Balancing patient preferences and clinical needs: Community versus hospital based care for patients with suspected DVT

Objective To establish patients’ preferences and willingness to pay (WTP) for different service models for suspected deep vein thrombosis (DVT). Methods We analysed patient responses to a discrete choice experiment (DCE) questionnaire which had been targeted at patients in Leicester, UK. The questionnaire elicited preferences/WTP for attributes of DVT provision including speed of diagnosis; access; continuity of care; and minimizing hospital visits. Additionally we evaluated trade-offs between clinical and service attributes. We analysed responses from 256 patients with suspected DVT (65% response rate). Results Respondents are WTP £4.82 per extra hour of dedicated DVT service provision; £17.12 per hospital visit avoided; £115.73 per day’s reduction in diagnostic wait; and £179.32 for ‘much’ not ‘some’ continuity, or £56.88 for ‘some’ not ‘lack’ of continuity in nursing. Conclusions Research evaluating different DVT service models usually reports on clinical efficacy in centres of excellence. Results show prompt diagnosis is valued by patients and may improve efficacy by reducing unnecessary anticoagulation. However, patients value ‘process’ measures such as continuity of care also. To ensure optimal provision, clinical benefit measurement ought to be augmented with information on patients’ preferences.