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Prioritising patients for bariatric surgery: building public preferences from a discrete choice experiment into public policy
  1. Jennifer A Whitty1,
  2. Julie Ratcliffe2,
  3. Elizabeth Kendall3,
  4. Paul Burton4,
  5. Andrew Wilson5,
  6. Peter Littlejohns6,
  7. Paul Harris7,
  8. Rachael Krinks3,
  9. Paul A Scuffham8
  1. 1Faculty of Health and Behavioural Sciences, School of Pharmacy, The University of Queensland, St Lucia, Queensland, Australia
  2. 2Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, South Australia, Australia
  3. 3Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
  4. 4Urban Research Program, Griffith School of Environment, Griffith University, Southport, Queensland, Australia
  5. 5Menzies Centre for Health Policy, University of Sydney, New South Wales, Australia
  6. 6Faculty of Life Sciences and Medicine, King's College London, London, UK
  7. 7School of Human Services and Social Work, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
  8. 8Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
  1. Correspondence to Dr Jennifer A Whitty; j.whitty{at}uq.edu.au

Abstract

Objectives To derive priority weights for access to bariatric surgery for obese adults, from the perspective of the public.

Setting Australian public hospital system.

Participants Adults (N=1994), reflecting the age and gender distribution of Queensland and South Australia.

Primary and secondary outcome measures A discrete choice experiment in which respondents indicated which of two individuals with different characteristics should be prioritised for surgery in repeated hypothetical choices. Potential surgery recipients were described by seven key characteristics or attributes: body mass index (BMI), presence of comorbid conditions, age, family history, commitment to lifestyle change, time on the surgical wait list and chance of maintaining weight loss following surgery. A multinomial logit model was used to evaluate preferences and derive priority weights (primary analysis), with a latent class model used to explore respondent characteristics that were associated with variation in preference across the sample (see online supplementary analysis).

Results A preference was observed to prioritise individuals who demonstrated a strong commitment to maintaining a healthy lifestyle as well as individuals categorised with very severe (BMI≥50 kg/m2) or (to a lesser extent) severe (BMI≥40 kg/m2) obesity, those who already have obesity-related comorbidity, with a family history of obesity, with a greater chance of maintaining weight loss or who had spent a longer time on the wait list. Lifestyle commitment was considered to be more than twice as important as any other criterion. There was little tendency to prioritise according to the age of the recipient. Respondent preferences were dependent on their BMI, previous experience with weight management surgery, current health state and education level.

Conclusions This study extends our understanding of the publics’ preferences for priority setting to the context of bariatric surgery, and derives priority weights that could be used to assist bodies responsible for commissioning bariatric services.

  • HEALTH ECONOMICS
  • obesity

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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