Conjoint experiments are popular, but there is a paucity of research on respondents’ underlying decision-making processes. We leverage eye-tracking methodology and a series of conjoint experiments, administered to university students and local community members, to examine how respondents process information in conjoint surveys. There are two main findings. First, attribute importance measures inferred from the stated choice data are correlated with attribute importance measures based on eye movement. This validation test supports the interpretation of common conjoint metrics, such as average marginal component effects (AMCEs), as measures of attribute importance. Second, when we experimentally increase the number of attributes and profiles in the conjoint table, respondents view a larger absolute number of cells but a smaller fraction of the total cells displayed. Moving from two to three profiles, respondents search more within-profile, rather than within-attribute, to build summary evaluations. However, respondents’ stated choices remain fairly stable regardless of the number of attributes and profiles in the conjoint table. Together, these patterns speak to the robustness of conjoint experiments and are consistent with a bounded rationality mechanism. Respondents adapt to complexity by selectively incorporating relevant new information to focus on important attributes, while ignoring less relevant information to reduce cognitive processing costs.

Objectives: The role and impact of health technology assessment (HTA) in health policy has been widely discussed. Researchers have started to analyze how decisions on coverage of new technologies are made. Although the involvement of HTA may be an indicator of a well established decision process, this hypothesis requires validation. Also, it is not known whether HTA involvement is associated with other characteristics of decision making like participation or transparency. The primary objective of this study was to develop and test statements on the association between the publication of an HTA and coverage decision making for newborn screening tests in European Union countries.

Methods: Five statements were defined on the relative role of HTA during the steps of decision processes: trigger, participation, publication, assessment, and appraisal. For this purpose, data on twenty-two decision processes in the area of newborn screening across Europe were analyzed, defined as a coverage decision for a given disorder in a specific country. Decision processes were compared by whether the decision was accompanied by the publication of an HTA report. To test differences, nonparametric statistical tests were used.

Results: The decision steps of trigger, participation and publication differed between the HTA and the non-HTA groups. No clear association between HTA and assessment methods in coverage decision making was identified.

Conclusions: It appeared that there is an association between HTA and coverage decision processes that are more explicit, inclusive, and transparent. It is unclear whether HTA is associated with formal evidence reviews and economic evaluations.