Saying yes, doing no? Investigating the internal and external validity of discrete choice experiments to inform healthcare decision making

Research output: Types of ThesisDoctoral ThesisInternal

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Decisions about health always involve trade-offs, both for individuals and for society. In a society with scarce healthcare resources and different preferences between individuals, difficult decisions are made on a societal level and not every individual can always get the care they prefer. One of the most used approaches to study individuals’ trade-offs in healthcare is the discrete choice experiment (DCE). This quantitative elicitation method has a strong theoretical foundation and preferences are elicited in a systematic way by letting respondents repeatedly trade-off alternatives. However, to be useful for healthcare decision making, it is of great importance that the method’s validity is sufficiently established, which currently is not the case. This PhD provides insights into the internal and external validity of DCEs to inform healthcare decision-making.

This thesis posits that the integration of public and patient preferences in healthcare decision making can benefit both individuals and society. Although research into the validity of preference elicitation methods has come a long way, many challenges remain. Internal validity of DCEs can be improved by identifying the multitude of factors that influence respondents when making decisions in particular contexts, and by trying to accommodate for these factors in the presentation of choices and data analysis of DCEs. External validity can be improved by paying close attention to the sampling procedure, model complexity and the versatility of factors causing hypothetical bias. To eventually incorporate preferences in healthcare decision making in a more systematic and scientifically valid way, a multi-stakeholder approach is needed whereby researchers, policymakers, the public, patients, and other stakeholders collaborate as research partners.
Original languageEnglish
Awarding Institution
  • Erasmus University Rotterdam
  • van Exel, Job, Supervisor
  • Grob, Esther, Supervisor
  • de Groot, Carin, Supervisor
Award date1 Dec 2022
Place of PublicationRotterdam
Print ISBNs978-94-6421-862-6
Publication statusPublished - 1 Dec 2022


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