Discrete choice experiments in health economics: a review of the literature
Abstract
SUMMARY: Discrete choice experiments (DCEs) have become a commonly used instrument in health economics. This paper updates a review of published papers between 1990 and 2000 for the years 2001–2008. Based on this previous review, and a number of other key review papers, focus is given to three issues: experimental design; estimation procedures; and validity of responses. Consideration is also given to how DCEs are applied and reported. We identified 114 DCEs, covering a wide range of policy questions. Applications took place in a broader range of health‐care systems, and there has been a move to incorporating fewer attributes, more choices and interview‐based surveys. There has also been a shift towards statistically more efficient designs and flexible econometric models. The reporting of monetary values continues to be popular, the use of utility scores has not gained popularity, and there has been an increasing use of odds ratios and probabilities. The latter are likely to be useful at the policy level to investigate take‐up and acceptability of new interventions. Incorporation of interactions terms in the design and analysis of DCEs, explanations of risk, tests of external validity and incorporation of DCE results into a decision‐making framework remain important areas for future research. Copyright © 2010 John Wiley & Sons, Ltd.
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To undertake sample size calculation, it is crucial to know the number of alternatives per choice set, the largest number of levels of any attribute (for main effects) or the largest level of any two attributes (for interaction effects), and the number of blocks.
“It is noteworthy that to undertake the sample size calculation, it is crucial to know the number of alternatives per choice set, the largest number of levels of any attribute (for DCEs looking at main effects only) or the largest level of any two attributes (for a DCE looking at interaction effects), and the number of blocks [38].”
From Understanding Uptake of Digital Health Products: Methodology Tutorial for a Discrete Choice Experiment Using the Bayesian Efficient Design (2021) · cites this paper as [38]
The multinomial logit (MNL) model is typically a starting point for basic model estimation in DCEs.
“The multinomial logit (MNL) model has been previously described as the “workhorse” of DCE estimation [38,39], and it typically serves as a starting point for basic model estimation (although alternative models, such as probit, may be used).”
From Understanding Uptake of Digital Health Products: Methodology Tutorial for a Discrete Choice Experiment Using the Bayesian Efficient Design (2021) · cites this paper as [38]
To date, there has been limited progress in testing for external validity due to the difficulty in investigating preferences in the real world.
“Nevertheless, to date, there has been limited progress in testing for external validity due to the difficulty in investigating preferences in the real world [38].”
From Understanding Uptake of Digital Health Products: Methodology Tutorial for a Discrete Choice Experiment Using the Bayesian Efficient Design (2021) · cites this paper as [38]
The DCE methodology is considered a convenient approach to investigate the uptake of new interventions, including digital health interventions.
“The DCE methodology is also considered a convenient approach to investigate the uptake of new interventions, including digital health interventions [38], for example, digital behavior change interventions using a health and well-being smartphone app.”
From Understanding Uptake of Digital Health Products: Methodology Tutorial for a Discrete Choice Experiment Using the Bayesian Efficient Design (2021) · cites this paper as [38]
There has been a recent change in thinking toward a nonorthogonal and statistically more efficient design.
“There has therefore been a recent change in thinking toward a nonorthogonal and statistically more efficient design [38].”
From Understanding Uptake of Digital Health Products: Methodology Tutorial for a Discrete Choice Experiment Using the Bayesian Efficient Design (2021) · cites this paper as [38]
Cites
Cragg, J. G., & Zarembka, P. (1975) · Canadian Journal of Economics/Revue canadienne d économique · doi:10.2307/134075 · Cited by 8,385 · see citing works
Louviere, J. J., Hensher, D. A., Swait́, J., & Adamowicz, W. (2000) · Cambridge University Press eBooks · doi:10.1017/cbo9780511753831 · Cited by 6,915 · see citing works
Mixed Logit with Repeated Choices: Households' Choices of Appliance Efficiency Level
Revelt, D., & Train, K. E. (1998) · The Review of Economics and Statistics · doi:10.1162/003465398557735 · Cited by 2,187 · see citing works
Applied Choice Analysis: A Primer
Hensher, D. A., Rose, J. M., & Greene, W. H. (2005) · doi:10.1017/cbo9780511610356 · Cited by 1,823 · see citing works
Conducting Discrete Choice Experiments to Inform Healthcare Decision Making: A User??s Guide
Lancsar, E., & Louviere, J. (2008) · PharmacoEconomics · doi:10.2165/00019053-200826080-00004 · Cited by 1,707 · see citing works
Economic Valuation with Stated Preference Techniques
Bateman, I. J., Carson, R. T., Day, B., et al. (2002) · Edward Elgar Publishing eBooks · doi:10.4337/9781781009727 · Cited by 1,383 · see citing works
The Generalized Multinomial Logit Model: Accounting for Scale and Coefficient Heterogeneity
Fiebig, D. G., Keane, M. P., Louviere, J. J., et al. (2009) · Marketing Science · doi:10.1287/mksc.1090.0508 · Cited by 817 · see citing works
Are Choice Experiments Incentive Compatible? A Test with Quality Differentiated Beef Steaks
Lusk, J. L., & Schroeder, T. C. (2004) · American Journal of Agricultural Economics · doi:10.1111/j.0092-5853.2004.00592.x · Cited by 816 · see citing works
Internal Consistency of Choice
Sen, A. K. (1993) · Econometrica · doi:10.2307/2951715 · Cited by 801 · see citing works
Best–worst scaling: What it can do for health care research and how to do it
Flynn, T. N., Louviere, J. J., Peters, T. J., & Coast, J. (2006) · Journal of Health Economics · doi:10.1016/j.jhealeco.2006.04.002 · Cited by 787 · see citing works
Using Discrete Choice Experiments to Value Health and Health Care
(2008) · The Economics of Non-Market Goods and Resources · doi:10.1007/978-1-4020-5753-3 · Cited by 765 · see citing works
Designing Choice Sets for Stated Preference Methods: The Effects of Complexity on Choice Consistency
DeShazo, J. R., & Fermo, G. (2002) · Journal of Environmental Economics and Management · doi:10.1006/jeem.2001.1199 · Cited by 732 · see citing works
Ryan, M., & Gerard, K. (2003) · PubMed · Cited by 630 · see citing works
Self-citationQuick and easy choice sets: Constructing optimal and nearly optimal stated choice experiments
Street, D. J., Burgess, L., & Louviere, J. J. (2005) · International Journal of Research in Marketing · doi:10.1016/j.ijresmar.2005.09.003 · Cited by 553 · see citing works
Do Hypothetical and Actual Marginal Willingness to Pay Differ in Choice Experiments?
Carlsson, F., & Martinsson, P. (2001) · Journal of Environmental Economics and Management · doi:10.1006/jeem.2000.1138 · Cited by 552 · see citing works
Homegrown Values and Hypothetical Surveys: Is the Dichotomous Choice Approach Incentive-Compatible?
Cummings, R. G., & Harrison, G. W. (1995) · American Economic Review · Cited by 538 · see citing works
Designing efficient stated choice experiments in the presence of reference alternatives
Rose, J. M., Bliemer, M. C. J., Hensher, D. A., & Collins, A. T. (2008) · Transportation Research Part B: Methodological · doi:10.1016/j.trb.2007.09.002 · Cited by 528 · see citing works
Ferrini, S., & Scarpa, R. (2007) · Journal of Environmental Economics and Management · doi:10.1016/j.jeem.2006.10.007 · Cited by 516 · see citing works
Designing Conjoint Choice Experiments Using Managers' Prior Beliefs
Sándor, Z., & Wedel, M. (2001) · Journal of Marketing Research · doi:10.1509/jmkr.38.4.430.18904 · Cited by 493 · see citing works
Lancsar, E., & Louviere, J. J. (2006) · Health Economics · doi:10.1002/hec.1104 · Cited by 402 · see citing works
The Construction of Optimal Stated Choice Experiments
Street, D. J., & Burgess, L. (2007) · Wiley series in probability and statistics · doi:10.1002/9780470148563 · Cited by 401 · see citing works
Ryan, M. (1999) · Social Science & Medicine · doi:10.1016/s0277-9536(98)00374-8 · Cited by 342 · see citing works
Self-citationUsing Conjoint Analysis to Assess Women's Preferences for Miscarriage Management
Ryan, M., & Hughes, J. (1997) · Health Economics · doi:10.1002/(sici)1099-1050(199705)6:3 · Cited by 340 · see citing works
Self-citationDeveloping attributes and levels for discrete choice experiments using qualitative methods
Coast, J., & Horrocks, S. (2007) · Journal of Health Services Research & Policy · doi:10.1258/135581907779497602 · Cited by 291 · see citing works
Several methods to investigate relative attribute impact in stated preference experiments
Lancsar, E., Louviere, J. J., & Flynn, T. N. (2007) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.12.007 · Cited by 290 · see citing works
Web-based surveys as an alternative to traditional mail methods
Fleming, C. M., & Bowden, M. P. (2007) · Journal of Environmental Management · doi:10.1016/j.jenvman.2007.09.011 · Cited by 276 · see citing works
Bech, M., Kjær, T., & Lauridsen, J. T. (2010) · Health Economics · doi:10.1002/hec.1587 · Cited by 265 · see citing works
What do patients and the public want from primary care?
Coulter, A. (2005) · BMJ · doi:10.1136/bmj.331.7526.1199 · Cited by 264 · see citing works
Handbook of Transport Modelling
Hensher, D. A., & Button, K. J. (2007) · Emerald Group Publishing Limited eBooks · doi:10.1108/9780857245670 · Cited by 263 · see citing works
Rationalising the ‘irrational’: a think aloud study of discrete choice experiment responses
Ryan, M., Watson, V., & Entwistle, V. A. (2008) · Health Economics · doi:10.1002/hec.1369 · Cited by 249 · see citing works
Self-citationDesigning Discrete Choice Experiments: Do Optimal Designs Come at a Price?
Louviere, J. J., Islam, T., Wasi, N., Street, D. J., & Burgess, L. (2008) · Journal of Consumer Research · doi:10.1086/586913 · Cited by 244 · see citing works
Louviere, J. J., Street, D. J., Burgess, L., et al. (2008) · Journal of Choice Modelling · doi:10.1016/s1755-5345(13)70025-3 · Cited by 241 · see citing works
A Comparison of Criteria to Design Efficient Choice Experiments
Kessels, R., Goos, P., & Vandebroek, M. L. (2006) · Journal of Marketing Research · doi:10.1509/jmkr.43.3.409 · Cited by 241 · see citing works
Calibration of the difference between actual and hypothetical valuations in a field experiment
List, J. A., & Shogren, J. F. (1998) · Journal of Economic Behavior & Organization · doi:10.1016/s0167-2681(98)00084-5 · Cited by 231 · see citing works
Profile Construction in Experimental Choice Designs for Mixed Logit Models
Sándor, Z., & Wedel, M. (2002) · Marketing Science · doi:10.1287/mksc.21.4.455.131 · Cited by 223 · see citing works
Dissecting the Random Component of Utility
Louviere, J. J., Street, D. J., Carson, R. T., Ainslie, A., DeShazo, J. R., Cameron, T. A., Hensher, D. A., Kohn, R., & Marley, T. (2002) · Marketing Letters · doi:10.1023/a:1020258402210 · Cited by 213 · see citing works
Olsen, S. B. (2009) · Environmental and Resource Economics · doi:10.1007/s10640-009-9303-7 · Cited by 211 · see citing works
Choice experiments in health: the good, the bad, the ugly and toward a brighter future
Louviere, J. J., & Lancsar, E. (2009) · Health Economics Policy and Law · doi:10.1017/s1744133109990193 · Cited by 209 · see citing works
Heterogeneous Conjoint Choice Designs
Sándor, Z., & Wedel, M. (2005) · Journal of Marketing Research · doi:10.1509/jmkr.42.2.210.62285 · Cited by 205 · see citing works
Estimating the monetary value of health care: lessons from environmental economics
Hanley, N. D., Ryan, M., & Wright, R. E. (2002) · Health Economics · doi:10.1002/hec.763 · Cited by 185 · see citing works
Self-citationOptimal designs for choice experiments with asymmetric attributes
Burgess, L., & Street, D. J. (2004) · Journal of Statistical Planning and Inference · doi:10.1016/j.jspi.2004.03.021 · Cited by 177 · see citing works
Comparing welfare estimates from payment card contingent valuation and discrete choice experiments
Ryan, M., & Watson, V. (2008) · Health Economics · doi:10.1002/hec.1364 · Cited by 165 · see citing works
Self-citationLancsar, E., & Savage, E. (2004) · Health Economics · doi:10.1002/hec.870 · Cited by 160 · see citing works
Using stated preference and revealed preference modeling to evaluate prescribing decisions
Mark, T. L., & Swait́, J. (2003) · Health Economics · doi:10.1002/hec.845 · Cited by 159 · see citing works
Observed Choices for Food Safety in Retail, Survey, and Auction Markets
Shogren, J. F., Fox, J. A., Hayes, D. J., et al. (1999) · American Journal of Agricultural Economics · doi:10.2307/1244106 · Cited by 153 · see citing works
Efficient stated choice experiments for estimating nested logit models
Bliemer, M. C. J., Rose, J. M., & Hensher, D. A. (2008) · Transportation Research Part B Methodological · doi:10.1016/j.trb.2008.05.008 · Cited by 152 · see citing works
'Irrational' stated preferences: a quantitative and qualitative investigation.
Miguel, F. S., Ryan, M., & Amaya-Amaya, M. (2005) · Health Economics · doi:10.1002/hec.912 · Cited by 133 · see citing works
Self-citationOptimal and near-optimal pairs for the estimation of effects in 2-level choice experiments
Street, D. J. (2003) · Journal of Statistical Planning and Inference · doi:10.1016/s0378-3758(02)00399-3 · Cited by 121 · see citing works
Viney, R. C., Savage, E., & Louviere, J. J. (2005) · Health Economics · doi:10.1002/hec.981 · Cited by 109 · see citing works
Confound it! That pesky little scale constant messes up our convenient assumptions
Louviere, J. J., & Eagle, T. C. (2006) · OPUS - Open Publications of UTS Scholars (University of Technology Sydney) · Cited by 106 · see citing works
Optimal Designs for 2kChoice Experiments
Burgess, L., & Street, D. J. (2003) · Communication in Statistics- Theory and Methods · doi:10.1081/sta-120024475 · Cited by 104 · see citing works
Validity of discrete-choice experiments evidence for health risk reduction
Telser, H., & Zweifel, P. S. (2006) · Applied Economics · doi:10.1080/00036840500427858 · Cited by 103 · see citing works
Computer-Aided Blocking of Factorial and Response-Surface Designs
Cook, R. D., & Nachtsheim, C. J. (1989) · Technometrics · doi:10.1080/00401706.1989.10488556 · Cited by 94 · see citing works
Araña, J. E., León, C. J., & Hanemann, W. M. (2007) · Journal of Health Economics · doi:10.1016/j.jhealeco.2007.10.003 · Cited by 78 · see citing works
Ratcliffe, J., Brazier, J., Tsuchiya, A., Symonds, T., & Brown, M. L. (2009) · Health Economics · doi:10.1002/hec.1426 · Cited by 71 · see citing works
Conjoint analysis. The cost variable: an Achilles' heel?
Skjoldborg, U. S., & Gyrd‐Hansen, D. (2002) · Health Economics · doi:10.1002/hec.742 · Cited by 71 · see citing works
Using Discrete Choice Experiments within a Cost-Benefit Analysis Framework
McIntosh, E. (2006) · PharmacoEconomics · doi:10.2165/00019053-200624090-00004 · Cited by 64 · see citing works
Deriving welfare measures in discrete choice experiments: a comment to Lancsar and Savage (1)
Ryan, M. (2004) · Health Economics · doi:10.1002/hec.869 · Cited by 58 · see citing works
Self-citationTesting for consistency in willingness to pay experiments
Ryan, M., & Miguel, F. S. (2000) · Journal of Economic Psychology · doi:10.1016/s0167-4870(00)00006-4 · Cited by 50 · see citing works
Self-citationDesigning Discrete Choice Experiments for Health Care
Street, D. J., Burgess, L., Viney, R. C., & Louviere, J. J. (2007) · The Economics of non-market goods and resources · doi:10.1007/978-1-4020-5753-3_2 · Cited by 48 · see citing works
Why worry about awareness in choice problems? Econometric analysis of screening for cervical cancer
Belkar, R., Fiebig, D. G., Haas, M. R., et al. (2005) · Health Economics · doi:10.1002/hec.1013 · Cited by 34 · see citing works
Formal Choice Models of Informal Choices
Louviere, J. J., & Meyer, R. J. (2008) · Emerald Group Publishing Limited eBooks · doi:10.1108/s1548-6435(2008)0000004005 · Cited by 32 · see citing works
‘Threats’ to and hopes for estimating benefits
Ryan, M., & Amaya‐Amaya, M. (2004) · Health Economics · doi:10.1002/hec.949 · Cited by 31 · see citing works
Self-citationComment on “Microeconometrics” by J.A. Hausman
Wansbeek, T. J., Wedel, M., & Meijer, E. (2001) · Journal of Econometrics · doi:10.1016/s0304-4076(00)00065-8 · Cited by 7 · see citing works
External Validity of Hypothetical Surveys and Laboratory ExperimentsPreprint
Chang, J. B., Lusk, J. L., Norwood, F. B., et al. (2008) · RePEc: Research Papers in Economics · doi:10.22004/ag.econ.43600 · Cited by 2 · see citing works
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- Authors
- de Bekker‐Grob, E. W., Ryan, M., & Gerard, K.
- Affiliations
- University of Aberdeen (GB)
- University of Southampton (GB)
- Corresponding author
- Ryan, Mandy
- ORCID
- Ryan, Mandy
- Venue
- Health Economics
- Publisher
- Wiley
- Published
- 2010-12-19
- Volume
- 21
- Issue
- 2
- Pages
- 145-172
- ISSN
- 1057-9230 (ISSN-L)
- 1099-1050
- OpenAlex
- W2121722424
- Cited by
- 1,329
- References
- 65
- Citations by year
- 2026: 91 · 2025: 113 · 2024: 83 · 2023: 97 · 2022: 108 · 2021: 117 · 2020: 104 · 2019: 94 · 2018: 83 · 2017: 78 · 2016: 76 · 2015: 80 · 2014: 90 · 2013: 57 · 2012: 39
- FWCI
- 9.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Economics (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Funders
- National Institute for Health and Care Research (CDF-2008-01-09)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Keywords
- discrete choice experiment, experimental design, estimation procedures, response validity, health policy, willingness to pay, utility scores, odds ratio, interaction terms, generalizability, health technology assessment
- MeSH terms
- Choice Behavior, Delivery of Health Care, Humans, Developed Countries, Patient Preference
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