Discrete choice experiments for complex health-care decisions: does hierarchical information integration offer a solution?

Debby van Helvoort-Postulart, Benedict G.C. Dellaert, Trudy van der Weijden, Maarten F. von Meyenfeldt and Carmen D. Dirksen
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Debby van Helvoort-Postulart: Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, The Netherlands, Postal: Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, The Netherlands
Trudy van der Weijden: Department of General Practice, School of Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands, Postal: Department of General Practice, School of Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands
Maarten F. von Meyenfeldt: Department of General Surgery, University Hospital Maastricht, Maastricht, The Netherlands, Postal: Department of General Surgery, University Hospital Maastricht, Maastricht, The Netherlands
Carmen D. Dirksen: Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, The Netherlands, Postal: Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, The Netherlands

Health Economics, 2009, vol. 18, issue 8, pages 903-920

Abstract: This paper describes an application of hierarchical information integration (HII) discrete choice experiments. We assessed theoretical and construct validity, as well as internal consistency, to investigate whether HII can be used to investigate complex multi-faceted health-care decisions (objective 1). In addition, we incorporated recent advances in mixed logit modelling (objective 2). Finally, we determined the response rate and predictive ability to study the feasibility of HII to support health-care management (objective 3). The clinical subject was the implementation of the guideline for breast cancer surgery in day care, which is a complex process that involves changes at the organizational and management levels, as well as the level of health-care professionals and that of patients.

We found good theoretical and construct validity and satisfactory internal consistency. The proposed mixed logit model, which included repeated measures corrections and subexperiment error scale variations, also performed well. We found a poor response, but the model had satisfactory predictive ability. Therefore, we conclude that HII can be used successfully to study complex multi-faceted health-care decisions (objectives 1 and 2), but that the feasibility of HII to support health-care management, in particular in challenging implementation projects, seems less favourable (objective 3). Copyright © 2008 John Wiley & Sons, Ltd.

Date: 2009
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