Marginal Rate Of Substitution Research Articles

Musculoskeletal patients’ preferences for care from physiotherapists or support workers: a discrete choice experiment

BackgroundDelegation of clinical tasks from physiotherapists to physiotherapy support workers is common yet varies considerably in musculoskeletal outpatient physiotherapy services, leading to variation in patient care. This study aimed to explore patients’ preferences and estimate specific trade-offs patients are willing to make in treatment choices when treated in musculoskeletal outpatient physiotherapy services.MethodsA discrete choice experiment was conducted using an efficient design with 16 choice scenarios, divided into two blocks. Adult patients with musculoskeletal conditions recruited from a physiotherapy service completed a cross-sectional, online questionnaire. Choice data analyses were conducted using a multinomial logit model. The marginal rate of substitution for waiting time to first follow-up physiotherapy appointment and distance from the physiotherapy clinic was calculated and a probability model was built to estimate the probability of choosing between two distinct physiotherapy service options under different scenarios.Results382 patient questionnaires were completed; 302 participants were treated by physiotherapists and 80 by physiotherapists and support workers. There was a significant preference to be seen by a physiotherapist, have more follow-up treatments, to wait less time for the first follow-up appointment, to be seen one-to-one, to see the same clinician, to travel a shorter distance to get to the clinic and to go to clinics with ample parking. Participants treated by support workers did not have a significant preference to be seen by a physiotherapist and it was more likely that they would choose to be seen by a support worker for clinic scenarios where the characteristics of the physiotherapy service were as good or better.ConclusionsFindings highlight that patients treated by support workers are likely to choose to be treated by support workers again if the other service characteristics are as good or better compared to a service where treatment is provided only by physiotherapists. Findings have implications for the design of physiotherapy services to enhance patient experience when patients are treated by support workers. The findings will contribute to the development of “best practice” recommendations to guide physiotherapists in delegating clinical work to physiotherapy support workers for patients with musculoskeletal conditions.

A novel choice model combining utility maximization and the disjunctive decision rules, application to two case studies

Most choice models, e.g. Multinomial Logit (MNL), rely on random utility theory, which assumes that a compensatory utility maximization decision rule explains an individual’s choice behaviour. Research has shown, however, that behaviour is sometimes better explained by non-compensatory decision rules. While some research has used Latent Class Choice Models (LCCMs) to account for multiple decision rules, many of them – such as the disjunctive rule – have yet to be explored. This paper formulates, estimates, and evaluates a LCCM that combines the MNL with a Generalised Random Disjunctive Model (GRDM), a new choice model we develop. Addressing deficiencies of existing disjunctive choice models, the GRDM allows for relative importance between attributes and is insensitive to irrelevant attributes. Unlike most non-compensatory models, it is tractable and incorporates random error terms for capturing unobserved heterogeneity across choice situations. The GRDM can be expressed as a Universal Logit (UL) model, which helps derive welfare metrics such as Marginal Rates of Substitution and elasticities and makes it possible to estimate the model with traditional software packages. The LCCM combining the GRDM and the MNL is estimated in two large-scale case studies: cyclists’ route choice and public transport route choice. Results are compared with other relevant LCCM specifications and the individual choice models, where it is found that the MNL + GRDM LCCM provides the best fit to the data. We also interpret the fitted parameters and calculate the Marginal Rates of Substitution, which align with behavioural expectations.

Assessing the American public’s preferences for reforms to teen driving licensure systems: a discrete choice experiment

ObjectivesTo analyse factors influencing the American public’s preferences for changes to teenage driver licensing requirements.MethodsWe employed a discrete choice experiment (DCE) with 808 participants from National Opinion Research Center’s AmeriSpeak...

Does Inflation Matter? The Influence of Perceived Price Changes on Well-being

We confirm the inflation and well-being correlation scheme while filling the gap in the literature and estimating the effects of inflation perception on wellbeing. We discover the significant heterogeneity in attitudes toward inflation and inflation perception among European countries. While the inflation perception influence on well-being in Eastern Europe is higher than the influence of HICP, for Western Europe, it is the opposite. Both groups differ in terms of the marginal rate of substitution between inflation and unemployment – the effects of higher unemployment are more severe in comparison to the influence of inflation in Western Europe.

Revealed Preferences for Utilitarian Cycling Energy Expenditure versus Travel Time

This paper quantifies the perceived cost of utilitarian cycling energy expenditure as the marginal rate of substitution between energy expenditure and travel time (MRSet). This trade-off manifests in, and can be inferred from cyclist cruising speeds. Median MRSet values for observed cruising events in a naturalistic cycling dataset range from 0.05 to 0.95 min/km per kcal/min. The revealed cost of energy expenditure (relative to travel time) increases significantly with road grade, traffic controls, and certain facility types, and is also significantly higher for women, less-dedicated cyclists, and people riding on weekends and for non-commute purposes.

Conceptual Properties of Islamic Economic Modeling: Complexity, Nonlinearity, and Endogeneity in Epistemological Perspectives

This paper introduces a new perspective of economic reasoning and analysis pertaining to situations of complexity combined with nonlinearity and endogenous relations among interacting, integrating and evolutionary entities. The entities comprise multi-variables representing different embedded systems that encompass economy, society, science, and ethics. In the emergent model of endogenous inter-causal relationships between such entities the ontological perspective assumes the nature of evaluating inter-causal intra- and inters- systemic relations by means of formalism belonging to functional ontology of mathematical forms (Gruber, 1993), as opposed to invoking metaphysical ontological speculation. The functional ontological approach to structure and formalize leads to a new framework of economic reasoning in the presence of embedded systems that continuously participate and complement, as opposed to being subjected to the central postulate of marginal rate of substitution and exogenous treatment of knowledge in mainstream economics. The continuous phenomenon of interaction, integration, and evolutionary (IIE) learning in such inter-causal systems establish ethical endogeneity. Thus, philosophical background of economic reasoning is invoked in the functional epistemological formalism of the interactive, integrative, and evolutionary systems. That is sush systems are characterized by IIE-learning processes induced by the episteme of unity of knowledge.

Physician preferences for nonmetastatic castration-resistant prostate cancer treatment in China.

The treatment preferences of Chinese physicians who treat nonmetastatic castration-resistant prostate cancer (nmCRPC) and how they weigh the benefits and risks of nmCRPC treatment are still unknown. This study aimed to evaluate Chinese physicians' benefit-risk treatment preferences for nmCRPC and assist in setting nmCRPC treatment goals. A paper-based discrete choice experiment (DCE) survey was administered to 80 nmCRPC-treating physicians. DCE responses were analyzed to produce the preference weight and the relative importance score for each attribute level. The marginal rate of substitution (MRS) was used to quantify the amount of overall survival (OS) physicians were willing to trade for a reduction in treatment-related adverse events (AEs). We further conducted the exploratory analysis, stratifying physicians from 5 perspectives into different subgroups and examining the treatment preferences and OS trade-off in each subgroup. In terms of efficacy attributes, physicians placed greater emphasis on OS than time to pain progression. With regard to safety attributes, serious fracture was perceived as the most important AE by physicians, followed by serious fall, cognitive problems, skin rash, and fatigue. In the exploratory analysis, we found generally that physicians with less clinical practice experience and those from more economically developed regions placed more emphasis on AEs and were willing to give up more of their patients' OS to reduce the risk of AEs. Physicians from mainland China value the importance of minimizing treatment-related AEs when considering different treatment options for patients with nmCRPC, and they are willing to trade a substantial amount of OS to avoid AEs.

Calculating the economic value of non-marginal mortality risk reductions

Benefit–cost analyses in public health typically calculate the benefits of mortality reduction interventions by multiplying the Value of a Statistical Life (VSL) and the expected decrease in fatalities. This procedure approximates the benefits of small mortality changes but is inaccurate for large risk changes because it holds constant the VSL—a marginal rate of substitution. Building on the theoretical framework of the VSL, we derive expressions to calculate the benefits of non-marginal mortality reductions with empirically calibrated compensating variations and illustrate their use.

The Win-Win-Win Papakonstantinidis Model and the Economic MRS: Some Lessons From Linear B

The suggested "win-win-win papakonstantinidis model" (coming from Nash1 win-win extended approach) tries to find ways for the three-pole bargaining conceptual equilibrium, under conditions, thus maximizing expected utilities for all the involved parties AND the Community in local decision-making by applying a combination of Descriptive Behavior (DB), Rational Choice, Instrumental Rationality and the Applied Behavioral Analysis (ABA) methodologies, then an updating community's behavioral state is expected. In the opposite, the Marginal Rate of Substitution - which is analyzed from the view of Political Economy- leads our thoughts into the pure individualism and the need to interpret all the transactions we make and the corresponding decisions through the maximization of our individual satisfaction By this definition the win-win-win papakonstantinidis model2 helps the scientific thought so to understand the "socially acceptable substitution" thus deriving profit from providing the community with the necessary “emotional intelligence” among the people of a self-organizing community, drawing stimuli from distributions made in the Greek area 1450 years BC.

Estimating utility values for non-alcoholic steatohepatitis health states: a discrete choice experiment.

Background: This study estimated utility values for non-alcoholic steatohepatitis (NASH). Previous studies have assumed that health-related quality of life does not vary between the early stages of NASH. Materials & Methods: Discrete choice experiment (DCE) surveys estimated the value of avoiding fibrosis progression. Patients also completed the EQ-5D-5L. Marginal rates of substitution estimated utility change associated with fibrosis progression. Results: DCE surveys were completed by the UK general public (n=520) and patients with NASH (n=154). The utility decline between fibrosis stages F1 and F4 decompensated was between -0.521 to -0.646 (depending on method). Conclusion: Three methods were used to estimate utilities for NASH, each one showed sensitivity to advancing fibrosis, including in the early stages, which is often considered asymptomatic.

The digitalisation, dematerialisation and decarbonisation of the global economy in historical perspective: the relationship between energy and information since 1850

To better understand the processes of digitalisation, dematerialisation and decarbonisation, this paper examines the relationship between energy and information for the global economy since 1850. It presents the long run trends in energy intensity and communication intensity, as a proxy for total information intensity. The evidence suggests that, relative to GDP, global economic production has been reducing energy and increasing information use since 1913. The analysis indicates that it initially required little information to replace energy in production and that the ability to substitute away from energy and towards information has been declining. The result implies that the global economy is now reducing energy and increasing information at a substitution rate of 0.2 kB per kWh of conserved energy or 0.8 GB per tonne of carbon dioxide mitigated. As the price ratio of energy to information is currently higher than this marginal rate of substitution, there are incentives to further substitute information for energy. However, one conclusion is that (without the long run escalation of carbon prices) substitution away from energy and towards information is likely to cease within the next few decades and, beyond that, digitalisation will play a declining role in the decarbonisation process.

Decision-making based on sustainability analysis using GREENSCOPE

Current economic and environmental pressure encourages companies to invest and reform processes in a sustainable way. However, the decision on the best sustainable investment in a given industry may not be as straightforward as given by the independent economic and environmental indicators. Analyzing such indicators for investment in process alternatives is a complex multi-objective decision-making process. Many methods can help solve multi-objective problems, GREENSCOPE suggests using the Addictive Utility Method, which may have some shortcomings. In this work, the Analytic Hierarchy Process and the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) are applied to the indicator scores obtained with the GREENSCOPE methodology. The Analytical Hierarchy Process is applied with Marginal Rate of Substitution, to obtain the priority matrices. MATLAB was used to apply the methods and through an algorithm, to determine the adequate number of indicators to be used. Three cases were studied, namely a biorefinery plant, and two academic case studies on the production of acetaldehyde from ethanol and propylene glycol from glycerol. The two academic cases were modeled in Aspen Plus, to obtain process data, and linked to GREENSCOPE using MATLAB. The methodology was applied to some proposed alternatives where the sustainability improvement of energy integration and material recycling was tested. The new methodology was able to identify the more sustainable case among the alternatives. This methodology based on TOPSIS proved to be the best choice, avoiding the weighting of indicators, and providing an expected analytical decision among alternatives.Graphical abstract

Time and distance matter: Study on the public sentiment during the COVID-19 pandemic in a mega-city

This study examines public sentiment during the COVID-19 pandemic, considering time, space, and the severity of the event, and leverages the marginal rate of substitution (MRS). Based on the context of COVID-19 transmission in a mega-city, we set up a novel theoretical model of public sentiment, showing the time-space substitution effect. Then, using the daily panel data including all the prefecture-level cities in China, empirical results show that the level of public sentiment is positively related to the severity of the event, while it is negatively related to the distance and the length of the period. To make the level of public sentiment equal, 1 km farther from the center of the event will require 0.072 to 0.130 days closer to the starting time on average. We further investigate the relationship between the level of public sentiment and time, which can be better depicted as a reversed U-shape. The original contribution of the piece arises principally around the novel application of the concept of the marginal rate of substitution drawn from neoclassical economics, providing insightful policy implications for pandemic control.

FISCAL ASPECTS OF THE EQUITY-EFFICIENCY TRADE-OFF

This study makes an attempt to trace out the extent to which (in)direct taxation distorts consumers’ behavior, thus being a hindrance towards achieving an optimal allocation of resources between equity and efficiency targets. To substantiate our argument, a utility maximization model is built to examine whether fiscal policy restores public confidence in attaining equilibrium between the marginal rate of substitution (MRS) and the marginal rate of transformation (MRT). The validity of our model is then tested by using a sample of eleven countries. Comparing actual with optimal (in)direct tax rates, we find that the tax system of eight countries tends to favor equity over efficiency (actual direct (indirect) tax rates higher (lower) than optimal direct (indirect) tax rates) and the tax system of three countries tends to apply the efficiency principle.

Effect of the COVID-19 pandemic on crowding aversion in public transport and transport mode choice: The case of Santiago, Chile

Mode choice modeling has shown a significant crowding effect over travel time perception. But the recent COVID-19 pandemic and the related sanitary measures have changed perceptions of overcrowding on the mode choice. This study aims to quantify these changes through a hybrid discrete choice model using data collected through a revealed preferences survey applied in two time periods in Santiago, Chile. Although the overcrowding aversion was included in the choice model as a latent variable, that had a significant effect on the mode choice of people only for the set of responses belonging to the first time period, which implies a reduction of the initial pandemic impact. Results also show that women and people younger than 35 years old have higher levels of crowding aversion. By analyzing the disutility generated by each alternative mode, it is determined that the bicycle is preferred over the car for trips of distances less than 4 km. In the same way, for trips of less than 3 km, the walk has a preference over public transport. Regarding the marginal rates of substitution between travel and walking time in public transport, for trips of 30 min with an overcrowding level of 6 pax/m2, women over 35 years are willing to trade 2 min of travel for 1 min of walking. When comparing the rates obtained in a pre-pandemic study, it is obtained that for trips of less than 9 min, people in the pandemic have more preferences for walking over spending time inside public transport.

Job preference of preventive medicine students during the COVID-19 pandemic: a discrete choice experiment survey in Shandong Province, China

BackgroundPublic health workers are a crucial part of the health workforce, particularly during the coronavirus disease (COVID-19) pandemic. They play an important role in achieving universal health coverage and sustainable development goals. Human resources in public health in China are in short supply, their distribution is unequal, and their turnover rate is high. A discrete choice experiment (DCE) was applied to investigate preventive medicine students’ preferred job choice criteria and trends in trade-offs by calculating the marginal rate of substitution between these criteria. This study identified the properties of jobs primarily selected by preventive medicine students and estimated the monetary value of each attribute.MethodsBased on discussions and in-depth interviews with preventive medicine students and a literature review, we developed a DCE that assessed how students’ stated preferences for a certain choice were influenced by several job attributes, including location, salary, bianzhi, career development opportunities, working environment, and workload. We applied this DCE to preventive medicine students in Shandong Province, China, using a brief, structured questionnaire. Conditional logit models were used to estimate the utility of each job’s attributes. Willingness to pay (WTP) was estimated as the ratio of the value of the coefficient of interest to the negative value of the cost attribute.ResultsA total of 307 respondents completed the questionnaire, and 261 passed the internal consistency test. All the attributes were statistically significant. Career development opportunities and work locations were the most important factors for the respondents. Preference heterogeneity existed among respondents, e.g., 3-year medical education college students placed a higher value on jobs with bianzhi compared to 5-year medical education college students. Furthermore, rural students’ WTP for a job located in the county or city is much lower than that of urban students.ConclusionsThe heterogeneity of attributes indicates the complexity of job preferences. Monetary and nonmonetary job characteristics significantly influenced the job preferences of preventive medicine students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both job incentives and the backgrounds of preventive medicine graduates.

On the (Near) Equivalence of Welfarist and Extra-Welfarist Methods to Value Healthcare With Implications for Assessing Equity

ObjectivesWhile welfarist economics (WE) methods rely wholly on individuals' valuations, extra-welfarist (EW) methods seek alternative measures of value. Major reviews of the EW literature conclude that EW studies almost universally replace “utility” with “health” as the maximand. This analysis seeks to understand what conclusions are necessary and sufficient to make EW and WE methods concurrent and discusses implications for measuring social value. MethodsUsing standard WE methods, I demonstrate that EW is equivalent to WE with 2 key restrictions—individuals have constant returns to health in producing utility and health budgets are fixed. Fixing budgets removes a key WE step, determining the marginal rate of substitution between consumption and health, the willingness to pay for health gains. ResultsBecause EW methods equate with WE with these 2 restrictions, I show how formal models to construct aggregated social welfare functions (SWFs) in WE frameworks lead directly to SWF models using EW models of value. I also show that, in fixed-budget health systems, when SWFs place different values for improving health of different subpopulations, aggregate health output fails as a SWF criterion. I demonstrate how different societal values can and should enter EW SWF models using WE criteria. I also discuss the implications when either of these key restrictions does not properly represent people's preferences. ConclusionsOnce EW methods are shown to be a restricted form of WE methods, those WE methods can illuminate how best to measure SWFs in EW environments.

Cross-regional heterogeneity in health and economic outcomes during the COVID-19 pandemic: An analysis of Japan

Health and macroeconomic outcomes varied substantially across prefectures in Japan during the COVID-19 crisis. Using an estimated macro-epidemiological model as well as the idea of revealed preference, we compute the marginal rate of substitution (MRS) and the conditional trade-off curve between health and economic outcomes in each prefecture. We find that there is a large heterogeneity in the MRS as well as the location and shape of the conditional trade-off curve.

Preferences for Adjuvant Immunotherapy in Adults with Resected Stage III Melanoma-A Discrete Choice Experiment.

This study aimed to quantify adult preferences for adjuvant immunotherapy for resected melanoma and the influence of varying levels of key attributes and baseline characteristics. A D-efficient design generated 12 choice tasks for two alternative treatments, adjuvant immunotherapy or no adjuvant immunotherapy. Recruitment to the online discrete choice experiment (DCE) occurred via survey dissemination by eight Australian melanoma consumer and professional groups, targeting adults with resected stage III melanoma, considering or having received adjuvant immunotherapy. The DCE included six attributes with two to three levels each, including 3-year risk of recurrence, mild, permanent and fatal adverse events (AEs), drug regimen and annual out-of-pocket costs. A mixed multinomial logit model was used to estimate preferences and calculate marginal rates of substitution and marginal willingness to pay (mWTP). The DCE was completed by 116 respondents, who chose adjuvant immunotherapy over no adjuvant immunotherapy in 70% of choice tasks. Respondents preferred adjuvant immunotherapy when associated with reduced: probabilities of recurrence, permanent and fatal AEs, and out-of-pocket costs. mWTP for an absolute reduction of 1% in 3-year risk of recurrence was less for respondents with lower rather than higher incomes, AU$794 (US$527) and AU$2190 (US$1454) per year. Respondents accepted an additional 4% chance of a permanent AE to reduce their absolute risk of 3-year recurrence by 1%. Respondents were willing to accept an extra 2% chance of 3-year recurrence to lower their chance of a fatal AE by 1%. Almost three-quarters of respondents chose adjuvant immunotherapy over no adjuvant immunotherapy, preferring treatment that improved efficacy and safety. Findings may inform decisions about access to adjuvant immunotherapy following surgery for melanoma.

The influence of the "cancer" label on perceptions and management decisions for low-grade prostate cancer.

Grade Group 1 (GG1) prostate cancer should be managed with active surveillance (AS). Global uptake of AS remains disappointingly slow and heterogeneous. Removal of cancer labels has been proposed to reduce GG1 overtreatment. We sought to determine the impact of GG1 disease terminology on individual's perceptions and decision making. Discrete choice experiments were conducted on 3 cohorts: healthy men, canonical partners (partners), and patients with GG1 (patients). Participants reported preferences in a series of vignettes with 2 scenarios each, permuting key opinion leader-endorsed descriptors: biopsy (adenocarcinoma, acinar neoplasm, prostatic acinar neoplasm of low malignant potential [PAN-LMP], prostatic acinar neoplasm of uncertain malignant potential), disease (cancer, neoplasm, tumor, growth), management decision (treatment, AS), and recurrence risk (6%, 3%, 1%, <1%). Influence on scenario selection were estimated by conditional logit models and marginal rates of substitution. Two additional validation vignettes with scenarios portraying identical descriptors except the management options were embedded into the discrete choice experiments. Across cohorts (194 healthy men, 159 partners, and 159 patients), noncancer labels PAN-LMP or prostatic acinar neoplasm of uncertain malignant potential and neoplasm, tumor, or growth were favored over adenocarcinoma and cancer (P < .01), respectively. Switching adenocarcinoma and cancer labels to PAN-LMP and growth, respectively, increased AS choice by up to 17%: healthy men (15%, 95% confidence interval [CI] = 10% to 20%, from 76% to 91%, P < .001), partners (17%, 95% CI = 12% to 24%, from 65% to 82%, P < .001), and patients (7%, 95% CI = 4% to 12%, from 75% to 82%, P = .063). The main limitation is the theoretical nature of questions perhaps leading to less realistic choices. "Cancer" labels negatively affect perceptions and decision making regarding GG1. Relabeling (ie, avoiding word "cancer") increases proclivity for AS and would likely improve public health.