Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA website (see opposite). NHS R&D HTA Programme T he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. Initially, six HTA panels (pharmaceuticals, acute sector, primary and community care, diagnostics and imaging, population screening, methodology) helped to set the research priorities for the HTA Programme. However, during the past few years there have been a number of changes in and around NHS R&D, such as the establishment of the National Institute for Clinical Excellence (NICE) and the creation of three new research programmes: Service Delivery and Organisation (SDO); New and Emerging Applications of Technology (NEAT); and the Methodology Programme. Although the National Coordinating Centre for Health Technology Assessment (NCCHTA) commissions research on behalf of the Methodology Programme, it is the Methodology Group that now considers and advises the Methodology Programme Director on the best research projects to pursue. The research reported in this monograph was funded as project number 96/49/04. The views expressed in this publication are those of the authors and not necessarily those of the Methodology Programme, HTA Programme or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

This paper considers the application of discrete choice experiments for eliciting preferences in the delivery of health care. Drawing upon the results from a recently completed systematic review, the paper summarises the application of this technique in health care. It then presents a case study applying the technique to rheumatology outpatient clinics. 200 patients were questioned about the importance of six attributes: staV seen (junior doctor or specialist nurse); time in waiting area; continuity of contact with same staV; provision of a phone-in/advice service; length of consultation; and change in pain levels. The systematic review indicated that discrete choice experiments have been applied to a wide number of areas and a number of methodological issues have been addressed. Consistent with this literature, the case study found evidence of both rationality and theoretical validity of responses. The approach was used to establish the relative importance of diVerent attributes, how individuals trade between these attributes, and overall benefit scores for diVerent clinic configurations. The value of attributes was estimated in terms of time, and this was converted to a monetary measure using the value of waiting time for public transport. Discrete choice experiments represent a potentially useful instrument for eliciting preferences. Future methodological work should explore issues related to the experimental design of the study, methods of data collection and analysis, and satisfaction with the economic axioms of the instrument. Collaborative work with psychologists and qualitative researchers will prove useful in this research agenda. Keywords: discrete choice experiments; patient preference; decision making; patient-caregiver communication Recent years have seen an increased use of discrete choice experiments (DCEs; also known as conjoint analysis) as a technique for eliciting preferences. This paper considers what we know to date about the application of DCEs in health and identifies important areas for future research. The technique is described and its use in health economics is considered. The results from a recently completed systematic review of the technique are summarised and a case study from an outpatient rheumatology clinic is presented which demonstrates both the standard approach to conducting a DCE and its potential uses. Methodological questions that need to be addressed are discussed. Discrete choice experimentsDiscrete choice experiments are based on the premise that, firstly, any good or service can be described by its characteristics (or attributes) and, secondly, the extent to which an individual values a good or service depends upon the nature and levels of these characteristics. The technique involves presenting individuals with choices of scenarios described in terms of characteristics and associated levels. For each choice they are asked to choose their preferred scenario. Response data are modelled within a benefit (or satisfaction) function which provides information on wh...

No abstract

Ruta and colleagues described an approach called programme budgeting and marginal analysis, which they argue recognises the need to balance clinical autonomy with financial responsibility.2 We describe two checklists to aid managers and doctors in implementing local frameworks for resource management based on this approach. These checklists deal with pragmatic and ethical considerations that are central to the successful design and implementation of priority setting processes. Why do we need an economic approach?The challenge of setting health service priorities is greater than ever. In the United Kingdom, despite the Wanless recommendation for up to a £29bn (43%) real increase in health spending over five years 3 many primary care trusts are overspent, with the total deficit estimated to be £500m ($870m; €727m) in 2005. 4 At the same time, important questions remain as to what managers and doctors are meant to do with national health technology guidance in their local contexts of resource management. 5There is a missing link between priority setting at national and local levels. This is highlighted in the United Kingdom by the absence of guidance on how managers and doctors are to commission effectively 6 and by the relatively poor record of the NHS in implementing evidence from economic appraisals at the local level.

No abstract