discrete choice
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Mục tiêu: Khảo sát khả năng chi trả của sinh viên ydược đối với một số vắc-xin phòng ngừa dịch bệnh tại Khoa Y, Đại học Quốc gia Thành phố Hồ Chí Minh. Đối tượng nghiên cứu: Sinh viên Yvà sinh viên Dược đang học tại Khoa Y, Đại học Quốc gia Thành phố Hồ Chí Minh. Phương pháp: Nghiên cứu cắt ngang mô tả từ tháng 01 tháng 07/2021, sử dụng phương pháp lựa chọn rời rạc (Discrete choice experiment, DCE), thông qua các câu hỏi gián tiếp để xác định ngưỡng chi trả tương ứng với các đặc tính của vắc-xin. Bên cạnh đó, mô hình tiện ích ngẫu nhiên với hồi quy logistic được áp dụng để phân tích ngưỡng chi trả và các yếu tố liên quan. Kết quả: Tổng cộng có 318 sinh viên tham gia khảo sát thỏa tiêu chí lựa chọn, đưa ra 15.264 lựa chọn vắc-xin với những đặc tính khác nhau ứng với bamức độ dịch bệnh. Ngưỡng chi trả phụ thuộc vào các đặc tính của vắc-xin như hiệu quả vắc-xin, thời gian bảo vệ, khuyến cáo của báo chí và cơ quan y tế. Kết luận: Ngưỡng chi trả có sự khác biệt rõ rệt giữa các trường hợp lựa chọn vắc xin khác nhau, phụ thuộc vào các đặc tính của vắc-xin và mức độ của bệnh.

Abstract Background. We aimed to assess public support of tailored and targeted public health interventions for various marginalized communities.Methods. We conducted a discrete choice experiment using a web-based survey advertised to Facebook and Instagram users living in Canada, aged >16. Participants were asked to choose between funding two hypothetical public health programs. Each program was described by its purpose; expected increase in life expectancy; and target group. Demographically-weighted generalized linear mixed-effects models were constructed to identify program factors associated with program selection.Results. 23,889 exercises were completed by 3,054 participants. Selected programs were less likely to focus on prevention (vs. treatment). For each 1-year increase in the marginal years of life gained, there was a 15% increase in the odds of a program being selected. Interventions tailored to marginalized communities or targeting stigmatized health conditions were less likely to be selected compared with interventions targeted to the general population or targeting chronic health conditions. Noteworthy exceptions included an increased preference for interventions aligning with the perceived needs of marginalized communities (e.g. HIV and men who have sex with men).Conclusions. Stigmatizing perceptions of health conditions and key populations likely influence public health programming preferences of Canadians. Informational campaigns highlighting disparities experienced by marginalized populations may improve support for targeted and tailored interventions.

Empowerment of control and choice of the service users in health and social care has been incorporated into service provision in various countries. This study aimed to elicit the preference of community-based long-term care (LTC) service users on levels of flexibility in service provision. A discrete choice experiment was performed among older community care service users to measure their preference for attributes of LTC services identified from a prior qualitative study. Each participant was asked to make choices in six choice tasks with two alternatives of hypothetical LTC services that were generated from the attributes. A generalized multinomial logistic model was applied to determine the relative importance and willingness to pay for the attributes. It found that the participants preferred multiple flexible providers, determining services by themselves, meeting case managers every month and social workers as sources of information on service provision. Significant preference heterogeneity was found for flexibility in providers and flexibility in services between those with and without activity of daily living impairment. The findings highlighted the preference of older adults for greater flexibility in LTC, while they rely heavily on social workers in decision making. The enhancement of flexibility in LTC should be supported by policies that allow the older service users to make decisions based on their own preferences or communication with social workers instead of determining the services and providers for them. Options should be offered to users to decide their preferred level of flexibility to better reflect their divided preferences.

IntroductionThe purpose of this investigation was to explore patients’ and oncologists’ preferences for the characteristics of a pharmacological regimen for patients with advanced renal cell carcinoma (aRCC).Material and MethodsCross-sectional observational study based on a discrete choice experiment (DCE) conducted in Spain. A literature review, a focus group with oncologists and interviews with patients informed the DCE design. Five attributes were included: progression survival gain, risk of serious adverse events (SAEs), health-related quality of life (HRQoL), administration mode, and treatment cost. Preferences were analyzed using a mixed-logit model to estimate relative importance (RI) of attributes (importance of an attribute in relation to all others), which was compared between aRCC patients and oncologists treating aRCC. Willingness to pay (WTP, payer: health system) for a benefit in survival or in risk reduction and maximum acceptable risk (MAR) in SAEs for improving survival were estimated from the DCE. Subgroup analyses were performed to identify factors that influence preference.ResultsA total of 105 patients with aRCC (77.1% male, mean age 65.9 years [SD: 10.4], mean time since RCC diagnosis 6.3 years [SD: 6.1]) and 67 oncologists (52.2% male, mean age 41.9 years [SD: 8.4], mean duration of experience in RCC 10.2 years [SD: 7.5]) participated in the study. The most important attribute for patients and oncologists was survival gain (RI: 43.6% vs. 54.7% respectively, p<0.05), followed by HRQoL (RI: 35.5% vs. 18.0%, respectively, p<0.05). MAR for SAEs was higher among oncologists than patients, while WTP (for the health system) was higher for patients. Differences in preferences were found according to time since diagnosis and education level (patients) or length of professional experience (oncologists).ConclusionPatients’ and oncologists’ preferences for aRCC treatment are determined mainly by the efficacy (survival gain) but also by the HRQoL provided. The results of the study can help to inform decision-making in the selection of appropriate aRCC treatment.

Neighborhood characteristics are important considerations when offenders make targeting decisions. Movement patterns among adults and juveniles vary widely, which impacts both the number of crime opportunities and the range of neighborhoods to which an offender is exposed. We test whether offending patterns among adult and juvenile burglars vary based on distances traveled, the types of neighborhoods targeted, and whether suspects acted alone or in a group. Using discrete choice modeling, we draw upon a unique sample of cleared burglaries in a representative city in the south over a 13-year period. Results show that adult burglars consistently travel further and are more sensitive to neighborhood conditions than their juvenile counterparts, but that group participation makes little difference in target decisions.

Understanding patients’ preferences for health facilities could help decision makers in designing patient-centered services. Therefore, this study aims to understand how patients’ willingness to trade for certain attributes affects the choice of public health facilities in the Western Cape province of Cape Town, South Africa. A discrete choice experiment was conducted in two community day centers (CDCs). Patients repetitively chose between two hypothetical health facilities that differed in six attributes: distance to facility, treatment by doctors vs. nurses, confidentiality during treatment, availability of medication, first visit (drop-in) waiting times, and appointment waiting times. The sample consisted of 463 participants. The findings showed that availability of medication (50.5%), appointment waiting times (19.5%), and first visit waiting times (10.2%) were the most important factors for patients when choosing a health facility. In addition, respondents preferred shorter appointment and first visit waiting times (<2 h). These results identified important characteristics in choosing public health facilities in Cape Town. These public health facilities could be improved by including patient voices to inform operational and policy decisions in a low-income setting.