Discrete Choice Experiment Instrument (DCE)

Abstract

The Discrete Choice Experiment Instrument (DCE), developed by dosReis et al. (2023), is a specialized scale designed to quantify patient Treatment Preferences regarding interventions for Major Depressive Disorder (MDD). The development process was robust, incorporating findings from a comprehensive literature review and essential feedback gathered from a stakeholder advisory group (SAG).

The resulting instrument is a concise 6-item measure structured around choice tasks. It was initially evaluated in a sample of adults diagnosed solely with MDD, specifically excluding populations with co-occurring conditions such as Bipolar Disorder or post-partum depression. However, the foundational study did not report formal psychometric properties, meaning reliability or validity results for the DCE items are currently unavailable in the primary literature.

Keywords

Treatment Preferences, Major Depressive Disorder, Discrete Choice Experiment, Patient Attitudes, Treatment Planning, Client Treatment Matching, Health Economics, Utility Assessment.

Authors

Susan dosReis, Laura M. Bozzi, Beverly Butler, Richard Z. Xie, Richard H. Chapman, Jennifer Bright, Erica Malik, Julia F. Slejko.

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Purpose

The primary purpose of the DCE instrument is to quantitatively assess and model patient preferences for key attributes of treatment regimens designed to address Major Depressive Disorder (MDD). By forcing respondents to make trade-offs between different treatment profiles, the instrument identifies the relative importance patients place on various treatment characteristics.

Specific attributes evaluated by the DCE include the modality of care (e.g., medication vs. combined approaches), the expected time until treatment efficacy is achieved, improvements in daily functioning metrics such as productivity and interpersonal relations, and the associated monthly out-of-pocket costs. This information is critical for patient-centered treatment planning and health economic evaluation.

Construct

The DCE instrument is fundamentally designed to measure the economic and psychological construct of patient utility, specifically within the context of healthcare decision-making. As a specialized form of the Discrete Choice Experiment methodology, it operates under the assumption that an individual’s ultimate preference for a specific treatment option is derived from the calculated utility of the attributes characterizing that option.

The core construct being quantified is the marginal utility patients derive from incremental changes in specific treatment attributes (e.g., moving from a high out-of-pocket cost to a lower cost, or achieving a smaller versus larger increase in productivity). This methodology allows researchers to rigorously understand the trade-offs patients are willing to make when faced with realistic, multi-faceted treatment choices for major depression, thereby informing value assessments.

Validity

As of the initial publication in 2023 (dosReis et al.), data pertaining to the formal psychometric validation of the DCE instrument are not yet available. Future research is needed to establish measures such as construct validity (e.g., whether the scale measures the theoretical construct of utility as intended) and criterion validity within the target population.

Reliability

No formal reliability data, such as internal consistency (e.g., Cronbach’s alpha) or test-retest reliability, were reported for the six items of the DCE instrument in the original study. Researchers applying the scale in clinical or research settings are advised to conduct reliability testing specific to their sample population.

Factor Analysis

No factor analysis or structural modeling results were provided in the initial documentation of the DCE instrument. Since the Discrete Choice Experiment methodology frequently employs econometric models (such as conditional logit or mixed logit models) to estimate attribute coefficients, the primary statistical focus is on utility estimation rather than traditional latent factor extraction.

Instrument

Test Type: Original instrument utilizing the Discrete Choice Experiment (DCE) methodology.

Format: The DCE comprises six choice task questions. In each task, respondents are presented with three distinct treatment profiles, each defined by varying levels of six attributes. The overarching instruction requires the respondent to select the single option they most prefer for treating depression. The instrument is administered electronically, and the estimated completion time during pre-testing was approximately 15–20 minutes. The measure consists of 6 core items (choice tasks).

Language Available: English

Population Group: Human; Male; Female

Age Group: Adulthood (18 years & older)

Population Details: Respondents were adults diagnosed with Major Depressive Disorder (MDD), located in the United States. Key exclusion criteria included the presence of Bipolar Disorder or post-partum depression, ensuring the sample was narrowly focused on MDD treatment decision-making.

Test Methodology: The instrument is a task-based measure designed to assess attitudes toward treatment via forced trade-offs, based on principles of random utility theory.

Keywords

Treatment Preferences, Major Depressive Disorder, Patient Attitudes, Client Attitudes, Major Depression, Preferences, Treatment Planning, Client Treatment Matching, Treatment Process and Outcome Measures.

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Authors

Author ORCID Identifier:

• dosReis, Susan: http://orcid.org/0000-0003-2210-6650

• Bozzi, Laura M.: http://orcid.org/0000-0001-5326-6521

• Xie, Richard Z.: http://orcid.org/0000-0002-2797-3019

• Chapman, Richard H.: http://orcid.org/0000-0002-1988-1368

• Bright, Jennifer: http://orcid.org/0000-0001-7442-3979

• Malik, Erica: http://orcid.org/0000-0002-2092-4273

• Slejko, Julia F.: http://orcid.org/0000-0001-6900-9220

Affiliation Email addresses:

• dosReis, Susan: University of Maryland Baltimore, School of Pharmacy, Department of Pharmaceutical Health Services Research. Email: [email protected]

• Bozzi, Laura M.: University of Maryland Baltimore, School of Pharmacy, Department of Pharmaceutical Health Services Research.

• Butler, Beverly: PAVE Center, School of Pharmacy, Department of Pharmaceutical Health Services Research.

• Xie, Richard Z.: Innovation and Value Initiative.

• Chapman, Richard H.: Innovation and Value Initiative.

• Bright, Jennifer: Innovation and Value Initiative.

• Malik, Erica: Innovation and Value Initiative.

• Slejko, Julia F.: University of Maryland Baltimore, School of Pharmacy, Department of Pharmaceutical Health Services Research.

Correspondence Address: dosReis, Susan: University of Maryland Baltimore, School of Pharmacy, Department of Pharmaceutical Health Services Research, Baltimore, Maryland, United States, 21201.

Permissions & Fee and Test Year

The Discrete Choice Experiment Instrument (DCE) is not a commercial scale. Permissions to use the instrument can be obtained by contacting the corresponding author, Susan dosReis.

There is no associated fee for using the instrument in academic or non-commercial research. The initial development and testing year for the DCE was 2023.

Reference’s

• dosReis, S., Bozzi, L. M., Butler, B., Xie, R. Z., Chapman, R. H., Bright, J., Malik, E., & Slejko, J. F. (2023). Preferences for treatments for major depressive disorder: Formative qualitative research using the patient experience. The Patient: Patient-Centered Outcomes Research, 16(1), 57–66. https://doi.org/10.1007/s40271-022-00596-6

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Items of the Discrete Choice Experiment Instrument (DCE)

The DCE has six choice task questions, with three profiles shown in each choice task, and an overarching question: ‘If you could only choose 1 option for treating depression, which do you most prefer?’ Response options for each item are as follows:

1. Mode of treatment: (medicine, medicine and psychotherapy, and all modalities)

2. Time to treatment effect: (4, 6, 9 weeks)

3. Days of hopefulness: (2, 4, 6 days/week)

4. Effect on productivity: (40%, 60%, 90% increase)

5. Relations with others: (strained, improved, no impact)

6. Monthly out-of-pocket costs: ($30, $90, $270)