Understanding the formation and influence of attitudes in patients' treatment choices for lower back pain: testing the benefits of a hybrid choice model approach.

A growing number of studies across different fields are making use of a new class of choice models, labelled variably as hybrid model structures or integrated choice and latent variable models, and incorporating the role of attitudes in decision making. To date, this technique has not been used in health economics. The present paper looks at the formation of such attitudes and their role in patients' treatment choices in the context of low back pain. We use stated choice data collected from a sample of 561 patients with 348 respondents referred to a regional spine centre in Middelfart, Denmark in spring/summer 2012. We show how the hybrid model structure is able to make a link between attitudinal questions and treatment choices, and also explains variation of these attitudes across key socio-demographic groups. However, we also show how, in this case, only a small share of the overall heterogeneity is linked to the latent attitude construct. Despite their growing popularity, the key findings of the advanced model, despite a greater insight into the drivers of attitudes and small gains in efficiency, are no different from standard approaches which remain easier to apply.