, Volume 32, Issue 9, pp 883–902 | Cite as

Discrete Choice Experiments in Health Economics: A Review of the Literature

  • Michael D. Clark
  • Domino Determann
  • Stavros Petrou
  • Domenico Moro
  • Esther W. de Bekker-Grob
Systematic Review



Discrete choice experiments (DCEs) are increasingly used in health economics to address a wide range of health policy-related concerns.


Broadly adopting the methodology of an earlier systematic review of health-related DCEs, which covered the period 2001–2008, we report whether earlier trends continued during 2009–2012.


This paper systematically reviews health-related DCEs published between 2009 and 2012, using the same database as the earlier published review (PubMed) to obtain citations, and the same range of search terms.


A total of 179 health-related DCEs for 2009–2012 met the inclusion criteria for the review. We found a continuing trend towards conducting DCEs across a broader range of countries. However, the trend towards including fewer attributes was reversed, whilst the trend towards interview-based DCEs reversed because of increased computer administration. The trend towards using more flexible econometric models, including mixed logit and latent class, has also continued. Reporting of monetary values has fallen compared with earlier periods, but the proportion of studies estimating trade-offs between health outcomes and experience factors, or valuing outcomes in terms of utility scores, has increased, although use of odds ratios and probabilities has declined. The reassuring trend towards the use of more flexible and appropriate DCE designs and econometric methods has been reinforced by the increased use of qualitative methods to inform DCE processes and results. However, qualitative research methods are being used less often to inform attribute selection, which may make DCEs more susceptible to omitted variable bias if the decision framework is not known prior to the research project.


The use of DCEs in healthcare continues to grow dramatically, as does the scope of applications across an expanding range of countries. There is increasing evidence that more sophisticated approaches to DCE design and analytical techniques are improving the quality of final outputs. That said, recent evidence that the use of qualitative methods to inform attribute selection has declined is of concern.


Discrete Choice Experiment Latent Class Model Mixed Logit Preference Heterogeneity Random Utility Theory 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

Dr. Michael D. Clark: no conflict of interest. Mr. Clark wrote the drafts of the paper, and then took on board feedback from co-authors and peer reviewers in order to further refine it. He will act as overall guarantor for this work. He also evaluated many of the analyses relating to the new review period (2009–2012), and conducted some of the literature searches. Dr. Domino Determann: no conflict of interest. Determann MD reviewed a significant proportion of DCE papers relating to the period 2009–2012, and conducted many of the literature searches. She also provided feedback on early drafts of the paper and suggested some amendments.

Professor Stavros Petrou: no conflict of interest. Professor Petrou supervised this new DCE review from the outset, and commented on drafts of the paper, suggesting edits.

Dr. Domenico Moro: no conflict of interest. Dr. Moro reviewed some papers involving the use of mixed logit or latent class models. He was part of the review team from the onset, and commented on drafts of the paper when appropriate.

Dr. Esther de Bekker-Grob: no conflict of interest. As the first author of a high-profile published review of the DCE literature [3] which reviewed the DCE literature for the period 2001–2008, this co-author helped to ensure consistency with the earlier published review in terms of application of review criteria. She also commented on drafts of the paper, and made some valuable contributions to the points raised by the paper in Sects. 9 and 10.

Ethics committee approval

Not required.

Supplementary material

40273_2014_170_MOESM1_ESM.doc (158 kb)
Supplementary material 1 (DOC 159 kb)


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Michael D. Clark
    • 1
  • Domino Determann
    • 2
    • 3
  • Stavros Petrou
    • 5
  • Domenico Moro
    • 4
  • Esther W. de Bekker-Grob
    • 2
  1. 1.Department of EconomicsUniversity of WarwickCoventryUK
  2. 2.Department of Public HealthErasmus MC, University Medical Centre RotterdamRotterdamThe Netherlands
  3. 3.Centre for Prevention and Health Services ResearchNational Institute of Public Health and the Environment (RIVM)BilthovenThe Netherlands
  4. 4.Department of Business and MarketingBirmingham City Business School, Birmingham City UniversityBirminghamUK
  5. 5.Warwick Medical School (WMS)University of WarwickCoventryUK

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