Discrete-Choice-Experimente zur Messung der Zahlungsbereitschaft für Gesundheitsleistungen - ein anwendungsbezogener Literaturreview

Aim: Discrete choice experiments (DCE) are a method to assess willingness-to-pay (WTP) within the framework of cost-benefit analysis. Compared to traditional tools, DCE offer a broad application spectrum for the measurement of preferences. The objective of this paper was to evaluate the application of DCE in the measurement of willingness-to-pay for medical interventions. Method: A literature review was conducted in healthcare and economic databases (PubMed, EconLit), as well as manual search and citation-tracking in bibliographies for papers and books published in the period 01 / 1998 - 05 / 2010. Results: Compared to conventional methods, utility measurement using DCE provides two advantages. First, the experiment is less cognitive demanding for respondents. Second, willingness-to-pay and DCE are based on a valid theoretical basis. From the literature, validity, reliability, acceptance by respondents, practicability, and efficiency were evaluated as criteria for assessing DCE. These criteria proved to be of high methodological validity and reliability. Particularly, the results concerning internal consistency and theoretical validity are very encouraging. DCE provide an informative basis for identifying medical service features which create a higher benefit for patients, eliminating services for which no willingness-to-pay exists, and the conception of medical services offered to specific patient groups. Optimized results may be achieved if the respondents are familiar with the framing of the decision situation. Particularly in healthcare systems where respondents exhibit inadequate price sensitivity, this may be a difficulty. Conclusion: DCE are a versatile tool for WTP measurement in health economics, which enables researchers both to evaluate process attributes and to observe individual trade-offs between service attributes. By mimicking everyday decision-making situations the method is especially suitable for the evaluation of intervention-specific effects. However, numerous criteria require empirical examination. Focusing on WTP measurement, aside from experimental design aspects, particularly psychological aspects and cognitive problems of decision heuristics should be taken into consideration