Stability of Stated Preferences: Vaccine Priority Setting before and during the First COVID-19 Lockdown

Abstract

Background Discrete choice experiments (DCEs) are frequently used to study preferences and quantify tradeoffs in decision making. It is important to understand how stable their results are. Objective To investigate to what extent an extreme change in context, the COVID-19 pandemic, affected preferences for vaccine priority setting, as observed in an earlier DCE. Methods We replicated a DCE in which participants had to prioritize vaccination programs for public funding. The initial DCE was executed in Flanders (Belgium) right before the onset of the SARS-CoV-2 pandemic (December 2019, N = 1,636). The replicated DCE was executed 6 months later when the population was in lockdown (April 2020, N = 1,127). A total of 612 respondents participated in both waves of the DCE. We used panel mixed logit models to quantify attribute and level importance and compared utility estimates for consistency. Results The number of vaccine-preventable deaths became less important during the pandemic than before, whereas the influential attributes, the vaccine’s contribution to disease eradication and certainty about vaccine effectiveness became even more important. Respondents attached equal importance to the number of patients with transient or permanent morbidity, to the disease’s economic impact as well as to its equity profile. Conclusion Different preferences for vaccine priority setting were observed during the first COVID-19 lockdown as compared with before, although these differences were, given the extreme nature of the changing circumstances, relatively small. Highlights We replicated a discrete choice experiment (DCE) about vaccine priority setting during the first COVID-19 lockdown and compared results with those from the original setting. The major attributes, contribution to disease eradication, and scientific certainty about vaccine effectiveness became even more important than they already were, whereas avoidable mortality became less important. Respondents attached equal importance to the number of patients with transient or permanent morbidity, to the disease’s economic impact as well as to its equity profile. An extreme change in directly related context to the choice assignment led to changes in stated preferences, although these changes were relatively small, given the extreme change in context. Priorities in the second DCE were even less aligned with cost-effectiveness analysis than those observed initially.