Measuring trade-offs in nephrology : a systematic review of Discrete Choice Experiments and Conjoint Analysis studies

Background: Discrete Choice Experiment [DCE], Conjoint Analysis [CA], or Adaptive Conjoint Analysis [ACA] methods are increasingly applied to obtain patient, clinician or community preferences in nephrology. This study systematically reviews the above mentioned published choice studies providing an overview of the issues addressed, methods, and findings. Methods: Choice studies relating to nephrology were identified using electronic databases, including Medline, Embase, PsychINFO and Econlit from 1990 to 2015. For inclusion in the review, studies had to primarily relate to kidney disease and include results from statistical (econometric) analyses of respondents’ choice or preference. Studies meeting the inclusion criteria were assessed against a range of systematic review criteria, and methods and results summarised. Results: We identified 14 eligible studies from Europe, Australasia, North America, and Asia, reporting preferences for treatment or screening, patient experiences, quality of life, health outcomes and priority setting frameworks. Specific contexts included medical interventions in kidney transplantation and renal cell carcinoma, health policies for organ donation and allocation, dialysis modalities and end-of-life care; using a variety of statistical models. The characteristics of ‘time’ (i.e. transplant waiting time, dialysis hours, transport time) and ‘quality of life’ (pre and post-transplant, or pre and post-dialysis) consistently influenced patient and clinician preferences across the choice studies. Conclusions: Discrete choice experiments are increasingly used to obtain information about key preferences in kidney transplantation and dialysis. These study methods provide quantitative information about respondents’ trade-offs between conflicting clinical and policy objectives, and can establish how preferences vary among stakeholder groups.