PIH66 - A Systematic Review To Identify the Use of Preference Elicitation Methods in Health Care Decision Making

Abstract

Objectives: Preference elicitation methods (PEMs) offer the potential to increase patient-centered medical decision-making (MDM), by offering a measure of benefit along with a measure of value. Preferences can be applied in decisions on: reimbursement, including health technology assessment (HTA); market access, including benefit-risk assessment (BRA), and clinical care. The three decision contexts have different requirements for use and elicitation of preferences. The aim of this systematic review was to identify studies that used PEMs to represent the patient view and identify the types of health care decisions addressed by PEMs. Additionally, PEMs were described by methodological and practical characteristics within the three contexts’ requirements. Methods: Search terms included those related to MDM and patient preferences. Only articles with original data from quantitative PEMs were included. Results: Articles (n=322) selected included 379 PEMs, comprising matching methods (MM) (n=71,18.7%), discrete choice experiments (DCE) (n=96,25.3%), multi-criteria decision analysis (n=12,3. 2%), and other methods (i. e. rating scales), which provide estimates inconsistent with utility theory (n=200,52.8%). Most publications of PEMs had an intended use for clinical decisions (n=134,40%), HTA (n=68,20%), or BRA (n=12,4%). However, many did not specify an intended use (n=156,41.1%). In clinical decisions, rating, ranking, visual analogue scales and direct choice are used most often. In HTA, DCEs and MM are both used frequently, and the elicitation of preferences in BRA was limited to DCEs. Conclusions: Relatively simple preference methods are often adequate in clinical decisions, because they are easy to administer, give fast results, place low cognitive burden on the patient, and low analytical burden on the provider. MM and DCE fulfill the requirements of HTA and BRA but are more complex for the respondents. There were no PEMs that had low cognitive burden, and strong methodological underpinnings which could deliver adequate information to inform HTA and BRA decisions.