Mesfin Genie
Ca' Foscari University of Venice | Italy
Title: Eliciting patients' preferences in kidney transplantation: A discrete choice experiment
Biography
Biography: Mesfin Genie
Abstract
Statement of the Problem: Kidney transplantation provides an expected survival advantage over dialysis treatment for patients with end--stage renal disease. Still, due to the disparity between large number of transplant candidates and scarcity of organs patients may face the trade-off between a long waiting list for a high quality kidney, or a "marginal'' organ transplanted immediately. Current allocation protocols do not explicitly take into consideration patients' preferences. The purpose of this study is to estimate candidates' time and risk preferences in kidney transplantation. Willingness to wait estimates for changes in transplant attributes are obtained and heterogeneous preferences are exploited through a mixture logit model.
Methodology: We study patients' time and risk preferences for kidney transplantation by means of a discrete choice experiment (DCE). We have the unique opportunity of running the experiment on the entire population of individuals actually waiting for a kidney transplant in an important hospital in Italy.
Findings: We find heterogeneity in time and risk preferences. Differences are not limited to mean values of willingness to wait (WTW) for better kidneys: we employ a mixed logit model to retrieve individual WTW and compare the entire distribution of preferences across different subgroups. We find that younger candidates are willing to wait longer than older candidates for extra year of graft survival and to give up augmented infectious and neoplastic risks. Moreover, patients with longer time on dialysis are willing to wait longer than the other patients to give up augmented infectious and neoplastic risks, and for an extra year of graft survival.
Conclusion & Significance: The implication for transplant practice is that accounting for individual preferences in kidney allocation algorithm would improve patients' satisfaction and efficiency of the donor receiver matching process.
Publications
1. Hole, Arne Risa. "Modeling heterogeneity in patients’ preferences for the attributes of a general practitioner appointment." Journal of health economics 27.4 (2008): 1078-1094.
2. Flynn, Terry Nicholas, et al. "Using discrete choice experiments to understand preferences for quality of life. Variance-scale heterogeneity matters." Social science & medicine 70.12 (2010): 1957-1965.
3. Davison, Sara N., Seija K. Kromm, and Gillian R. Currie. "Patient and health professional preferences for organ allocation and procurement, end-of-life care and organization of care for patients with chronic kidney disease using a discrete choice experiment." Nephrology Dialysis Transplantation (2010): gfq072.
4. Greene, William H., and David A. Hensher. "A latent class model for discrete choice analysis: contrasts with mixed logit." Transportation Research Part B: Methodological 37.8 (2003): 681-698.
5. de Bekker-Grob, Esther W., Mandy Ryan, and Karen Gerard."Discrete choice experiments in health economics: a review of the literature." Health economics 21.2 (2012): 145-172.