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Using discrete choice experiments to understand preferences for quality of life. Variance-scale heterogeneity matters.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
2010 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 12, 1957-65 p.Article in journal (Refereed) Published
Abstract [en]

Health services researchers are increasingly using discrete choice experiments (DCEs) to model a latent variable, be it health, health-related quality of life or utility. Unfortunately it is not widely recognised that failure to model variance heterogeneity correctly leads to bias in the point estimates. This paper compares variance heterogeneity latent class models with traditional multinomial logistic (MNL) regression models. Using the ICECAP-O quality of life instrument which was designed to provide a set of preference-based general quality of life tariffs for the UK population aged 65+, it demonstrates that there is both mean and variance heterogeneity in preferences for quality of life, which covariate-adjusted MNL is incapable of separating. Two policy-relevant mean groups were found: one group that particularly disliked impairments to independence was dominated by females living alone (typically widows). Males who live alone (often widowers) did not display a preference for independence, but instead showed a strong aversion to social isolation, as did older people (of either sex) who lived with a spouse. Approximately 6-10% of respondents can be classified into a third group that often misunderstood the task. Having a qualification of any type and higher quality of life was associated with smaller random component variances. This illustrates how better understanding of random utility theory enables richer inferences to be drawn from discrete choice experiments. The methods have relevance for all health studies using discrete choice tasks to make inferences about a latent scale, particular QALY valuation exercises that use DCEs, best-worst scaling and ranking tasks.

Place, publisher, year, edition, pages
2010. Vol. 70, no 12, 1957-65 p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
URN: urn:nbn:se:uu:diva-244621DOI: 10.1016/j.socscimed.2010.03.008PubMedID: 20382460OAI: oai:DiVA.org:uu-244621DiVA: diva2:789356
Available from: 2015-02-18 Created: 2015-02-18 Last updated: 2015-02-18

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Flynn, Terry Nicholas
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