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Title: Developing and applying Discrete Choice Experiments (DCEs) to inform pharmacy policy
Author: Tinelli, Michela
Awarding Body: University of Aberdeen
Current Institution: University of Aberdeen
Date of Award: 2007
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Introduction. In the United Kingdom (UK), recent policy developments include an increased role for the community phannacist in the management of drug therapy in primary care. When embarking on such service redesign, it is recognised that. patient preferences must be considered. The quality adjusted life years (QALY) approach is the common economic approach ~o 1'. considering preferences in economic evaluations. However, it is limited to consideration of - ·only health outcomes. Other approaches widely used in health services research, such as · satisfaction surveys, do not find a place in the economic eval~tion framework because they' do not incorporate any notion of opportunity cost or strength of preference. Another measure of benefit is required to go beyond the scope of the QALY and pla~e a value on non-health outcomes (e.g. information, reassurance, regret, anxiety) and process attributes (e.g. waiting · time at the ~ealth care centre, staff involyed, waiting time for test res!llts), as well as estimate trade-offs between such aspects ofcare. . . One technique adopted over the past decade in health economics to go beyond health outcome is Discrete Choice Experiment (DCEs). This is an attribute-based technique for eliciting preferenc~s. ~en a price proxy is included, willingness to pay (WTP), a monetary measure of benefit, can be estimated for both marginal changes in service characteristics and changes in the overall service. Whilst the last 15 years has seen an increased uSe of DeEs in health care, there has been limited application in pharmacy. The Community Pharmacy Medicines Management Project (Medman study) constituted the perfect platfonn for this PhD thesis. It was a large, randomised, controlled trial (ReT) to evaluate the introduction of a pharmacy-led medicines management service for patients with 'cQronary- heart -disease-(CHD): It- allowed comparison of results between traditional outcome measures (such as clinical outcomes, QALYs and satisfaction) and a broader measure of benefit llsing the DCE. As well as considering the relevance of DCE ·to policy making, methodological issues in their development were also considered. Aim and ·objectives. The aims of this PhD programme are: to consider the implications of ..taking a .broader patient centred approach (which goes beyond he~th outcomes) to ev~luating ' . a proposed policy change in community pharmacy; and to develop' and apply the DCE '. ' ~ . methodology to pharmacy. The specific objectives ofthe thesis are: • to conduct a review ofthe literature relating to benefit evaluation and its application to the economic evaluation framework in pharmacy; ' • to apply traditional benefit evaluation approaches, including' clinical outcomes, - . QALYs and a satisfaction survey to a' pharmacy setting;. jI ' i .J I' • to develop an alternative approach, DCEs, to value benefits, looking at different design appr?ache~ \\,~en defining multiple choice· DCEs and addressing welfare . estimation issJles when.analysing the data; • to apply DCE to phaimacy within the Medman .study and to compare the results with _these ofclinical and QALY approaches within an economic evaluation framework; • to consider the impact on policy when different approaches are applied. Methods. A fully comprehensive review of the health care literature was conducted to . identify possible methods for valuing community pharmacy-based services and their integration into economic evaluation.
Supervisor: Not available Sponsor: Not available
Qualification Name: University of Aberdeen, 2007 Qualification Level: Doctoral
EThOS ID:  DOI: Not available