OBJECTIVES: Discrete choice experiments (DCEs) are increasingly advocated as a way to quantify preferences for healthcare. However, increasing support does not necessitate increasing quality. Although specific reviews have been conducted in certain contexts, there exists no recent description of the current-state-of-play in healthcare DCEs more generally. The aim of this paper was to update previous reviews, which covered the period 1990-2012, to identify all health-related DCEs and provide a description of trends, current practice and future challenges.
METHODS: A systematic literature review was conducted to identify health-related empirical DCE studies published between 2013-2017. The search strategy (terms and electronic database) replicated previous reviews to allow the reporting of trends. Data were also extracted in line with previous reviews and included information on attributes and levels, experimental design, analytical methods, validity and outcome measures.
RESULTS: From the generated 3381 possible references, 308 DCEs met the inclusion criteria and were selected for data extraction. The number of DCEs per year has continued to increase and in an expanding number of countries. A trend towards the inclusion of attributes involving money, risk or time was also observed. Studies reported using more sophisticated designs with associated software, for example, Bayesian D-efficient designs generated using Ngene. The trend towards the use of more complex econometric models also continued. However, many reports presented sophisticated methods with insufficient detail. Qualitative methods have become more popular as an approach to selecting attributes and levels and to increase understanding of results, which might improve validity.
CONCLUSIONS: The use of empirical DCEs in health economics continues to grow, although less rapidly than before. However, inadequate reporting of methodological details inhibits quality assessment, reducing confidence in the results and the ability for decision-makers to act on the results. How and when to integrate health-related DCE outcomes into decision-making remains an important area for future research.
