Patients' preferences regarding the process and outcomes of life-saving technology - An application of conjoint analysis to liver transplantation

The economic technique of conjoint analysis was used to assess the relative importance of health outcome versus several process attributes !e.g., wait ing time, continuity of contact with the same medical staff) in determining patients' preferences for liver transplantation services. The attributes w ere established by reference to the literature and through initial qualitat ive interviews with liver transplant recipients (n = 12). Following a pilot study of 40 patients, a sample of patients (n = 213) who have received a l iver transplant at the Queen Elizabeth Hospital in Birmingham were surveyed . The technique of conjoint analysis was used to ascertain the relative imp ortance of the attributes included in the exercise and to estimate the marg inal rates of substitution (MRS) between different attributes. A useable re sponse rate of 89% was achieved. Although a small proportion of respondents (15%) exhibited dominant preferences for the chance of success attribute, the majority of respondents indicated that they would be prepared to exchan ge a reduction in health outcome for an improvement in the process characte ristics of the liver transplantation service. The results of this study hav e potentially important implications for the assessment of the benefits of medical technologies since they suggest that, even in the extreme case of l ife-saving interventions, the preferences of respondents may not be depende nt solely upon health outcomes but may also be determined by attributes ass ociated with the process of care.