Alternative-specific Conditional Logit Research Articles

Preferences for coordinated care for rare diseases: discrete choice experiment

BackgroundEvidence suggests that coordination of care for people affected by rare diseases is poor. In order to improve the way that care is coordinated it is necessary to understand the preferences of people affected by these conditions, and providers. The aim of this study was to examine patient, parent and carer, and health care professional preferences for different attributes of care coordination for people affected by rare diseases. We conducted a discrete choice experiment using online surveys. There were no restrictions on participants in terms of rare conditions, demographic factors other than age, or geographical location within the UK. Choice scenarios were based on the following attributes: annual cost of attending appointments; access to health records; access to clinical expertise; support of a care coordinator; access to a specialist centre; and, the existence of a documented plan for emergency care. Data were analysed using alternative-specific conditional logit regression models.ResultsValid responses were obtained from 996 individuals (528 patients, 280 carers, 188 health care professionals) between August and December 2019. All attributes significantly influenced the type of service respondents preferred. Patients, carers and health professionals’ preferences for care coordination were influenced by: the cost of attending appointments; access to health records; clinical expertise; role of care coordinators; access to specialist centres; and the existence of plan for emergency care. There were no statistically significant differences in the preferences between patients and carers. Preferences of health professionals differed to those of patients and carers. Both patients and carers selected responses which granted them a greater degree of autonomy in relation to the role of care coordinators, whereas health professionals preferred services where care coordinators had more autonomy. Health care professionals also expressed a stronger preference for a documented formal emergency plan to be in place.ConclusionsThe findings highlight that people value better coordinated care, in line with policy documents emphasising commitments to coordinated care for people affected by rare diseases. This study highlights the factors that could be included in service provision as ways of improving the coordination of care for people affected by rare diseases.

Patient Preferences for Rescue Medications in the Treatment of Breakthrough Cancer Pain.

The discrete choice experiment (DCE) is conducted in this study to discuss Chinese cancer patients' risk-benefit preferences for rescue medications (RD) and their willingness to pay (WTP) in the treatment of breakthrough cancer pain (BTcP). Through literature reviews, specialist consultation, and patient surveys, this work finally included five attributes in the DCE questionnaire, i.e., the remission time of breakthrough pain, adverse reactions of the digestive system, adverse reactions of the neuropsychiatric system, administration routes, and drug costs (estimating patients' WTP). The alternative-specific conditional logit model is used to analyze patients' preferences and WTP for each attribute and its level and to assess the sociodemographic impact and clinical characteristics. A total of 134 effective questionnaires were collected from January, 1 to April, 5 in 2022. Results show that the five attributes all have a significant impact on cancer patients' choice of "rescue medications" (P<0.05). Among these attributes, the remission time after drug administration (10.0; 95%CI 8.5-11.5) is the most important concern for patients, followed by adverse reactions of the digestive system (8.5; 95%CI 7.0-10.0), adverse reactions of the neuropsychiatric system (2.9; 95%CI 1.4-4.3), and administration routes (0.9; 95%CI 0-1.8). The respondents are willing to spend 1182 yuan (95%CI 605-1720 yuan) per month for "rescue medications" to take effect within 15 minutes and spend 1002 yuan (95%CI 605-1760 yuan) per month on reducing the incidence of drug-induced adverse reactions in the digestive system to 5%. For Chinese cancer patients, especially those with moderate/severe cancer pain, the priority is to relieve the BTcP more rapidly and reduce adverse drug reactions more effectively. This study indicates these patients' expectations for the quick control of breakthrough pain and their emphasis on the reduction of adverse reactions. These findings are useful for doctors, who are encouraged to communicate with cancer patients about how to better alleviate the BTcP.

Work, Childcare, or Both? Experimental Evidence on the Efficacy of Childcare Subsidies in Raising Parental Labor Supply

As a policy tool aimed at raising parental labor supply, childcare subsidies come with high expectations. Using data from a factorial survey conducted in the City of Bern, Switzerland, we examine whether childcare subsidies reach their goal. Because of the simultaneity of the decision to take up a job and arranging childcare, we experimentally alter hypothetical income (e.g., gross earnings from a job, income from other sources) as well as aspects of the childcare setting including subsidy levels. Using an alternative-specific conditional logit model, we show that subsidies have the expected effect of increasing parents’ labor supply. Moreover, the results from simulations based on the estimated utility function show that varying subsidy levels have different effects on subgroups of parents. Subsidies are especially efficient in raising the labor supply of low-status parents, and especially for women. We also find that subsidies already have the desired effect at 25% of total childcare costs and that the marginal utility of higher subsidy levels decreases beyond that threshold. Subsidies covering 25% of the total costs for childcare lead to an approximately 2 h per week increase in the labor supply of women.

Patient Preference for Antiepileptic Drugs Treatment in China: Evidence From the Discrete Choice Experiment.

Objective: Explore Chinese patients' risk-benefit preferences and willingness-to-pay (WTP) for antiepileptic drugs (AEDs) treatment through the discrete choice experiment (DCE).Method: Six attributes including the efficacy of AEDs, adverse reactions (digestive system, neuropsychic systems, and the effects on the fetus), dosing frequency and drug costs (to estimate patient WTP) were included in the DCE questionnaire based on results collected from literature reviews, expert consultation, and patient survey. The alternative-specific conditional logit model was used to analyze patient preference and WTP for each attribute and its level and to assess the sociodemographic impact and clinical characteristics.Results: A total of 151 valid questionnaires were collected. The result shows that five out of the six attributes are significant, except the dosing frequency. Among the six attributes, the efficacy of AEDs (10.0; 95% CI 8.9–11.1) is mostly concerned by patients, followed by the effects of AEDs on the fetus (8.9; 95% CI 7.7–10.1), duration of side effects in the neuropsychic system (4.9; 95% CI 3.7–6.0) and adverse reactions of the digestive system (3.2; 95% CI 1.5–4.2). The patients surveyed are willing to spend ¥ 1,246 (95% CI, ¥ 632- ¥ 1,861) per month to ensure 100% seizure control, and ¥ 1,112 (95% CI, ¥ 586–¥ 1,658) to reduce the risk of the drug affecting the fetus to 3%. Besides, it was found that personal characteristics including the intention for conception and AEDs treatment regimens have statistical significance.Conclusion: Improving the drug's efficacy and reducing its side effects are predominant considerations for patients with epilepsy in China, especially for those who are concerned about the seizure control and the drug effect on the fetus. This finding is useful to physicians and can encourage shared decision-making between the patients and their doctors in the clinic.

District or distributed space heating in rural residential sector? Empirical evidence from a discrete choice experiment in South China

Rural residential space heating is strongly linked to policy considerations related to the clean energy supply and rural sustainable development. As there has been a hot debate on whether to promote district heating in South China, this paper aims to investigate household heating choices with a particular focus on rural residential sector, using the survey data from Sichuan Province. In order to investigate the main influencing factors of household decision-making behaviors, a multinomial logit (MNL) model with sample selection correction and an alternative-specific conditional logit (ASCL) model were used to respectively analyze the actual and stated choices. The estimation results show that energy-specific attributes such as safety level and smoky level have statistically significant effects on household stated preferences for heating systems. Households prefer to adopt lower-cost heating system with high quality energy sources. Among household-specific characteristics, income level, educational level of the decision-maker, household demographic structure, and household location are important determinants of heating fuel choices. These findings suggest that future energy policy should pay more attention to its combined effect on both cost and quality of heating system as well as its different regional effects. Besides, enhancing household socio-economic status should also be attached importance in policy design.

Hotel choice: A closer look at demographics and online ratings

In this paper, the authors explore how demographic variables and online ratings may affect hotel choice in a sample of 279 customers. By means of an alternative-specific conditional logit (asclogit) method, the authors evidence that age and gender affect choice decisions about motels, city hotels, and hotel resorts differently. There is a lower chance for customers to choose a motel if they have a higher income. The authors also find that domestic customers have a higher preference for hotel resorts, while foreign customers prefer city hotels, even though there are more motels in their area. Finally, online ratings exert strong effects on hotel choice at the 5-star rating level. The findings of this study provide marketing scholars and practitioners the necessary evidence for making statistic inferences on a choice behavior model and predicting customer decision-making.

Investigating consumer hospital choice: Demand and supply-side levers could address health care costs

ObjectivePolicies that aim to steer patients from higher to lower cost providers of comparable quality have potential to impact health care cost growth – but their effectiveness depends, in part, on consumer perceptions of value and willingness to make tradeoffs. We sought to understand what was required to shift substantial numbers of consumers to higher-value care settings for several “shoppable” conditions. MethodsA discrete choice experiment (DCE) was conducted to elicit patient preferences for hospital type. We used an Internet panel of 1005 Massachusetts residents to conduct this experiment in 2016. The DCE data were analyzed using alternative-specific conditional logit regression. ResultsConsumers reported large influences of out of pocket costs, physician referrals and quality ratings on their choice of hospital. For example, up to a third of consumers would shift from Academic Medical Centers to community hospitals if the latter had higher quality ratings, lower copays or a physician referral. Choice of site for maternity care was most influenced by physician referral; cancer treatment and orthopedic procedures by quality ratings; and MRI by cost, suggesting that patients prioritize quality over cost as perceived risk increases. Conclusions and implicationsOur findings provide guidance for identifying promising policy levers that most influence consumer choice of provider. However, the extent to which potential levers can influence choice is likely to be dependent upon the kind of care being sought.

Influences of Material Aspirations on Migration.

In this article, we investigate the influences of material aspirations on migration in Nepal, positing that material aspirations may have important influences on decisions to migrate and where to locate. We discuss a theoretical model explaining how these aspirations might be key influences in the migration decision. Using detailed continuous migration histories from the 2008-2012 Chitwan Valley Family Study, we estimate logistic and alternative-specific conditional logit models to examine how material aspirations in Nepal influence migration rates and destinations. Our empirical analyses provide strong evidence that material aspirations have large effects on overall rates of migration and affect destination-specific migration rates, particularly for relatively wealthy Western and Asian destinations. We also show an interaction effect between material aspirations and destination-specific expected earnings in influencing people's migration choices. It is the people with high aspirations who migrate to destinations with high earning potentials.

What to Buy When Forum Shopping? Analyzing Court Selection in Patent Litigation

This paper examines court selection by plaintiffs in patent litigation. We build a forum shopping model that provides a set of predictions regarding plaintiffs' court preferences, and the way these preferences depend on the market proximity between the plaintiff and the defendant. Then, using a rich dataset of patent litigation at German regional courts between 2003 and 2008, we estimate the determinants of court selection with alternative-specific conditional logit models. In line with our theoretical predictions, our empirical results show that plaintiffs prefer courts that have shorter proceedings, especially when they compete against the defendants they face. Further, we find negative effects of the plaintiff's, as well as the defendant's, distance to court on the plaintiff's court selection. Our empirical analysis also allows us to infer whether plaintiffs perceive a given court as more or less pro-patentee than another one.

Effect Of Liability Of Foreignness And Family Ownership On Cross-Listing Location Choice

Firms incur liability of foreignness (LOF) when they expand their businesses to foreign countries. This study examines the applicability of LOF in the context of financing in a foreign capital market. Using an alternative-specific conditional logit model, we investigate the cross-listing decisions of firms from 28 countries that select among eight target destinations from 1994 to 2008. These firms target capital markets with lower LOF, which is measured by institutional, economic, geographic, and cultural distance. Such preference is particularly stronger for firms with higher levels of family ownership, suggesting family owners’ tendency to be averse to risk is also manifested in financing context.

Household biomass energy choice and its policy implications on improving rural livelihoods in Sichuan, China

It is widely known that a switch from traditional biomass energy to modern clean, safe and efficient energy could improve local rural livelihoods by enhancing the access to ‘high quality’ energy and reducing the negative impacts of traditional biomass energy on health, environment and living standards. Hence, in this paper, we used alternative-specific conditional logit model (ASCLM) to examine the rural household energy choice behaviors in Sichuan Province of China from the perspective of revealed and stated preferences. The results show that the fuel switching in our study region is not a simple unidirectional process from traditional biomass energy to modern fuels as incomes improve. Household energy choice behaviors could be not only affected by energy-specific characteristics such as fuel price, smoky level and safety risk, but also influenced by household-specific factors such as income level, age and educational level of the decision maker, household demographic structure, number of people frequently eating at home, distance to the nearest biomass collecting spot and household location, suggesting that government should attach more importance to simultaneously improve energy quality, control energy price and enhance household socio-economic status.

Healthcare seeking behaviour among self-help group households in Rural Bihar and Uttar Pradesh, India.

BackgroundIn recent years, supported by non-governmental organizations (NGOs), a number of community-based health insurance (CBHI) schemes have been operating in rural India. Such schemes design their benefit packages according to local priorities. This paper examines healthcare seeking behaviour among self-help group households with a view to understanding the implications for the benefit packages offered by such schemes.MethodsWe use cross-sectional data collected from two of India’s poorest states and estimate an alternative-specific conditional logit model to examine healthcare seeking behaviour.ResultsWe find that the majority of respondents do access some form of care and that there is overwhelming use of private providers. Non-degree allopathic providers (NDAP) also called rural medical practitioners are the most popular providers. In the case of acute illnesses, proximity plays an important role in determining provider choice. For chronic illnesses, cost of care influences provider choice.ConclusionGiven the importance of proximity in determining provider choice, benefit packages offered by CBHI schemes should consider coverage of transportation costs and reimbursement of foregone earnings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1254-9) contains supplementary material, which is available to authorized users.