Publications by authors named "Trine Kjær"

25 Publications

  • Page 1 of 1

Barriers to a healthy postpartum lifestyle and the possibilities of an information technology-based intervention: A qualitative study.

Midwifery 2021 Apr 3;98:102994. Epub 2021 Apr 3.

Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark; Department of Endocrinology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark. Electronic address:

Background: Being overweight or obese is associated with higher risk of adverse maternal and fetal outcomes, including gestational diabetes and childhood obesity. Many women exceed the gestational weight gain recommendations. Thus, it is important to focus on the women's lifestyle between their pregnancies to lower the risk of weight retention before the next pregnancy as well as in a life course perspective.

Objective: The objective of this study was to explore barriers postpartum women experience with respect to a healthy lifestyle during the postpartum period, and to assess whether an IT-based intervention might be a supportive tool to assist and motivate postpartum women to healthy lifestyle.

Method: A systematic text condensation was applied to semi-structured focus groups. Five focus group interviews were carried out with a total of 17 postpartum women and two interviews with a total of six health professionals. Participants were recruited through the municipality in Svendborg, Denmark, and at Odense University Hospital in Odense, Denmark, during a four-month period in early 2018. The results were analysed within the frame of the capability, opportunity, motivation and behaviour model (COM-B).

Results: From the women's perspective, better assistance is needed from the health professionals to obtain or maintain a healthy lifestyle. The women need tools that inform and help them understand and prioritize own health related risks, and to motivate them to plan and take care of their own health. There is room for engaging the partner more in the communication related to the baby and family's lifestyle. Lastly, the women already use audiobooks and podcasts to obtain information.

Conclusion: Postpartum women need tools that inform and motivate for a healthy lifestyle postpartum. The tools should allow access to high quality information from health care professionals when the information is needed and also allow engagement from the partner. An IT-based intervention could be a way to support and motivate postpartum women for a healthy lifestyle.
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http://dx.doi.org/10.1016/j.midw.2021.102994DOI Listing
April 2021

Sample restrictions and the elicitation of a constant willingness to pay per quality adjusted life year.

Health Econ 2021 May 10;30(5):923-931. Epub 2021 Feb 10.

DaCHE, Department of Public Health, University of Southern Denmark, Odense, Denmark.

It is well established that the underlying theoretical assumptions needed to obtain a constant proportional trade-off between a quality adjusted life year (QALY) and willingness to pay (WTP) are restrictive and often empirically violated. In this paper, we set out to investigate whether the proportionality conditions (in terms of scope insensitivity and severity independence) can be satisfied when data is restricted to include only respondents who pass certain consistency criteria. We hypothesize that the more we restrict the data, the better the compliance with the requirement of constant proportional trade-off between WTP and QALY. We revisit the Danish data from the European Value of a QALY survey eliciting individual WTP for a QALY (WTP-Q). Using a "chained approach" respondents were first asked to value a specified health state using the standard gamble (SG) or the time-trade-off (TTO) approach and subsequently asked their WTP for QALY gains of 0.05 and 0.1 (tailored according to the respondent's SG/TTO valuation). Analyzing the impact of the different exclusion criteria on the two proportionality conditions, we find strong evidence against a constant WTP-Q. Restricting our data to include only respondents who pass the most stringent consistency criteria does not impact on the performance of the proportionality conditions for WTP-Q.
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http://dx.doi.org/10.1002/hec.4236DOI Listing
May 2021

Disentangling public preferences for health gains at end-of-life: Further evidence of no support of an end-of-life premium.

Soc Sci Med 2019 09 21;236:112375. Epub 2019 Jun 21.

DaCHE - Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Denmark.

In many countries, it has been publicly debated whether health gains for patients at end-of-life (EoL) should be valued higher than health gains for other patients. This has led to a range of stated preference studies examining the justification for an EoL premium on the basis of public preferences - so far with mixed findings. In the present study, we seek to extend this literature. We apply a simple stated preference approach with illustrative binary choices to elicit both individual and social preferences for several types of health gains. More specifically, we investigate whether health gains at EoL, resulting from either an improvement in quality of life (QoL) or life expectancy (LE) are valued differently from similarly sized health gains from preventive treatment and treatment of a temporary disease. Furthermore, we examine whether social preferences are affected by the age of beneficiaries. A web-based survey was conducted in 2015 using a random sample of 1047 members of the general public in Denmark. Overall, we do not find evidence to support an EoL premium compared to other health gains, neither when preferences are elicited from a social nor an individual perspective. Furthermore, our results demonstrate that the type of the health gain received matters to preferences for treatment at EoL with more weight given to gains in QoL than gains in LE. Finally, we find heterogeneity in preferences according to respondent characteristics, perspectives and age of beneficiaries.
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http://dx.doi.org/10.1016/j.socscimed.2019.112375DOI Listing
September 2019

Physical exercise versus shorter life expectancy? An investigation into preferences for physical activity using a stated preference approach.

Health Policy 2019 08 28;123(8):790-796. Epub 2019 May 28.

DaCHE - Danish Center for Health Economic Research, Department of Public Health, University of Southern Denmark, Winsløwsvej 9b, 1., 5230 Odense M, Denmark. Electronic address:

The positive life-prolonging effect of physical activity is often used as a promotion argument to motivate people to change their behaviour. Yet the decision of investing in health by exercising depends not only on the potential health effect but also on the costs of physical activity including time costs and the individual's (dis)utility of performing physical activity. The objective of this study was to investigate the trade-off between costs and benefits of engaging in physical activity. A web-based stated preference experiment was conducted to elicit individual preferences for physical activity among a representative sample of the Danish population, 18-60 years of age, categorised as moderately physically active or physically inactive. The results of the study suggest that perceived negative quality of life impact of physical activity is an important predictor of the choice of not attending physical activity, and hence should be acknowledged as a barrier to engaging in physical activity. Furthermore, we find time costs to have a significant impact on stated uptake. For individuals categorised as moderately active, the marginal health effect of physical activity is significant but minor. For inactive individuals, this effect is insignificant suggesting that information on long-term health effects does not work as motivation for engaging in exercise for this group. Instead, focus should be on reducing the perceived disutility of physical activity.
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http://dx.doi.org/10.1016/j.healthpol.2019.05.015DOI Listing
August 2019

Can present biasedness explain early onset of diabetes and subsequent disease progression? Exploring causal inference by linking survey and register data.

Soc Sci Med 2017 08 26;186:34-42. Epub 2017 May 26.

COHERE, University of Southern Denmark, Institute of Public Health, Department of Business and Economics, Campusvej 55, DK-5500 Odense M, Denmark. Electronic address:

Diabetes is a major cause of morbidity, disability, mortality and health care resource use. The increasing prevalence of diabetes may therefore have dramatic future consequences for western societies. Diabetes entails a significant self-management component and it has previously been estimated that people with diabetes provide about 95% of their own care. Despite increased focus, self-management skills including basic knowledge acquisition, problem solving and setting realistic goals are often not mastered. The main contribution of this paper is to provide evidence that the heterogeneity in self-management and health outcomes amongst diabetes patients is partly attributable to individual differences in time-inconsistent preferences in terms of present biased behaviour. Using a unique data set consisting of survey data from 2014 merged with registry data on a sample of 79 chronically ill patients, we present empirical evidence that present biased individuals are more prone to onset of diabetes at an early age, and have a poorer prognosis after diagnosis. Furthermore, we conclude that present biasedness has a casual effect on the onset and management of diabetes.
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http://dx.doi.org/10.1016/j.socscimed.2017.05.050DOI Listing
August 2017

22q11.2 Deletion Syndrome Is Associated With Impaired Auditory Steady-State Gamma Response.

Schizophr Bull 2018 02;44(2):388-397

Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.

Background: The 22q11.2 deletion syndrome confers a markedly increased risk for schizophrenia. 22q11.2 deletion carriers without manifest psychotic disorder offer the possibility to identify functional abnormalities that precede clinical onset. Since schizophrenia is associated with a reduced cortical gamma response to auditory stimulation at 40 Hz, we hypothesized that the 40 Hz auditory steady-state response (ASSR) may be attenuated in nonpsychotic individuals with a 22q11.2 deletion.

Methods: Eighteen young nonpsychotic 22q11.2 deletion carriers and a control group of 27 noncarriers with comparable age range (12-25 years) and sex ratio underwent 128-channel EEG. We recorded the cortical ASSR to a 40 Hz train of clicks, given either at a regular inter-stimulus interval of 25 ms or at irregular intervals jittered between 11 and 37 ms.

Results: Healthy noncarriers expressed a stable ASSR to regular but not in the irregular 40 Hz click stimulation. Both gamma power and inter-trial phase coherence of the ASSR were markedly reduced in the 22q11.2 deletion group. The ability to phase lock cortical gamma activity to regular auditory 40 Hz stimulation correlated with the individual expression of negative symptoms in deletion carriers (ρ = -0.487, P = .041).

Conclusions: Nonpsychotic 22q11.2 deletion carriers lack efficient phase locking of evoked gamma activity to regular 40 Hz auditory stimulation. This abnormality indicates a dysfunction of fast intracortical oscillatory processing in the gamma-band. Since ASSR was attenuated in nonpsychotic deletion carriers, ASSR deficiency may constitute a premorbid risk marker of schizophrenia.
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http://dx.doi.org/10.1093/schbul/sbx058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815132PMC
February 2018

Be Careful What You Ask For: Effects of Benefit Descriptions on Diabetes Patients' Benefit-Risk Tradeoff Preferences.

Value Health 2017 Apr 9;20(4):670-678. Epub 2017 Feb 9.

University of Southern Denmark, Odense, Denmark.

Background: As more studies report on patient preferences for diabetes treatment, identifying diabetes outcomes other than glycated hemoglobin (HbA) to describe effectiveness is warranted to understand patient-relevant, benefit-risk tradeoffs.

Objective: The aim of the study was to evaluate how preferences differ when effectiveness (glycemic control) is presented as long-term sequela (LTS) risk mitigation rather than an asymptomatic technical marker (HbA).

Methods: People with type 2 diabetes and using insulin (n = 3160) were randomly assigned to four self-administered, discrete-choice experiments that differed by their presentation of effectiveness. Epidemiologic reviews were conducted to ensure a close approximation of LTS risk relative to HbA levels. The relative importance of treatment benefit-risk characteristics and maximum acceptable risk tradeoffs was estimated using an error-component logit model. Log-likelihood ratio tests were used to compare parameter vectors.

Results: In total, 1031 people responded to the survey. Significantly more severe hypoglycemic events were accepted for a health improvement in terms of LTS mitigation versus HbA improvement (0.7 events per year; 95% confidence interval [CI]: 0.4-1.0 vs. 0.2 events per year 95% CI: -0.02 to 0.5) and avoidance of treatment-related heart attack risk (1.4 severe hypoglycemic events per year; 95% CI: 0.8-1.9 vs. 1 event per year; 95% CI: 0.6-1.3). This finding is supported by a log-likelihood test that rejected at the 0.05 level that respondent preference structures are similar across the different experimental arms of the discrete-choice experiment.

Conclusion: We found evidence that benefit descriptions influence elicited preferences for the benefit-risk characteristics of injectable diabetes treatment. These findings argue for using carefully defined effectiveness measures to accurately take account of the patient perspective in benefit-risk assessments.
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http://dx.doi.org/10.1016/j.jval.2016.11.023DOI Listing
April 2017

Asymmetric information and user orientation in general practice: Exploring the agency relationship in a best-worst scaling study.

J Health Econ 2016 12 28;50:115-130. Epub 2016 Sep 28.

Centre of Health Economics Research (COHERE), Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.

This study uses a best-worst scaling experiment to test whether general practitioners (GPs) act as perfect agents for the patients in the consultation; and if not, whether this is due to asymmetric information and/or other motivations than user orientation. Survey data were collected from 775 GPs and 1379 Danish citizens eliciting preferences for a consultation. Sequential models allowing for within-person preference heterogeneity and heteroskedasticity between best and worst choices were estimated. We show that GPs do not always act as perfect agents and that this non-alignment stems from GPs being both unable and unwilling to do so. Unable since GPs have imperfect information about patients' preferences, and unwilling since they are also motivated by other factors than user orientation. Our findings highlight the need for multi-pronged strategies targeting different motivational factors to ensure that GPs act in correspondence with patients' preferences in areas where alignment is warranted.
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http://dx.doi.org/10.1016/j.jhealeco.2016.09.008DOI Listing
December 2016

The value of mortality risk reductions. Pure altruism - a confounder?

J Health Econ 2016 09 19;49:184-92. Epub 2016 Jul 19.

COHERE, Department of Business and Economics, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark; Newcastle University Business School, 5 Barrack Road, NE1 4SE Newcastle upon Tyne, United Kingdom.

This paper examines public valuations of mortality risk reductions. We set up a theoretical framework that allows for altruistic preferences, and subsequently test theoretical predictions through the design of a discrete choice experiment. By varying the tax scenario (uniform versus individual tax), the experimental design allows us to verify whether pure altruistic preferences are present and the underlying causes. We find evidence of negative pure altruism. Under a coercive uniform tax system respondents lower their willingness to pay possibly to ensure that they are not forcing others to pay at a level that corresponds to their own - higher - valuations. This hypothesis is supported by the observation that respondents perceive other individuals' valuations to be lower than their own. Our results suggest that public valuations of mortality risk reductions may underestimate the true societal value because respondents are considering other individuals' welfare, and wrongfully perceive other people's valuations to be low.
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http://dx.doi.org/10.1016/j.jhealeco.2016.07.002DOI Listing
September 2016

Associations between patients' risk attitude and their adherence to statin treatment - a population based questionnaire and register study.

BMC Fam Pract 2016 Mar 9;17:28. Epub 2016 Mar 9.

Research Unit of General practice, Department of Public Health, University of Southern Denmark, JB Winsløws Vej 9A, 5000, Odense C, Denmark.

Background: Poor adherence to medical treatment may have considerable consequences for the patients' health and for healthcare costs to society. The need to understand the determinants for poor adherence has motivated several studies on socio-demographics and comorbidity. Few studies focus on the association between risk attitude and adherence. The aim of the present study was to estimate associations between patients' adherence to statin treatment and different dimensions of risk attitude, and to identify subgroups of patients with poor adherence.

Methods: Population-based questionnaire and register-based study on a sample of 6393 persons of the general. Danish population aged 20-79. Data on risk attitude were based on 4 items uncovering health-related as well as financial dimensions of risk attitude. They were collected through a web-based questionnaire and combined with register data on redeemed statin prescriptions, sociodemographics and comorbidity. Adherence was estimated by proportion of days covered using a cut-off point at 80 %.

Results: For the dimension of health-related risk attitude, "Preference for GP visit when having symptoms", risk-neutral and risk-seeking patients had poorer adherence than the risk-averse patients, OR 0.80 (95 %-CI 0.68-0.95) and OR 0.83 (95 %-CI 0.71-0.98), respectively. No significant association was found between adherence and financial risk attitude. Further, patients in the youngest age group and patients with no CVD were less adherent to statin treatment.

Conclusion: We find some indication that risk attitude is associated with adherence to statin treatment, and that risk-neutral and risk-seeking patients may have poorer adherence than risk-averse patients. This is important for clinicians to consider when discussing optimal treatment decisions with their patients. The identified subgroups with the poorest adherence may deserve special attention from their GP regarding statin treatment.
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http://dx.doi.org/10.1186/s12875-016-0423-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784361PMC
March 2016

Government interventions to aid choice: Help to self-help or paternalism?

Health Policy 2015 Jul 11;119(7):874-81. Epub 2015 Feb 11.

Department of Business and Economics & Institute of Public Health, University of Southern Denmark, Denmark.

A random sample of Danish respondents was asked in which aspects of every-day life they find it more difficult to adhere to behavioural patterns that they believe are best for them and their family. Individuals report high degrees of lack of self-control in specific areas of everyday life, suggesting that individuals are not consistently exhibiting utility optimising behaviour, a finding that accords with behavioural economics and the expected prevalence of irrational behaviour. We observe greater self-perceived self-control problems amongst individuals from the lower economic strata. Thus, to the extent that self-control relates to environmental factors, there is justification for introducing government interventions targeting such factors to improve equity in health and to increase utility levels amongst those with lower incomes and lower levels of education. Further, the public's preferences for a range of government interventions targeting different facets of life-style were elicited. Individuals who were the target of interventions were less supportive of these interventions. Individuals in the target group whose self-perceived self-control was low tended to be more supportive, but still less so than those who were not targeted. Since support was shown to come mainly from those not targeted by the intervention, and especially from those who feel in control of their lives, our results indicate that the interventions cannot be justified on the grounds of libertarianism (help to self-help).
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http://dx.doi.org/10.1016/j.healthpol.2015.02.001DOI Listing
July 2015

The impact of pecuniary and non-pecuniary incentives for attracting young doctors to rural general practice.

Soc Sci Med 2015 Mar 20;128:1-9. Epub 2014 Dec 20.

Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Norway; Centre for Health Economics, Monash University, Melbourne, Australia.

Shortages of GPs in rural areas constitute a profound health policy issue worldwide. The evidence for the effectiveness of various incentives schemes, which can be specifically implemented to boost recruitment to rural general practice, is generally considered to be poor. This paper investigates young doctors' preferences for key job attributes in general practice (GP), particularly concerning location and income, using a discrete choice experiment (DCE). The subjects were all final year medical students and interns in Norway (N = 1562), of which 831 (53%) agreed to participate in the DCE. Data was collected in November-December 2010. Policy simulations were conducted to assess the potential impact of various initiatives that can be used to attract young doctors to rural areas. Most interestingly, the simulations highlight the need to consider joint policy programs containing several incentives if the policies are to have a sufficient impact on the motivation and likelihood to work in rural areas. Furthermore, we find that increased income seem to have less impact as compared to improvements in the non-pecuniary attributes. Our results should be of interest to policy makers in countries with publicly financed GP systems that may struggle with the recruitment of GPs in rural areas.
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http://dx.doi.org/10.1016/j.socscimed.2014.12.022DOI Listing
March 2015

Framing the willingness-to-pay question: impact on response patterns and mean willingness to pay.

Health Econ 2014 May 22;23(5):550-63. Epub 2013 May 22.

The Danish Institute for Health Services Research, Copenhagen, Denmark; COHERE, University of Southern Denmark, Odense, Denmark; Australian Centre for Economic Research on Health (ACERH), University of Queensland, Herston, Queensland, Australia.

In this study, respondents were randomly allocated to three variants of the payment card format and an open-ended format in order to test for convergent validity. The aim was to test whether preferences (as measured by willingness to pay additional tax) would be affected by framing the willingness-to-pay question differently. Results demonstrated that valuations were highly sensitive to whether respondents were asked to express their maximum willingness to pay per month or per year. Another important finding is that the introduction of a binary response filter prior to the payment card follow-up tends to eliminate the positive aspects of introducing a payment card and produces response patterns that are much in line with those of the open-ended contingent valuation format. However, although a filter will impact on the distribution of willingness-to-pay bids and on the rate of zero and protest bids, the overall impact on the welfare estimate is minor. The outcomes of this study indicate that valuations in the stated preference literature may be, at least in part, a function of the instrument designed to obtain the valuations.
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http://dx.doi.org/10.1002/hec.2932DOI Listing
May 2014

Public preferences for establishing nephrology facilities in Greenland: estimating willingness-to-pay using a discrete choice experiment.

Eur J Health Econ 2013 Oct 14;14(5):739-48. Epub 2012 Sep 14.

COHERE, University of Southern Denmark, Winsløwsvej 9B, 1., 5000, Odense, Denmark.

At present there are no nephrology facilities in Greenland. Greenlandic patients with renal failure needing dialysis thus have to travel to Denmark to obtain treatment. For patients in haemodialysis this necessitates a permanent residence in Denmark. Our study was aimed at examining Greenlanders' preferences for establishing nephrology facilities in Greenland at Queen Ingrid's Hospital in Nuuk, and to estimate the associated change in welfare. Preferences were elicited using a discrete choice experiment (DCE). A random sample of 500 individuals of the general population was sent a postal questionnaire in which they were asked to consider the trade-offs of establishing nephrology facilities in Greenland as opposed to the current situation. This involved trading off the benefits of having such facilities in their home country against the costs of the intervention. Besides including a payment attribute described in terms of incremental tax payment, the DCE included two interventions attributes related to (1) the organisation of labour, and (2) the physical settings of the patients. Respondents succeeded in answering the DCE despite cultural and linguistic disparity. We found that all the included attributes had a significant effect on respondents' choices, and that respondents' answers to the DCE were in keeping with their values as stated in the questionnaire. DCE data was analyzed using a random parameter logit model reparametrized in willingness-to-pay space. The results showed that establishing facilities in Greenland were preferred to the current treatment in Denmark. The welfare estimate from the DCE, at DKK 18.74 million, exceeds the estimated annual costs of establishing treatment facilities for patients with chronic renal failure. Given the estimated confidence interval this result seems robust. Establishing facilities in Greenland therefore would appear to be welfare-improving, deriving positive net benefits. Despite the relatively narrow policy focus, we believe that our findings provide some insight into individuals' preferences for decentralization of public services and on citizens' views of 'self-governance' that go beyond the case of Greenland. More generally, this paper illustrates how DCE can be applied successfully to developing countries with culturally, demographically, and geographically distinct features.
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http://dx.doi.org/10.1007/s10198-012-0418-3DOI Listing
October 2013

Valuation of morbidity and mortality risk reductions. Does context matter?

Accid Anal Prev 2012 Sep 23;48:246-53. Epub 2012 Feb 23.

University of Southern Denmark, COHERE, Denmark.

The main research purpose of the present study was to test for any differences in the valuation of morbidity and mortality risk reductions across two contexts; traffic and health. A contingent valuation study on preferences for morbidity and mortality risk was carried out in Denmark in 2007. Respondents were randomised into two different arms: one arm in which the valuation took place in the context of health and another arm in which the context was traffic. In both contexts, the inferior health state was described by way of the standardized EQ-5D descriptive system. We obtained a total sample of 520 respondents from an online database. In the present study we found clear evidence of a context effect on expressed valuations of identical risk reductions. This was true irrespective of whether the adverse outcome in question was death or inferior health. This result suggests that interventions targeting risks of death or risks of ill health should not necessarily be valued equally across sectors. From a welfare economic perspective, the use of the same estimates across contexts - and especially across sectors - could be misleading and in worst case lead to inefficient resource allocations.
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http://dx.doi.org/10.1016/j.aap.2012.01.018DOI Listing
September 2012

Do general practitioners know patients' preferences? An empirical study on the agency relationship at an aggregate level using a discrete choice experiment.

Value Health 2012 May 16;15(3):514-23. Epub 2012 Feb 16.

Research Unit of Health Economics, Institute of Public Health, University of Southern Denmark, Odense C, Denmark.

Objectives: This study investigated whether general practitioners (GPs) know patients' preferences regarding a number of organizational characteristics in general practice (i.e., waiting time on the telephone, opening hours, waiting time to the appointment, distance to the general practice, waiting time in the waiting room, consultation time, and whether the GP or assisting personnel performs routine tasks) to examine whether there is a basis for improving the agency relationship at an aggregate level.

Data: A total of 698 respondents from the Danish population and 969 GPs answered the questionnaire in May and September 2010.

Methods: In a discrete choice experiment, GPs and patients made both forced and unforced choices, allowing us to explore the congruence of preferences 1) when patients must choose a new GP and 2) when they can stay with their current GP.

Results: Results show that in the forced choice, preferences are seen to differ. In the unforced choice also, preferences differ--mainly because GPs overestimate their own importance to the patients. Rank orders, however, are similar for both GPs and patients.

Conclusions: It is concluded that GPs do not have a precise knowledge of patients' preferences. However, in the unforced choice, GPs do know on which attributes to compete although they underestimate the necessity of competition. The overall conclusion is that there is room for improving the agency relationship in the organization of general practice.
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http://dx.doi.org/10.1016/j.jval.2012.01.002DOI Listing
May 2012

General practitioners' preferences for the organisation of primary care: a discrete choice experiment.

Health Policy 2012 Aug 7;106(3):246-56. Epub 2012 Apr 7.

University of Southern Denmark, Institute of Public Health, Research Unit of Health Economics, J.B. Winsløwsvej 9B, 5000 Odense C, Denmark.

Objectives: To examine GPs' preferences for organisational characteristics in general practice with focus on aspects that can potentially mitigate problems with GP shortages.

Methods: A simple random sample of 1823 GPs (corresponding to half of all GPs in Denmark) was drawn at the beginning of 2010, and a response rate of 68% was obtained. A discrete choice experiment (DCE) is applied, and attributes included are: practice type (solo/shared), number of GPs in general practice, collaboration with other practices (yes/no), change in weekly working hours (administrative versus patient related) and change in yearly surplus. Multinomial logit analyses (with and without interaction variables) are used, and marginal rates of substitution are calculated.

Results: GPs working in solo practices have different preferences for the organisational attributes compared to GPs in shared practices. The compensation needed for GPs to re-organise from solo to shared practice is associated with the size of the practice. GP characteristics such as age, working hours and surplus affect their willingness to undergo organisational changes.

Conclusions: Our results are of relevance to decision makers in designing policies aimed at influencing GPs' organisation in order to overcome problems related to shortages.
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http://dx.doi.org/10.1016/j.healthpol.2012.03.006DOI Listing
August 2012

The influence of information and private versus public provision on preferences for screening for prostate cancer: a willingness-to-pay study.

Health Policy 2011 Aug 15;101(3):277-89. Epub 2011 Jun 15.

University of Southern Denmark, Institute of Public Health, Research Unit of Health Economics, J.B. Winsløwsvej 9B, 1, 5000 Odense C, Denmark.

This study investigates the influence of information and public versus private provision on preferences for introducing screening (i.e. PSA-test) for prostate cancer in Denmark. The aim is to disclose if preferences (measured as willingness-to-pay) are influenced by whether the service is provided by the private or public health care sector, and the extent to which negative information on the PSA-test influences the perceptions of the screening programme. It is also investigated whether the impact of information differs dependent on public-private provision. A random sample of the Danish male population (all between 50 and 70 years of age) were invited to fill out a web-based questionnaire. It was found that two thirds of the respondents were willing to participate and willing to pay for a public intervention programme, when provided with all relevant information. In contrast, only approximately one third were so inclined if a prostate cancer screening service was offered by private clinics. Results suggest that public provision framing increases the perceived value of the screening programme, and that the provision of full information regarding the negative characteristics of the programme decreases programme valuation.
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http://dx.doi.org/10.1016/j.healthpol.2011.05.008DOI Listing
August 2011

Disentangling WTP per QALY data: different analytical approaches, different answers.

Health Econ 2012 Mar 20;21(3):222-37. Epub 2011 Jan 20.

Institute of Public Health, University of Southern Denmark, Denmark.

A large random sample of the Danish general population was asked to value health improvements by way of both the time trade-off elicitation technique and willingness-to-pay (WTP) using contingent valuation methods. The data demonstrate a high degree of heterogeneity across respondents in their relative valuations on the two scales. This has implications for data analysis. We show that the estimates of WTP per QALY are highly sensitive to the analytical strategy. For both open-ended and dichotomous choice data we demonstrate that choice of aggregated approach (ratios of means) or disaggregated approach (means of ratios) affects estimates markedly as does the interpretation of the constant term (which allows for disproportionality across the two scales) in the regression analyses. We propose that future research should focus on why some respondents are unwilling to trade on the time trade-off scale, on how to interpret the constant value in the regression analyses, and on how best to capture the heterogeneity in preference structures when applying mixed multinomial logit.
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http://dx.doi.org/10.1002/hec.1709DOI Listing
March 2012

Cost analysis of establishing dialysis facilities for the treatment of chronic renal failure in Greenland.

Int J Circumpolar Health 2010 Dec 30;69(5):470-9. Epub 2010 Nov 30.

University of Southern Denmark, Institute of Public Health, Health Economics Research Unit, J.B. Winsløws Vej 9, Odense, Denmark.

Objectives: At present there are no facilities offering treatment for chronic renal failure with dialysis in Greenland. Patients in need of treatment must go to Denmark. It has been proposed that treatment facilities should be established at Dronning Ingrids Hospital in Nuuk, Greenland. The objective of this study is to explore the costs of such an alternative compared with the situation today.

Methods: The costs of establishing dialysis facilities in Nuuk, Greenland, and providing dialysis for Greenlandic patients were compared with the costs of the current way of managing dialysis for Greenlandic patients in need of treatment. Data for the study were collected from publicly available statistics, from Dronning Ingrids Hospital in Nuuk and from Rigshospitalet in Copenhagen.

Results: The actual number of patients in dialysis was found to be lower than expected. Based on Danish prevalence statistics, it was expected that about 27 persons in Greenland would be in dialysis each year. Over a time horizon of 10 years, the additional costs of establishing and offering dialysis treatment in Nuuk were expected to amount to an average of 1.4 million Danish kroner (€190,000) per year compared with the current treatment costs. Results were sensitive to the demand for dialysis treatment among people in need of treatment. If all patients in need of dialysis were treated, the additional costs of establishing dialysis facilities and providing treatment in Nuuk were estimated to about 7 million Danish Kroner (€930,000) per year compared with the status quo.

Conclusions: Changes in the demand for dialysis treatment may influence the cost of establishing treatment facilities in Nuuk.
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http://dx.doi.org/10.3402/ijch.v69i5.17687DOI Listing
December 2010

Does the number of choice sets matter? Results from a web survey applying a discrete choice experiment.

Health Econ 2011 Mar;20(3):273-86

University of Southern Denmark, Institute of Public Health, Health Economics, Denmark.

Optimising the design of discrete choice experiments (DCE) involves maximising not only the statistical efficiency, but also how the nature and complexity of the experiment itself affects model parameters and variance. The present paper contributes by investigating the impact of the number of DCE choice sets presented to each respondent on response rate, self-reported choice certainty, perceived choice difficulty, willingness-to-pay (WTP) estimates, and response variance. A sample of 1053 respondents was exposed to 5, 9 or 17 choice sets in a DCE eliciting preferences for dental services. Our results showed no differences in response rates and no systematic differences in the respondents' self-reported perception of the uncertainty of their DCE answers. There were some differences in WTP estimates suggesting that estimated preferences are to some extent context-dependent, but no differences in standard deviations for WTP estimates or goodness-of-fit statistics. Respondents exposed to 17 choice sets had somewhat higher response variance compared to those exposed to 5 choice sets, indicating that cognitive burden may increase with the number of choice sets beyond a certain threshold. Overall, our results suggest that respondents are capable of managing multiple choice sets - in this case 17 choice sets - without problems.
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http://dx.doi.org/10.1002/hec.1587DOI Listing
March 2011

Preference heterogeneity and choice of cardiac rehabilitation program: results from a discrete choice experiment.

Health Policy 2008 Jan 28;85(1):124-32. Epub 2007 Aug 28.

Health Economics, Institute of Public Health, University of Southern Denmark, Winsløwsvej 9B, 1, 5000 Odense C, Denmark.

This paper focuses on the elicitation of patients' preferences for cardiac rehabilitation activities from a discrete choice experiment using a mixed model. We observed a high level of preference heterogeneity among patients for all the five cardiac rehabilitation activities--even when age and smoking status were taken into account. The random parameter model provided additional policy relevant information as well as a better fit to the data than did the standard logit model. The paper focuses on one of the potential problems with the standard logit specification which in the worst case can lead to wrong policy conclusions by assuming homogeneity in preferences across individuals. The generalised RPL specification may be a more appropriate specification that can provide additional information on the heterogeneity preferences.
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http://dx.doi.org/10.1016/j.healthpol.2007.07.002DOI Listing
January 2008

Graded pairs comparison - does strength of preference matter? Analysis of preferences for specialised nurse home visits for pain management.

Health Econ 2007 May;16(5):513-29

Institute of Public Health, University of Southern Denmark, Denmark.

In the stated preference method called graded pairs comparisons respondents are asked to rate the intensity of their preference for their preferred alternative in a pairwise comparison of alternatives. Econometricians anticipate that the additional information will improve statistical efficiency compared to the standard DCE format. However, this paper reveals that added information inherent in graded pairs scale does not provide smaller standard deviations for the WTP estimated. Secondly, the ordered-response regression models employing the full range of the graded pairs data tend to overestimate WTP, which presumably is caused by the inherent tendency of the ordered-response models to 'predict to the extremes'.
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http://dx.doi.org/10.1002/hec.1159DOI Listing
May 2007

Ordering effect and price sensitivity in discrete choice experiments: need we worry?

Health Econ 2006 Nov;15(11):1217-28

Department of Health Economics, Institute for Public Health, University of Southern Denmark, Denmark.

The objective of this paper is to analyse the impact that attribute ordering has on the relative importance of the price attribute. A discrete choice experiment was performed in order to elicit psoriasis patients' preferences for treatment. We tested for ordering effect with respect to the price attribute, and disclosed noticeable higher price sensitivity when the price attribute was placed at the end of the program description. Our results indicate that preferences are context dependent and that heuristics may be used in the choice process. Our result does not, however, suggest that ordering effect is a symptom of lexicographic ordering.
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http://dx.doi.org/10.1002/hec.1117DOI Listing
November 2006

Investigating patients' preferences for cardiac rehabilitation in Denmark.

Int J Technol Assess Health Care 2006 ;22(2):211-8

Department of Health Economics/Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Odense C, Denmark.

Objectives: The objective of this study was to analyze preferences for activities comprised in comprehensive cardiac rehabilitation programs among former cardiac patients from three different hospitals in Copenhagen County, Denmark.

Methods: A discrete choice experiment was applied to elicit the preferences for the offer of participation in various cardiac rehabilitation program activities: smoking cessation course, physical exercise program, personal meetings with cardiac nurse, group meetings managed by cardiac nurses, and nutritional counseling guidance. The questionnaire was sent to 742 former cardiac patients. We had a response rate of 69 percent.

Results: We found that preferences differed with respect to gender and age and that the offer of participation in cardiac rehabilitation activities was not highly valued by older patients, in particular among older men.

Conclusions: The discrete choice experiment proved a valuable instrument for the measurement of preferences for cardiac rehabilitation. The study provides important information on patients' preferences for cardiac rehabilitation for healthcare professionals and decision makers.
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http://dx.doi.org/10.1017/S0266462306051038DOI Listing
May 2006