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A Systematic Review of Discrete Choice Experiments in Oncology Treatments

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Abstract

Background

As the number and type of cancer treatments available rises and patients live with the consequences of their disease and treatments for longer, understanding preferences for cancer care can help inform decisions about optimal treatment development, access, and care provision. Discrete choice experiments (DCEs) are commonly used as a tool to elicit stakeholder preferences; however, their implementation in oncology may be challenging if burdensome trade-offs (e.g. length of life versus quality of life) are involved and/or target populations are small.

Objectives

The aim of this review was to characterise DCEs relating to cancer treatments that were conducted between 1990 and March 2020.

Data Sources

EMBASE, MEDLINE, and the Cochrane Database of Systematic Reviews were searched for relevant studies.

Study Eligibility Criteria

Studies were included if they implemented a DCE and reported outcomes of interest (i.e. quantitative outputs on participants’ preferences for cancer treatments), but were excluded if they were not focused on pharmacological, radiological or surgical treatments (e.g. cancer screening or counselling services), were non-English, or were a secondary analysis of an included study.

Analysis Methods

Analysis followed a narrative synthesis, and quantitative data were summarised using descriptive statistics, including rankings of attribute importance.

Result

Seventy-nine studies were included in the review. The number of published DCEs relating to oncology grew over the review period. Studies were conducted in a range of indications (n = 19), most commonly breast (n =10, 13%) and prostate (n = 9, 11%) cancer, and most studies elicited preferences of patients (n = 59, 75%). Across reviewed studies, survival attributes were commonly ranked as most important, with overall survival (OS) and progression-free survival (PFS) ranked most important in 58% and 28% of models, respectively. Preferences varied between stakeholder groups, with patients and clinicians placing greater importance on survival outcomes, and general population samples valuing health-related quality of life (HRQoL). Despite the emphasis of guidelines on the importance of using qualitative research to inform attribute selection and DCE designs, reporting on instrument development was mixed.

Limitations

No formal assessment of bias was conducted, with the scope of the paper instead providing a descriptive characterisation. The review only included DCEs relating to cancer treatments, and no insight is provided into other health technologies such as cancer screening. Only DCEs were included.

Conclusions and Implications

Although there was variation in attribute importance between responder types, survival attributes were consistently ranked as important by both patients and clinicians. Observed challenges included the risk of attribute dominance for survival outcomes, limited sample sizes in some indications, and a lack of reporting about instrument development processes.

Protocol Registration

PROSPERO 2020 CRD42020184232.

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Acknowledgements

The authors would like to thank Lauren Randall, Janet Dooley and Dawn Ri'chard for their support in editing and formatting this manuscript, and Rienne Schinner for her support in reviewing and executing the searches.

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  1. Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK

    Hannah Collacott, Caitlin Thomas, Ella Brookes, Rachel Lo & Sebastian Heidenreich

  2. Erasmus University, Rotterdam, The Netherlands

    Vikas Soekhai

  3. Erasmus University Medical Center, Rotterdam, The Netherlands

    Vikas Soekhai

  4. Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA

    Anne Brooks & Sarah Mulnick

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Hannah Collacott, Vikas Soekhai, Caitlin Thomas, Anne Brooks, Ella Brookes, Rachel Lo, Sarah Mulnick and Sebastian Heidenreich have no conflicts of interest to declare relevant to this study.

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The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

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HC, VS, CT, AB, RL, SM and SH participated in the conception, design, planning and conduct of the study, and analysis and interpretation of data.

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Collacott, H., Soekhai, V., Thomas, C. et al. A Systematic Review of Discrete Choice Experiments in Oncology Treatments. Patient 14, 775–790 (2021). https://doi.org/10.1007/s40271-021-00520-4

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