Using conjoint analysis to take account of patient preferences and go beyond health outcomes: an application to in vitro fertilisation

There has been an assumption in the health economics literature that health outcomes are all that need to be considered when attempting to measure the benefits from health care interventions. This is most evident in the development of the quality adjusted life year (QALY) approach to benefit assessment. This paper challenges this view and considers the technique of conjoint analysis (CA) as a methodology for both taking account of patient preferences and considering attributes beyond health outcomes. The technique is applied to in vitro fertilisation. CA is shown to be sensitive to considering health outcomes, nonhealth outcomes and process attributes. It is also shown to be internally consistent and internally valid. The paper demonstrates the application of CA to estimating willingness to pay indirectly. It is argued that benefit assessment within health economics should extend beyond health outcomes and future research should investigate more thoroughly the potential application of CA in this area. However, methodological issues need addressing before the instrument becomes an established evaluative instrument.