Does Convenience Matter in Health Care Delivery? A Systematic Review of Convenience-Based Aspects of Process Utility

Abstract

Objectives: To systematically review the existing literature on the value associated with convenience in health care delivery, independent of health outcomes, and to try to estimate the likely magnitude of any value found. Methods: A systematic search was conducted for previously published studies that reported preferences for convenience-related aspects of health care delivery in a manner that was consistent with either cost-utility analysis or cost-benefit analysis. Data were analyzed in terms of the methodologies used, the aspects of convenience considered, and the values reported. Results: Literature searches generated 4715 records. Following a review of abstracts or full-text articles, 27 were selected for inclusion. Twentysix studies reported some evidence of convenience-related process utility, in the form of either a positive utility or a positive willingness to pay. The aspects of convenience valued most often were mode of administration (n ¼ 11) and location of treatment (n ¼ 6). The most common valuation methodology was a discrete-choice experiment containing a cost component (n ¼ 15). Conclusions: A preference for convenience-related process utility exists, independent of health outcomes. Given the diverse methodologies used to calculate it, and the range of aspects being valued, however, it is difficult to assess how large such a preference might be, or how it may be effectively incorporated into an economic evaluation. Increased consistency in reporting these preferences is required to assess these issues more accurately.

The Community IntraVenous Antibiotic Study (CIVAS): a mixed-methods evaluation of patient preferences for and cost-effectiveness of different service models for delivering outpatient parenteral antimicrobial therapy

“…These sources of process utility are clearly important to patients and this is a consistent finding across stated preference studies. 128 The order of attribute preference was relatively stable across the short-and long-term infection groups. Indeed, significant differences were not observed for preferences for treatment type or key characteristics such as risk, with differences only for appointment times, training and seeing or speaking to someone the patient knows.…”

Strength of public preferences for endovascular or open aortic aneurysm repair

“…Another strength of this study is that, unlike many previous studies in other areas that have attempted to measure process utilities using alternative numeraires such as money, this study has quantified strength of preference in terms of QALYs. This means that the value attached to process utility can readily and explicitly be incorporated into the type of cost‐effectiveness analyses favoured by NICE.…”

“…In formulating its guidance, NICE uses quality‐adjusted life‐years (QALYs) as the measure of benefit in cost‐effectiveness analyses, implicitly assuming that improvements in health are the only thing of relevance to patients. However, there may be many other influences on patient preferences regarding healthcare technologies. Examples of such influences are patient autonomy, dignity, and the procedures patients have to undergo to achieve an improvement in health outcome.…”

Comparison of utilization of urgent care and primary care 2011-2015

“…The concept of a patient panel goes to the core of primary care: that general individual patient health management is the responsibility of the PCP, requiring a relationship between patient and physician. Patient health management involves continuous, comprehensive and coordinated healthcare between the patient and the physician which develops a shared knowledge of health status and treatment plans [12].…”