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Public stated preferences for pharmaceutical funding decisions

Aguiar, Magda Francisca Calás Oliveira Carvalho
Fonte: Universidade do Minho Publicador: Universidade do Minho
Tipo: Dissertação de Mestrado
Publicado em //2013 ENG
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Dissertação de mestrado em Health Economics and Policy; Introduction: In Portugal, the pharmaceutical consumption is subsidized by public funds. The rising NHS expenditures and the recent need of cost containment policies emphasize the discussion on priority setting in health care and raise questions of which criteria are appropriate to support funding decisions. Decision-makers base the pharmaceutical funding grant on clinical and economical evidence. Vulnerable sub groups, such as chronically ill and elderly with low income, benefit of higher financing rates than the general population. Little is known about the preferences of the public for pharmaceutical funding criteria in Portugal. Discrete Choice Experiments (DCEs) are suitable for the estimation of stated preferences as they measure of benefit that describes the good through a bundle of attributes and levels and it is based on the assumption that an individual’s valuation depends upon the levels of these attributes. DCE have the potential to contribute to outcome measurement for use in economic evaluation, uniquely allowing the investigation of diverse questions, such as clinical, economic and ethical. Aim: This work seeks to investigate criteria considered important by the Portuguese public for allocating resources for pharmaceuticals. In particular...

“Pay them if it works”: Discrete choice experiments on the acceptability of financial incentives to change health related behaviour

Promberger, Marianne; Dolan, Paul; Marteau, Theresa M.
Fonte: Pergamon Publicador: Pergamon
Tipo: Artigo de Revista Científica
Publicado em /12/2012 EN
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The use of financial incentives to change health-related behaviour is often opposed by members of the public. We investigated whether the acceptability of incentives is influenced by their effectiveness, the form the incentive takes, and the particular behaviour targeted. We conducted discrete choice experiments, in 2010 with two samples (n = 81 and n = 101) from a self-selected online panel, and in 2011 with an offline general population sample (n = 450) of UK participants to assess the acceptability of incentive-based treatments for smoking cessation and weight loss. We focused on the extent to which this varied with the type of incentive (cash, vouchers for luxury items, or vouchers for healthy groceries) and its effectiveness (ranging from 5% to 40% compared to a standard treatment with effectiveness fixed at 10%). The acceptability of financial incentives increased with effectiveness. Even a small increase in effectiveness from 10% to 11% increased the proportion favouring incentives from 46% to 55%. Grocery vouchers were more acceptable than cash or vouchers for luxury items (about a 20% difference), and incentives were more acceptable for weight loss than for smoking cessation (60% vs. 40%). The acceptability of financial incentives to change behaviour is not necessarily negative but rather is contingent on their effectiveness...

Eliciting preferences for priority setting in genetic testing: a pilot study comparing best-worst scaling and discrete-choice experiments

Severin, Franziska; Schmidtke, Jörg; Mühlbacher, Axel; Rogowski, Wolf H
Fonte: Nature Publishing Group Publicador: Nature Publishing Group
Tipo: Artigo de Revista Científica
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Given the increasing number of genetic tests available, decisions have to be made on how to allocate limited health-care resources to them. Different criteria have been proposed to guide priority setting. However, their relative importance is unclear. Discrete-choice experiments (DCEs) and best-worst scaling experiments (BWSs) are methods used to identify and weight various criteria that influence orders of priority. This study tests whether these preference eliciting techniques can be used for prioritising genetic tests and compares the empirical findings resulting from these two approaches. Pilot DCE and BWS questionnaires were developed for the same criteria: prevalence, severity, clinical utility, alternatives to genetic testing available, infrastructure for testing and care established, and urgency of care. Interview-style experiments were carried out among different genetics professionals (mainly clinical geneticists, researchers and biologists). A total of 31 respondents completed the DCE and 26 completed the BWS experiment. Weights for the levels of the six attributes were estimated by conditional logit models. Although the results derived from the DCE and BWS experiments differed in detail, we found similar valuation patterns in the DCE and BWS experiments. The respondents attached greatest value to tests with high clinical utility (defined by the availability of treatments that reduce mortality and morbidity) and to testing for highly prevalent conditions. The findings from this study exemplify how decision makers can use quantitative preference eliciting methods to measure aggregated preferences in order to prioritise alternative clinical interventions. Further research is necessary to confirm the survey results.


Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /03/2011 EN
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Willingness-to-pay (WTP) estimates derived from discrete-choice experiments (DCEs) generally assume that the marginal utility of income is constant. This assumption is consistent with theoretical expectations when costs are a small fraction of total income. We analyze the results of five DCEs that allow direct tests of this assumption. Tests indicate that marginal utility often violates theoretical expectations. We suggest that this result is an artifact of a cognitive heuristic that recodes cost levels from a numerical scale to qualitative categories. Instead of evaluating nominal costs in the context of a budget constraint, subjects may recode costs into categories such as ‘low’, ‘medium’, and ‘high’ and choose as if the differences between categories were equal. This simplifies the choice task, but undermines the validity of WTP estimates as welfare measures. Recoding may be a common heuristic in healthcare applications when insurance coverage distorts subjects’ perception of the nominal costs presented in the DCE instrument. Recoding may also distort estimates of marginal rates of substitution for other attributes with numeric levels. Incorporating ‘cheap talk’ or graphic representation of attribute levels may encourage subjects to be more attentive to absolute attribute levels.

Testing a discrete choice experiment including duration to value health states for large descriptive systems: Addressing design and sampling issues

Bansback, Nick; Hole, Arne Risa; Mulhern, Brendan; Tsuchiya, Aki
Fonte: Pergamon Publicador: Pergamon
Tipo: Artigo de Revista Científica
Publicado em /08/2014 EN
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There is interest in the use of discrete choice experiments that include a duration attribute (DCETTO) to generate health utility values, but questions remain on its feasibility in large health state descriptive systems. This study examines the stability of DCETTO to estimate health utility values from the five-level EQ-5D, an instrument with depicts 3125 different health states. Between January and March 2011, we administered 120 DCETTO tasks based on the five-level EQ-5D to a total of 1799 respondents in the UK (each completed 15 DCETTO tasks on-line). We compared models across different sample sizes and different total numbers of observations. We found the DCETTO coefficients were generally consistent, with high agreement between individual ordinal preferences and aggregate cardinal values. Keeping the DCE design and the total number of observations fixed, subsamples consisting of 10 tasks per respondent with an intermediate sized sample, and 15 tasks with a smaller sample provide similar results in comparison to the whole sample model. In conclusion, we find that the DCETTO is a feasible method for developing values for larger descriptive systems such as EQ-5D-5L, and find evidence supporting important design features for future valuation studies that use the DCETTO.

Sample Size Requirements for Discrete-Choice Experiments in Healthcare: a Practical Guide

de Bekker-Grob, Esther W.; Donkers, Bas; Jonker, Marcel F.; Stolk, Elly A.
Fonte: Springer International Publishing Publicador: Springer International Publishing
Tipo: Artigo de Revista Científica
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Discrete-choice experiments (DCEs) have become a commonly used instrument in health economics and patient-preference analysis, addressing a wide range of policy questions. An important question when setting up a DCE is the size of the sample needed to answer the research question of interest. Although theory exists as to the calculation of sample size requirements for stated choice data, it does not address the issue of minimum sample size requirements in terms of the statistical power of hypothesis tests on the estimated coefficients. The purpose of this paper is threefold: (1) to provide insight into whether and how researchers have dealt with sample size calculations for healthcare-related DCE studies; (2) to introduce and explain the required sample size for parameter estimates in DCEs; and (3) to provide a step-by-step guide for the calculation of the minimum sample size requirements for DCEs in health care.

Attracting Doctors and Medical Students to Rural Vietnam : Insights from a Discrete Choice Experiment

Vujicic, Marko; Alfano, Marco; Shengelia, Bukhuti; Witter, Sophie
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
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Persuading medical doctors to work in rural areas is one of the main challenges facing health policy makers, in both developing and developed countries. Discrete Choice Experiments (DCEs) have increasingly been used to analyze the preferences of health workers, and how they would respond to alternative incentives associated with working in a rural location. Previous DCE studies focusing on the rural recruitment and retention problem have sampled either in-service health workers or students in the final year of their training program. This study is the first to sample both of these groups in the same setting. It carry out a DCE to compare how doctors and final-year medical students in Vietnam value six job attributes, and use the results to simulate the impact of alternative incentive packages on recruitment in rural areas. Results show significant differences between the two groups. The location of workplace (rural or urban) was by far the most important attribute for doctors; for medical students it was long-term education. More surprising...

A comparison of responses to single and repeated discrete choice questions

McNair, Benjamin; Bennett, Jeff; Hensher, David
Fonte: Environmental Management and Development Programme, Crawford School of Economics and Government, The Australian National University; http://www.crawford.anu.edu.au Publicador: Environmental Management and Development Programme, Crawford School of Economics and Government, The Australian National University; http://www.crawford.anu.edu.au
Tipo: Other; Working/Technical Paper Formato: 39 pages
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According to neoclassical economic theory, a stated preference elicitation format comprising a single binary choice between the status quo and one alternative is incentive compatible under certain conditions. Formats typically used in choice experiments comprising a sequence of discrete choice questions do not hold this property. In this paper, the effect on stated preferences of expanding the number of binary choice tasks per respondent from one to four is tested using a split sample treatment in an attribute-based survey relating to the undergrounding of overhead electricity and telecommunications wires. We find evidence to suggest that presenting multiple choice tasks per respondent decreases estimates of expected willingness to pay. Preferences stated in the first of a sequence of choice tasks are not significantly different from those stated in the incentive compatible single binary choice task, but, in subsequent choice tasks, responses are influenced by cost levels observed in past questions. Three behavioural explanations can be advanced – weak strategic misrepresentation, reference point revision and cost-driven value learning. The evidence is contrary to the standard assumption of truthful response with stable preferences.

Preferences for CT colonography and colonoscopy as diagnostic tests for colorectal cancer: A discrete choice experiment

Howard, K.; Salkeld, G.; Pignone, M.; Hewett, P.; Cheung, P.; Olsen, J.; Clapton, W.; Roberts-Thomson, I.
Fonte: Wiley-Blackwell Publishing, Inc. Publicador: Wiley-Blackwell Publishing, Inc.
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
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OBJECTIVE: Computed tomography colonography (CTC) is an alternative diagnostic test to colonoscopy for colorectal cancer and polyps. The aim of this study was to determine test characteristics important to patients and to examine trade-offs in attributes that patients are willing to accept in the context of the diagnosis of colorectal cancer. METHODS: A discrete choice study was used to assess preferences of patients with clinical indications suspicious of colorectal cancer who experienced both CTC and colonoscopy as part of a diagnostic accuracy study in South Australia. Results were analyzed by using a mixed logit model and presented as odds ratios (ORs) for preferring CTC over colonoscopy. RESULTS: Colonoscopy was preferred over CTC as the need for a second procedure after CTC increased (OR of preferring CTC to colonoscopy = 0.013), as the likelihood of missing cancers or polyps increased (OR of preferring CTC to colonoscopy = 0.62), and as CTC test cost increased (OR of preferring CTC to colonoscopy = 0.65-0.80). CTC would be preferred to colonoscopy if a minimal bowel preparation was available (OR = 1.7). Some patients were prepared to trade off the diagnostic and therapeutic advantage of colonoscopy for a CTC study with a less intensive bowel preparation. Preferences also varied significantly with sociodemographic characteristics. CONCLUSIONS: Despite CTC's often being perceived as a preferred test...

Tarification logit dans un réseau

Gilbert, François
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
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Le problème de tarification qui nous intéresse ici consiste à maximiser le revenu généré par les usagers d'un réseau de transport. Pour se rendre à leurs destinations, les usagers font un choix de route et utilisent des arcs sur lesquels nous imposons des tarifs. Chaque route est caractérisée (aux yeux de l'usager) par sa "désutilité", une mesure de longueur généralisée tenant compte à la fois des tarifs et des autres coûts associés à son utilisation. Ce problème a surtout été abordé sous une modélisation déterministe de la demande selon laquelle seules des routes de désutilité minimale se voient attribuer une mesure positive de flot. Le modèle déterministe se prête bien à une résolution globale, mais pèche par manque de réalisme. Nous considérons ici une extension probabiliste de ce modèle, selon laquelle les usagers d'un réseau sont alloués aux routes d'après un modèle de choix discret logit. Bien que le problème de tarification qui en résulte est non linéaire et non convexe, il conserve néanmoins une forte composante combinatoire que nous exploitons à des fins algorithmiques. Notre contribution se répartit en trois articles. Dans le premier, nous abordons le problème d'un point de vue théorique pour le cas avec une paire origine-destination. Nous développons une analyse de premier ordre qui exploite les propriétés analytiques de l'affectation logit et démontrons la validité de règles de simplification de la topologie du réseau qui permettent de réduire la dimension du problème sans en modifier la solution. Nous établissons ensuite l'unimodalité du problème pour une vaste gamme de topologies et nous généralisons certains de nos résultats au problème de la tarification d'une ligne de produits. Dans le deuxième article...

A review of the application and contribution of discrete choice experiments to inform human resources policy interventions

Lagarde, Mylene; Blaauw, Duane
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em 24/07/2009 EN
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Although the factors influencing the shortage and maldistribution of health workers have been well-documented by cross-sectional surveys, there is less evidence on the relative determinants of health workers' job choices, or on the effects of policies designed to address these human resources problems. Recently, a few studies have adopted an innovative approach to studying the determinants of health workers' job preferences. In the absence of longitudinal datasets to analyse the decisions that health workers have actually made, authors have drawn on methods from marketing research and transport economics and used Discrete Choice Experiments to analyse stated preferences of health care providers for different job characteristics.

Use of discrete choice experiments to elicit preferences

Ryan, M; Bate, A; Eastmond, C; Ludbrook, A
Fonte: BMJ Group Publicador: BMJ Group
Tipo: Artigo de Revista Científica
Publicado em /09/2001 EN
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This paper considers the application of discrete choice experiments for eliciting preferences in the delivery of health care. Drawing upon the results from a recently completed systematic review, the paper summarises the application of this technique in health care. It then presents a case study applying the technique to rheumatology outpatient clinics. 200 patients were questioned about the importance of six attributes: staff seen (junior doctor or specialist nurse); time in waiting area; continuity of contact with same staff; provision of a phone-in/advice service; length of consultation; and change in pain levels. The systematic review indicated that discrete choice experiments have been applied to a wide number of areas and a number of methodological issues have been addressed. Consistent with this literature, the case study found evidence of both rationality and theoretical validity of responses. The approach was used to establish the relative importance of different attributes, how individuals trade between these attributes, and overall benefit scores for different clinic configurations. The value of attributes was estimated in terms of time, and this was converted to a monetary measure using the value of waiting time for public transport. Discrete choice experiments represent a potentially useful instrument for eliciting preferences. Future methodological work should explore issues related to the experimental design of the study...

Effects of alternative elicitation formats in discrete choice experiments

Scheufele, Gabriela; Bennett, Jeffrey
Fonte: Blackwell Publishing Ltd Publicador: Blackwell Publishing Ltd
Tipo: Artigo de Revista Científica
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An elicitation format prevalently applied in discrete choice experiments (DCE) is to offer each respondent a sequence of choice tasks containing more than two choice options. However, empirical evidence indicates that repeated choice tasks influence choic

Response Strategies and Learning in Discrete Choice Experiments

Scheufele, Gabriela; Bennett, Jeffrey
Fonte: Kluwer Academic Publishers Publicador: Kluwer Academic Publishers
Tipo: Artigo de Revista Científica
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This study explores ordering effects and response strategies in repeated binary discrete choice experiments. Mechanism design theory and empirical evidence suggest that repeated choice tasks per respondent induce strategic behaviour. We find evidence that

Developing Attributes and Attribute-Levels for a Discrete Choice Experiment on Micro Health Insurance in Rural Malawi

Abiiro, Gilbert Abotisem; Leppert, Gerald; Bongololo Mbera, Grace; Robyn, Paul J.; De Allegri, Manuela
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Journal Article; Publications & Research :: Journal Article; Publications & Research
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Discrete choice experiments (DCEs) are attribute-driven experimental techniques used to elicit stakeholders’ preferences to support the design and implementation of policy interventions. The validity of a DCE, therefore, depends on the appropriate specification of the attributes and their levels. There have been recent calls for greater rigor in implementing and reporting on the processes of developing attributes and attribute-levels for discrete choice experiments (DCEs). This paper responds to such calls by carefully reporting a systematic process of developing micro health insurance attributes and attribute-levels for the design of a DCE in rural Malawi.

Using stated preference methods to assess environmental impacts of forest biomass power plants in Portugal

Botelho, Anabela; Gomes, Lina Lourenço; Pinto, Lígia; Sousa, Sara; Valente, Marieta
Fonte: Universidade do Minho. Núcleo de Investigação em Microeconomia Aplicada Publicador: Universidade do Minho. Núcleo de Investigação em Microeconomia Aplicada
Tipo: Trabalho em Andamento
Publicado em /11/2015 ENG
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As a renewable energy source, the use of forest biomass for electricity generation is advantageous in comparison with fossil fuels, however the activity of forest biomass power plants causes adverse impacts, affecting particularly neighbouring communities. The main objective of this study is to estimate the effects of the activity of forest biomass power plants on the welfare of two groups of stakeholders, namely local residents and the general population and we apply two stated preference methods: contingent valuation and discrete choice experiments, respectively. The former method was applied to estimate the minimum compensation residents of neighbouring communities of two forest biomass power plants in Portugal would be willing to accept. The latter method was applied among the general population to estimate their willingness to pay to avoid specific environmental impacts. The results show that the presence of the selected facilities affects individuals’ well-being. On the other hand, in the discrete choice experiments conducted among the general population all impacts considered were significant determinants of respondents’ welfare levels. The results of this study stress the importance of performing an equity analysis of the welfare effects on different groups of stakeholders from the installation of forest biomass power plants...

Generalized Indirect Inference for Discrete Choice Models

Bruins, Marianne; Duffy, James A.; Keane, Michael P.; Smith Jr, Anthony A.
Fonte: Universidade Cornell Publicador: Universidade Cornell
Tipo: Artigo de Revista Científica
Publicado em 22/07/2015
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This paper develops and implements a practical simulation-based method for estimating dynamic discrete choice models. The method, which can accommodate lagged dependent variables, serially correlated errors, unobserved variables, and many alternatives, builds on the ideas of indirect inference. The main difficulty in implementing indirect inference in discrete choice models is that the objective surface is a step function, rendering gradient-based optimization methods useless. To overcome this obstacle, this paper shows how to smooth the objective surface. The key idea is to use a smoothed function of the latent utilities as the dependent variable in the auxiliary model. As the smoothing parameter goes to zero, this function delivers the discrete choice implied by the latent utilities, thereby guaranteeing consistency. We establish conditions on the smoothing such that our estimator enjoys the same limiting distribution as the indirect inference estimator, while at the same time ensuring that the smoothing facilitates the convergence of gradient-based optimization methods. A set of Monte Carlo experiments shows that the method is fast, robust, and nearly as efficient as maximum likelihood when the auxiliary model is sufficiently rich.; Comment: ii + 36 pp....

The Economics of Malaria Vector Control

Brown, Zachary Steven
Fonte: Universidade Duke Publicador: Universidade Duke
Tipo: Dissertação
Publicado em //2011
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In recent years, government aid agencies and international organizations have increased their financial commitments to controlling and eliminating malaria from the planet. This renewed emphasis on elimination is reminiscent of a previous worldwide campaign to eradicate malaria in the 1960s, a campaign which ultimately failed. To avoid a repeat of the past, mechanisms must be developed to sustain effective malaria control programs.

A number of sociobehavioral, economic, and biophysical challenges exist for sustainable malaria control, particularly in high-burden areas such as sub-Saharan Africa. Sociobehavioral challenges include maintaining high long-term levels of support for and participation in malaria control programs, at all levels of society. Reasons for the failure of the previous eradication campaign included a decline in donor, governmental, community, and household-level support for control programs, as malaria prevalence ebbed due in part to early successes of these programs.

Biophysical challenges for the sustainability of national malaria control programs (NMCPs) encompass evolutionary challenges in controlling the protozoan parasite and the mosquito vector, as well as volatile transmission dynamics which can lead to epidemics. Evolutionary challenges are particularly daunting due to the rapid generational turnover of both the parasites and the vectors: The reliance on a handful of insecticides and antimalarial drugs in NMCPs has placed significant selection pressures on vectors and parasites respectively...

Essays in Industrial Organization and Econometrics

Blevins, Jason Ryan
Fonte: Universidade Duke Publicador: Universidade Duke
Tipo: Dissertação Formato: 874673 bytes; application/pdf
Publicado em //2010 EN_US
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This dissertation consists of three chapters relating to

identification and inference in dynamic microeconometric models

including dynamic discrete games with many players, dynamic games with

discrete and continuous choices, and semiparametric binary choice and

duration panel data models.

The first chapter provides a framework for estimating large-scale

dynamic discrete choice models (both single- and multi-agent models)

in continuous time. The advantage of working in continuous time is

that state changes occur sequentially, rather than simultaneously,

avoiding a substantial curse of dimensionality that arises in

multi-agent settings. Eliminating this computational bottleneck is

the key to providing a seamless link between estimating the model and

performing post-estimation counterfactuals. While recently developed

two-step estimation techniques have made it possible to estimate

large-scale problems, solving for equilibria remains computationally

challenging. In many cases, the models that applied researchers

estimate do not match the models that are then used to perform

counterfactuals. By modeling decisions in continuous time...

Best–worst scaling vs. discrete choice experiments: an empirical comparison using social care data

Potoglou, Dimitris; Burge, Peter; Flynn, Terry; Netten, Ann; Malley, Juliette; Forder, Julien; Brazier, John E.
Fonte: Elsevier Publicador: Elsevier
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em /05/2011 EN; EN
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This paper presents empirical findings from the comparison between two principal preference elicitation techniques: discrete choice experiments and profile-based best–worst scaling. Best–worst scaling involves less cognitive burden for respondents and provides more information than traditional “pick-one” tasks asked in discrete choice experiments. However, there is lack of empirical evidence on how best–worst scaling compares to discrete choice experiments. This empirical comparison between discrete choice experiments and best–worst scaling was undertaken as part of the Outcomes of Social Care for Adults project, England, which aims to develop a weighted measure of social care outcomes. The findings show that preference weights from best–worst scaling and discrete choice experiments do reveal similar patterns in preferences and in the majority of cases preference weights – when normalised/rescaled – are not significantly different.