; Surveys and Questionnaires; Treatment Outcome; United Kingdom; Waiting Lists; willingness to pay
• ISSN: 1356-1294; 1365-2753
• DOI: 10.1111/j.1365-2753.2005.00539.x

Background  This study builds on the results of a randomized controlled trial concerned with examining the effect of reducing waiting times on the health status of patients referred for non‐urgent rheumatology opinion. No difference in clinical outcomes was found between a ‘fast‐track’ and ‘ordinary’ appointment system. This suggests that rationing by waiting times is not detrimental to health. However, such an approach ignores the value patients attach to reducing waiting time. Objectives  To estimate the monetary value of reducing waiting time, as well as changes in duration of appointment and the introduction of a pain management service, in the provision of rheumatology services. Methods  Discrete choice experiment (DCE). Setting  The main outpatient clinic of the rheumatology service for the Lothian and Borders region. Subjects  262 patients who had received a specialist rheumatology opinion – 73 had received fast‐track treatment, 65 standard care and 124 were non‐trial patients. Results  A response rate of 71% was achieved. Patients valued a 9‐week reduction in waiting time at £131. However, the introduction of a pain management service was valued at £209. Thus, the latter is of more value to respondents. Evidence was also found of the internal consistency and theoretical validity of the DCE approach. Conclusions  The reduction of waiting times is a central plank of NHS policy. Whilst a reduction in waiting time is of value, a pain management service is of more benefit than a 9‐week reduction in waiting time. DCE were shown to be a potentially useful technique for valuing different aspects of health care interventions.