Does It Matter How You Ask? Assessing the Impact of Failure or Effectiveness Framing on Preferences for Antibiotic Treatments in a Discrete Choice Experiment

Abstract

Ian P Smith,1,* Mirko Ancillotti,2,* Esther W de Bekker-Grob,3,4 Jorien Veldwijk2– 4 1Julius Center for Health and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; 2Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; 3Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands; 4Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands*These authors contributed equally to this workCorrespondence: Ian P Smith, Julius Center for Health and Primary Care, University Medical Center Utrecht, Str. 6.131, P.O. Box 85500 3508 GA, Utrecht, the Netherlands, Tel [phone], Fax [phone], Email [email protected]: Studies assessing framing effects in discrete choice experiments (DCE) primarily focused on attributes related to mortality/survival information. Little is known about framing effects for other attributes in health-related DCEs. This study aimed to investigate how framing treatment outcome as effective, failure, or a combined frame impacts respondent choices and DCE outcomes.Patients and Methods: Three Bayesian D-efficient designed DCE surveys measuring preferences for antibiotic treatments were randomly distributed to a representative sample of the Swedish population aged 18– 65 years (n=1119). Antibiotic treatments were described using five attributes. Four attributes were static: Contribution to Antibiotic Resistance, Treatment Duration, Likelihood of Side-Effects, and Costs. A fifth treatment attribute was framed in three ways: Effectiveness, Failure Rate, or both. Mixed logit models were used to analyze attribute level estimates, importance value, and choice predictions.Results: Significant differences between the frames were found for the parameter estimates of the attributes of Treatment Duration and Likelihood of Side-Effects, but not Treatment Outcome which was the alternatively framed attribute. Contribution to Antibiotic Resistance and Costs were the most important attributes for all participants regardless of framing. Choice predictions for the “best option” antibiotic only slightly differed between the groups based on the frame seen (95.2– 92.4%).Conclusion: Our study showed that attribute framing can impact preferences regardless of the attribute’s importance value in alternative valuation. However, the practical implication of this effect may be limited. A theoretical discussion is needed to identify how researchers should accommodate and report any potential framing effect in their studies.Keywords: patient preferences, patient-centered care, DCE

Keywords

• patient preferences
• patient-centered care
• dce