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Assessing preferences for improved smoking cessation medications: a discrete choice experiment

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Abstract

Background

The use of smoking cessation medications can considerably enhance the long-term abstinence rate at a reasonable cost, but only a small proportion of quitters seek medical assistance. The objective of this study was to evaluate the factors that influence the decision to use such treatments and the willingness-to-pay of smokers for improved cessation drugs.

Method

A discrete choice experiment was conducted amongst smokers in the French-speaking part of Switzerland. Choice sets consisted of two hypothetical medications described via five attributes (price, efficacy, possibility of minor side effects, attenuation of weight gain and availability) and an opt-out option. Various discrete choice models were estimated to analyse both the factors that influence treatment choice and those that influence the overall propensity to use a smoking cessation medication.

Results

Our results indicate that smokers are willing to pay for higher efficacy, less-frequent side effects and prevention of weight gain. Whether the drug is available over-the-counter or on medical prescription is of secondary importance. In addition, we show that there are several individual-specific factors influencing the decision to use such medications, including education level. Results also indicate substantial preference heterogeneity.

Conclusion

This study shows that there is a potential demand for improved cessation medications. Broader usage could be reached through lower out-of-pocket price and greater efficacy. Secondary aspects such as side effects and weight gain should also be taken into consideration.

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Notes

  1. In 2007, 54% of Swiss smokers wanted to quit, but only 10% within the next 30 days and 30% within the next 6 months [2].

  2. NRTs partially relieve the withdrawal symptoms that people experience when they quit, by compensating for the lack of nicotine in the organism. There are several NRTs currently available over-the-counter in Switzerland, including patches, gum, inhalers, lozenges and nasal sprays.

  3. Two nicotine-free medications are available in Switzerland by medical prescription only (A list): bupropion (brand name Zyban®), whose exact mode of action is still unclear [6], and varenicline (brand name Champix®), which relieves symptoms of nicotine withdrawal and blocks the reinforcing effect of continued nicotine use through an antagonist and agonist action [7].

  4. Also known as alternative-specific choice experiments. DCEs that use generic titles for the alternatives are called unlabelled DCEs, contrary to labelled choice experiments, where each alternative refers to a particular commodity (e.g., Zyban®) [31].

  5. The perceived value of quitting is defined as “the difference between the lifetime utility from quitting and the lifetime utility from continuing to smoke” (Avery et al. [28]).

  6. For instance, if we compare two medications, one that has a lower price, higher efficacy and fewer side-effects, with the other attributes being at the same level, is considered dominant.

  7. IIA holds in the same nest but not across different nests.

  8. In short, draws from \( f(\beta \left| \theta \right.) \) are used to get a simulated value of the log-likelihood function. This is done for different values of θ, until we obtain the maximum simulated likelihood (Train [50]).

  9. In order to assess potential non-linearity within these attributes, a MNL model was also estimated using the levels of the attributes in the utility function (the levels were effects coded [31]). Results, available upon request, show that the linearity assumption is reasonable.

  10. The IV parameter associated with the opt-out option was set to one.

  11. This method, which is also referred to as parametric bootstrap, consists of taking draws from a multivariate normal distribution with means and covariance given by the estimated coefficients and the associated variance–covariance matrix. Here, we performed 10,000 draws to obtain 10,000 values of the coefficients from the joint distribution. We used these values to compute 10,000 mWTP estimates for each non-price attribute. The 95% confidence interval is then defined by taking the upper and lower 2.5 percentiles of the distribution.

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  1. Faculty of Economics, Institute for Research in Economics, University of Neuchâtel, 2000, Neuchâtel, Switzerland

    Joachim Marti

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Table 9 Example of choice set
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Marti, J. Assessing preferences for improved smoking cessation medications: a discrete choice experiment. Eur J Health Econ 13, 533–548 (2012). https://doi.org/10.1007/s10198-011-0333-z

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