Discrete choice experiments (DCEs) are regularly used in health economics to elicit preferences for healthcare products and programmes. There is growing recognition that DCEs can provide more than information on preferences and, in particular, they have the potential to contribute more directly to outcome measurement for use in economic evaluation. Almost uniquely, DCEs could potentially contribute to outcome measurement for use in both cost-benefit and cost-utility analysis. Within this expanding remit, our intention is to provide a resource for current practitioners as well as those considering undertaking a DCE, using DCE results in a policy/commercial context, or reviewing a DCE. We present the fundamental principles and theory underlying DCEs. To aid in undertaking and assessing the quality of DCEs, we discuss the process of carrying out a choice study and have developed a checklist covering conceptualizing the choice process, selecting attributes and levels, experimental design, questionnaire design, pilot testing, sampling and sample size, data collection, coding of data, econometric analysis, validity, interpretation and welfare and policy analysis. In this fast-moving area, a number of issues remain on the research frontier. We therefore outline potentially fruitful areas for future research associated both with DCEs in general, and with health applications specifically, paying attention to how the results of DCEs can be used in economic evaluation. We also discuss emerging research trends. We conclude that if appropriately designed, implemented, analysed and interpreted, DCEs offer several advantages in the health sector, the most important of which is that they provide rich data sources for economic evaluation and decision making, allowing investigation of many types of questions, some of which otherwise would be intractable analytically. Thus, they offer viable alternatives and complements to existing methods of valuation and preference elicitation.

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Conducting discrete choice experiments to inform healthcare decision making: a user's guide.

ne of the major obstacles to reaching a comprehensive agreement on global warming is the setting of greenhouse gas emission reduction targets for individual countries. Long-standing tensions between industrialized and developing countries have raised the issue of equity in burden-sharing. Moreover, individual industrialized nations have pleaded special circumstances and have sought differentiation in their obligations. This paper analyzes alternative rules for distributing tradable carbon dioxide emissions permits. A non-linear programming model, which distinguishes between allocation-based and outcome-based rules, is used to analyze the relative welfare outcomes. The model is applied to the world body of nations and yields several important policy implications.

International Equity and Differentiation in Global Warming Policy

The efficiency and equity of marketable permits for CO2 emissions

Carbon coalitions: the cost and effectiveness of energy agreements to alter trajectories of atmospheric carbon dioxide emissions

An equity- and sustainability-based policy response to global climate change

A strategy for a successful climate protection convention must highlight the role of equity in order to bring more nations to the bargaining table. The authors propose two commercial energy protocols for consideration by negotiators in this light. The first links international trading in greenhouse-gas emission ‘rights’ to a country's historical per capita carbon emissions. The charge for these rights should be based on the negotiated reduction in global emissions and the demand for them, via the marketplace. The second requires inefficient countries to make steady improvements in energy efficiency or fuel substitution away from carbon as their economies develop.

International reductions of greenhouse-gas emissions

The U.S. Environmental Protection Agency is implementing a program of SO2 emission allowance trading as part of the Acid Rain Program authorized by the Clean Air Act Amendments of 1990. Electric utilities may use allowance trading as part of their compliance strategy to meet SO2 emission reduction requirements, which begin in 1995. In the interest of a free market in emission credits, some utilities began trading in 1992. A strict but essential requirement for continuous-emissions monitoring was developed to support the trading program. This program is being widely watched and will be evaluated as part of an effort to determine if market concepts can be successfully extended to other environmental issues. One such issue is greenhouse gas emissions and their link with global warming and climate change. This paper focuses on the early lessons learned, issues, and challenges involved in going from a domestic electric utility SO2 emissions trading program to inter-industry, inter-gas and international as well as national emissions trading and offsets programs. Prominent among these issues are CO2 allowance allocations, equity, emissions monitoring, enforcement, and cost-effectiveness.

Global CO2 emissions trading: Early lessons from the U.S. acid rain program

The EPA's protocols for verifying savings from utility energy-conservation programs

Nuclear waste disposal is a growing international problem. In 1990 there were 416 operating commercial nuclear reactor units in the world, 26 per cent (110) of them in the USA and 37 per cent of the total (154) in Western Europe, all producing irradiated (spent) reactor fuel and other toxic wastes. Radioactive wastes are also generated from uranium mining and milling, spent fuel reprocessing, nuclear weapons production, and from industry, research and medical facilities. All nuclear wastes can be dangerous and even deadly, hence they must be isolated from the accessible environment. Yet the rapid proliferation in the production of civil nuclear power, weapons, and other nuclear products has not been matched by the development of safe methods of waste management. Until the 1980s the commitment by governments to the exploitation of the ‘peaceful’ atom was in stark contrast to their wilful neglect of the consequences.

An Achilles Heel

The American approach to radioactive waste management can be explained by four geopolitical and institutional characteristics. The first and most obvious characteristic is the geographical scale of the country: the US is 38 times the size of Britain, and nine American states are larger than the UK in area. Moreover, the UK is far more densely populated than the US. California, the most populous state, has but half the UK’s population and the seven states with the smallest population can barely muster together the population of Greater London. Geography thus confers upon the US much greater opportunity for finding remote sites for radioactive waste disposal. It also imposes greater distances between the various stages in the nuclear fuel cycle, making transportation a significant issue.1 To take an extreme example, the Palo Verde nuclear power plant 50 miles west of Phoenix, Arizona, obtains uranium from New Mexico, which is converted to uranium hexafluoride in Illinois, sent to be enriched in Ohio, Kentucky or Tennessee, and thence to be fabricated into fuel rods in Connecticut before being shipped back to Arizona.2 This uranium would thereby travel over 4000 miles before the fuel rods are loaded in the nuclear reactor. Power from the plant is distributed to four states and spent fuel rods are stored pending transport to a deep repository whose location has yet to be determined.

Barry D. Solomon

Papers

International reductions of greenhouse-gas emissions

Global CO2 emissions trading: Early lessons from the U.S. acid rain program

The EPA's protocols for verifying savings from utility energy-conservation programs

An Achilles Heel

The United States: In Search of the Nuclear Oasis