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Using the Threshold Technique to Elicit Patient Preferences: An Introduction to the Method and an Overview of Existing Empirical Applications

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  • Brett Hauber

    (RTI Health Solutions)

  • Joshua Coulter

    (RTI Health Solutions)

Abstract

Patient preference information (PPI) is a topic of interest to regulators and industry. One of many known methods for eliciting PPI is the threshold technique (TT). However, empirical studies of the TT differ from each other in many ways and no effort to date has been made to summarize them or the evidence regarding the performance of the method. We sought to describe the TT and summarize the empirical applications of the method. Forty-three studies were reviewed. Most studies estimated the minimum level of benefit required to make a treatment worthwhile, and over half estimated the maximum level of risk patients would accept to achieve a treatment benefit. The evidence demonstrates that the TT can be used to elicit multiple types of thresholds and can be used to explore preference heterogeneity and preference non-linearity. Some evidence suggests that the method may be sensitive to anchoring and shift-framing effects; however, no evidence suggests that the method is more or less sensitive to these potential biases than other stated-preference methods. The TT may be a viable method for eliciting PPI to support regulatory decision-making; however, additional understanding of the performance of this method may be needed. Future research should focus on TT performance compared with other stated-preference methods, the extent to which results predict patient choice, and the ability of the TT to inform individual treatment decisions at the point of healthcare delivery.

Suggested Citation

  • Brett Hauber & Joshua Coulter, 2020. "Using the Threshold Technique to Elicit Patient Preferences: An Introduction to the Method and an Overview of Existing Empirical Applications," Applied Health Economics and Health Policy, Springer, vol. 18(1), pages 31-46, February.
  • Handle: RePEc:spr:aphecp:v:18:y:2020:i:1:d:10.1007_s40258-019-00521-3
    DOI: 10.1007/s40258-019-00521-3
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    References listed on IDEAS

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    1. Keeney,Ralph L. & Raiffa,Howard, 1993. "Decisions with Multiple Objectives," Cambridge Books, Cambridge University Press, number 9780521438834.
    2. Llewellyn-Thomas, H. A. & McGreal, M. J. & Thiel, E. C. & Fine, S. & Erlichman, C., 1991. "Patients' willingness to enter clinical trials: Measuring the association with perceived benefit and preference for decision participation," Social Science & Medicine, Elsevier, vol. 32(1), pages 35-42, January.
    3. Klose, Thomas, 1999. "The contingent valuation method in health care," Health Policy, Elsevier, vol. 47(2), pages 97-123, May.
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    1. Jorien Veldwijk & Rachael Lynn DiSantostefano & Ellen Janssen & Gwenda Simons & Matthias Englbrecht & Karin Schölin Bywall & Christine Radawski & Karim Raza & Brett Hauber & Marie Falahee, 2023. "Maximum Acceptable Risk Estimation Based on a Discrete Choice Experiment and a Probabilistic Threshold Technique," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 16(6), pages 641-653, November.

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