Date of Award

January 2016

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Shiyi Wang

Second Advisor

Liana Fraenkel


Objectives. The objective of this study was to explore the impact of specific cost formats on individuals’ decision making.

Methods. Mechanical Turk workers completed a choice based conjoint (CBC) analysis survey designed to examine preferences for three second line agents used to treat diabetes: a sulfonylurea, exenatide, and insulin. Diabetes was chosen because the disease is familiar to the general public and people are generally aware of the importance of controlling blood sugar levels. The CBC survey included five attributes: route of administration, efficacy, risk of low blood sugar, frequency of checking blood sugar levels and cost. We developed seven versions of the CBC survey which were identical except for the cost attribute. We described cost in terms of: Affordability, Monthly Co-pay, Dollar Sign Rating, How Expensive or How Cheap compared to other medications, Monthly Co-pay, Working Hours Equivalent (per month) and Percent of Monthly Income. The resulting part-worth utilities were used to calculate the relative importance of cost and to estimate treatment preferences.

Results: Cost had the greatest influence on participants’ decisions when framed in terms of Affordability and the lowest influence when framed in terms of How Cheap (compared to other drugs). Sulfonylurea is strongly preferred across Affordability, Percentage of Monthly Income, Monthly Copay and Dollar Sign formats. Exenatide is preferred when cost is described using the How Cheap and How Expensive format.

Conclusions. How to frame cost impacts subjects’ medical decision remarkably. Patients will be the most cost-sensitive when cost is framed in terms of affordability, the least cost-sensitive when considering how cheap the medication is compared to others. Further researches are needed to evaluate the impact of presentation of cost on decision making in clinical contexts.


This is an Open Access Thesis.

Open Access

This Article is Open Access