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      Discrete choice analysis of health worker job preferences in Ethiopia: Separating attribute non‐attendance from taste heterogeneity

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          Abstract

          When measuring preferences, discrete choice experiments (DCEs) typically assume that respondents consider all available information before making decisions. However, many respondents often only consider a subset of the choice characteristics, a heuristic called attribute non‐attendance (ANA). Failure to account for ANA can bias DCE results, potentially leading to flawed policy recommendations. While conventional latent class logit models have most commonly been used to assess ANA in choices, these models are often not flexible enough to separate non‐attendance from respondents' low valuation of certain attributes, resulting in inflated rates of ANA. In this paper, we show that semi‐parametric mixtures of latent class models can be used to disentangle successfully inferred non‐attendance from respondent's “weaker” taste sensitivities for certain attributes. In a DCE on the job preferences of health workers in Ethiopia, we demonstrate that such models provide more reliable estimates of inferred non‐attendance than the alternative methods currently used. Moreover, since we find statistically significant variation in the rates of ANA exhibited by different health worker cadres, we highlight the need for well‐defined attributes in a DCE, to ensure that ANA does not result from a weak experimental design.

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          A New Approach to Consumer Theory

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            Discrete Choice Experiments in Health Economics: Past, Present and Future

            Objectives Discrete choice experiments (DCEs) are increasingly advocated as a way to quantify preferences for health. However, increasing support does not necessarily result in increasing quality. Although specific reviews have been conducted in certain contexts, there exists no recent description of the general state of the science of health-related DCEs. The aim of this paper was to update prior reviews (1990–2012), to identify all health-related DCEs and to provide a description of trends, current practice and future challenges. Methods A systematic literature review was conducted to identify health-related empirical DCEs published between 2013 and 2017. The search strategy and data extraction replicated prior reviews to allow the reporting of trends, although additional extraction fields were incorporated. Results Of the 7877 abstracts generated, 301 studies met the inclusion criteria and underwent data extraction. In general, the total number of DCEs per year continued to increase, with broader areas of application and increased geographic scope. Studies reported using more sophisticated designs (e.g. D-efficient) with associated software (e.g. Ngene). The trend towards using more sophisticated econometric models also continued. However, many studies presented sophisticated methods with insufficient detail. Qualitative research methods continued to be a popular approach for identifying attributes and levels. Conclusions The use of empirical DCEs in health economics continues to grow. However, inadequate reporting of methodological details inhibits quality assessment. This may reduce decision-makers’ confidence in results and their ability to act on the findings. How and when to integrate health-related DCE outcomes into decision-making remains an important area for future research. Electronic supplementary material The online version of this article (10.1007/s40273-018-0734-2) contains supplementary material, which is available to authorized users.
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              Discrete choice experiments in health economics: a review of the literature.

              Discrete choice experiments (DCEs) have become a commonly used instrument in health economics. This paper updates a review of published papers between 1990 and 2000 for the years 2001-2008. Based on this previous review, and a number of other key review papers, focus is given to three issues: experimental design; estimation procedures; and validity of responses. Consideration is also given to how DCEs are applied and reported. We identified 114 DCEs, covering a wide range of policy questions. Applications took place in a broader range of health-care systems, and there has been a move to incorporating fewer attributes, more choices and interview-based surveys. There has also been a shift towards statistically more efficient designs and flexible econometric models. The reporting of monetary values continues to be popular, the use of utility scores has not gained popularity, and there has been an increasing use of odds ratios and probabilities. The latter are likely to be useful at the policy level to investigate take-up and acceptability of new interventions. Incorporation of interactions terms in the design and analysis of DCEs, explanations of risk, tests of external validity and incorporation of DCE results into a decision-making framework remain important areas for future research. Copyright © 2010 John Wiley & Sons, Ltd.
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                Author and article information

                Contributors
                Nikita.arora@lshtm.ac.uk
                Journal
                Health Econ
                Health Econ
                10.1002/(ISSN)1099-1050
                HEC
                Health Economics
                John Wiley and Sons Inc. (Hoboken )
                1057-9230
                1099-1050
                17 February 2022
                May 2022
                : 31
                : 5 ( doiID: 10.1002/hec.v31.5 )
                : 806-819
                Affiliations
                [ 1 ] Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine London UK
                [ 2 ] Department of Health Policy London School of Economics and Political Science London UK
                [ 3 ] School of Public Health Addis Ababa University Addis Ababa Ethiopia
                [ 4 ] Centre for Decision Research, Management Division Leeds University Business School Leeds UK
                Author notes
                [*] [* ] Correspondence

                Nikita Arora, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.

                Email: Nikita.arora@ 123456lshtm.ac.uk

                Author information
                https://orcid.org/0000-0001-5123-7751
                https://orcid.org/0000-0001-9291-1511
                https://orcid.org/0000-0002-5713-2659
                Article
                HEC4475
                10.1002/hec.4475
                9305885
                35178825
                49a363d9-1c1f-4a79-8b90-ca5f44a90dbb
                © 2022 The Authors. Health Economics published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 January 2022
                : 28 January 2021
                : 11 January 2022
                Page count
                Figures: 1, Tables: 6, Pages: 0, Words: 8201
                Funding
                Funded by: Bill and Melinda Gates Foundation , doi 10.13039/100000865;
                Award ID: OPP1149259
                Funded by: Wellcome Trust
                Award ID: 212771/Z/18/Z
                Categories
                C01
                C35
                D01
                D80
                Research Article
                Research Articles
                Custom metadata
                2.0
                May 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:22.07.2022

                Economics of health & social care
                attribute non‐attendance,discrete choice experiment,health workers,preference heterogeneity

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