Li Fuming, Liu Shimeng, Gu Yuanyuan, Li Shunping, Tao Ying, Wei Yan, Chen Yingyao
School of Public Health, Fudan University, Shanghai, People's Republic of China.
National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, People's Republic of China.
Patient Prefer Adherence. 2024 Aug 30;18:1803-1813. doi: 10.2147/PPA.S470310. eCollection 2024.
Discrete choice experiment (DCE) and profile case (case 2) best-worst scaling (BWS) present uncertainties regarding the acceptability of quantifying individual healthcare preferences, which may adversely affect the validity of responses and impede the reflection of true healthcare preferences. This study aimed to assess the acceptability of these two methods from the perspective of patients with type 2 diabetes mellitus (T2DM) and examine their association with specific characteristics of the target population.
This cross-sectional study was based on a nationally representative survey; data were collected using a multistage stratified cluster-sampling procedure between September 2021 and January 2022. Eligible adults with confirmed T2DM voluntarily participated in this study. Participants completed both the DCE and case 2 BWS (BWS-2) choice tasks in random order and provided self-reported assessments of acceptability, including task completion difficulty, comprehension of task complexity, and response preference. Logistic regression and random forest models were used to identify variables associated with acceptability.
In total, 3286 patients with T2DM were included in the study. Respondents indicated there was no statistically significant difference in completion difficulty between the DCE and BWS-2, although the DCE scores were slightly higher (3.07 ± 0.68 vs 3.03 ± 0.67, P = 0.06). However, 1979 (60.2%) respondents found the DCE easier to comprehend. No significant preferences were observed between the two methods (1638 (49.8%) vs 1648 (50.2%)). Sociodemographic factors, such as residence, monthly out-of-pocket costs, and illness duration were significantly associated with comprehension complexity and response preference.
This study yielded contrasting results to most of previous studies, suggesting that DCE may be less cognitively demanding and more suitable for patients with T2DM from the perspective of self-reported acceptability of DCE and BWS. This study promotes a focus on patient acceptability in quantifying individual healthcare preferences to inform tailored optimal stated-preference method for a target population.
离散选择实验（DCE）和简况案例（案例2）的最佳-最差尺度法（BWS）在量化个体医疗偏好的可接受性方面存在不确定性，这可能会对回答的有效性产生不利影响，并阻碍对真实医疗偏好的反映。本研究旨在从2型糖尿病（T2DM）患者的角度评估这两种方法的可接受性，并检验它们与目标人群特定特征的关联。
本横断面研究基于一项全国代表性调查；2021年9月至2022年1月期间，采用多阶段分层整群抽样程序收集数据。确诊为T2DM的符合条件的成年人自愿参与本研究。参与者以随机顺序完成DCE和案例2 BWS（BWS-2）选择任务，并提供自我报告的可接受性评估，包括任务完成难度、对任务复杂性的理解以及回答偏好。采用逻辑回归和随机森林模型来识别与可接受性相关的变量。
本研究共纳入3286例T2DM患者。受访者表示，DCE和BWS-2在完成难度上无统计学显著差异，尽管DCE得分略高（3.07±0.68对3.03±0.67，P = 0.06）。然而，1979名（60.2%）受访者认为DCE更容易理解。两种方法之间未观察到显著偏好（1638名（49.8%）对1648名（50.2%））。社会人口学因素，如居住地、每月自付费用和病程，与理解复杂性和回答偏好显著相关。
本研究结果与大多数先前研究形成对比，表明从DCE和BWS自我报告的可接受性角度来看，DCE对认知的要求可能较低，更适合T2DM患者。本研究促使人们在量化个体医疗偏好时关注患者的可接受性，以便为目标人群量身定制最佳的陈述偏好方法。
