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Liu X, Makaroff KE, Almario CV, Khalil C, Choi SY, Curtis JR, Spiegel BMR. Determining patient preferences for the medical management of osteoporosis using conjoint analysis. Osteoporos Int 2024; 35:153-164. [PMID: 37721558 PMCID: PMC10787002 DOI: 10.1007/s00198-023-06882-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023]
Abstract
We used conjoint analysis-a method that assesses complex decision making-to quantify patients' choices when selecting an osteoporosis therapy. While 60% of people prioritized medication efficacy when deciding among treatments, the remaining 40% highly valued factors other than efficacy, suggesting the need for personalized shared decision-making tools. INTRODUCTION In this study, we aimed to examine patient decision-making surrounding osteoporosis medications using conjoint analysis. METHODS We enrolled osteoporosis patients at an academic medical center to complete an online conjoint exercise which calculated each patient's relative importance score of 6 osteoporosis medication attributes (higher = greater relative importance in decision-making). We used latent class analysis to identify distinct segments of patients with similar choice patterns and then used logistic regression to determine if demographics and osteoporosis disease features were associated with latent class assignment. RESULTS Overall, 304 participants completed the survey. The rank order of medication attributes by importance score was the following: efficacy at preventing hip fractures (accounted for 31.0% of decision making), mode of administration (17.5%); risk of serious side effects (16.6%); dose frequency (13.9%); efficacy at preventing spine fractures (12.5%); risk of non-serious side effects (8.4%). We found that 60.9% of the cohort prioritized medication efficacy as their top factor when selecting among the therapies. Being a college graduate, having stronger beliefs on the necessity of using medications for osteoporosis, and never having used osteoporosis medicines were the only factors associated with prioritizing medication efficacy for fracture prevention over the other factors in the decision-making process. CONCLUSIONS While about 60% of patients prioritized efficacy when selecting an osteoporosis therapy, the remaining 40% valued other factors more highly. Furthermore, individual patient characteristics and clinical factors did not reliably predict patient decision making, suggesting that development and implementation of shared decision-making tools is warranted.
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Affiliation(s)
- Xiaoyu Liu
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Katherine E Makaroff
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Christopher V Almario
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Carine Khalil
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - So Yung Choi
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Cancer, Los Angeles, CA, USA
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Nogués X, Carbonell MC, Canals L, Lizán L, Palacios S. Current situation of shared decision making in osteoporosis: A comprehensive literature review of patient decision aids and decision drivers. Health Sci Rep 2022; 5:e849. [DOI: 10.1002/hsr2.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/20/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Xavier Nogués
- Internal Medicine Department, Instituto de investigación hospital del Mar (IMIM)—Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES) Universitat Autonòma de Barcelona Barcelona Spain
| | - María Cristina Carbonell
- Department of Medicine, Atenció Primària Barcelona—Institut Català de la Salut (ICS), Grupo GREMPAL Universidad de Barcelona Barcelona Spain
| | - Laura Canals
- Department of Medicine Amgen Europe Risch‐Rotkreuz Switzerland
| | - Luis Lizán
- Department of Outcomes Research Outcomes'10 Castellón de la Plana Spain
- Department of Medicine Universitat Jaume I Castellón de la Plana Spain
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van der Keylen P, Zeschick N, Schlenz AR, Kühlein T. Treatment thresholds and minimal clinically important effect sizes of antiosteoporotic medication–Survey among physicians and lay persons in Germany. PLoS One 2022; 17:e0272985. [PMID: 35951613 PMCID: PMC9371311 DOI: 10.1371/journal.pone.0272985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 08/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patient decisions to take preventative treatments for osteoporosis depend on their perceptions of fracture risk, medication effect sizes (ES) of benefits and harms. However, physicians and lay persons may have differing perceptions of risks and medication efficacy. Both tend to overestimate medication benefits. This study surveyed at what risk physicians would prescribe and lay persons would be willing to take bisphosphonates, the minimum ES both groups do demand and the physicians estimates of the actual benefit of bisphosphonates. Design Cross-sectional online questionnaire survey. Methods Respondents were confronted with a case vignette with an osteoporotic patient (10-year femoral fracture risk: 32%). They were asked at what threshold of 10-year-risk of femoral neck fracture they would prescribe or take a drug. They were asked for the minimum ES (absolute risk reduction, ARR) they demand from bisphosphonates to prescribe or take them. Physicians were asked to provide their estimate of the actual ARR of bisphosphonates. Results 114 physicians and 140 lay persons answered (convenience sample/snowball distribution). The 10-year-risk threshold of lay persons (Mdnlay = 60%) willing to take medication was twice as high as the physicians’ threshold (Mdnphy = 30%) to prescribe it (p < .001). The median minimum ARR physicians demanded for bisphosphonates prescription was 17%, whereas lay persons demanded 22% (p < .001). Physicians estimated the actual ARR of bisphosphonates to be 12%. This estimated effect size was below their own minimum threshold for prescription. Conclusions Lay persons tolerate a higher fracture risk and demand a larger benefit of antiosteoporotic medication for fracture prevention than physicians. Physicians demand higher minimum benefits than their own estimates which in turn are above the benefit evidence suggests. Physicians should be more familiar with ES of antiosteoporotic drugs concerning patient outcomes and actively advise lay persons before preventive treatment decisions are taken.
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Affiliation(s)
- Piet van der Keylen
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- * E-mail:
| | - Nikoletta Zeschick
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Anna Ruth Schlenz
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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A Qualitative Study to Assess US Patient Preferences between new Transdermal System and Injectable Anabolic Therapies for Osteoporosis Treatment. Arch Osteoporos 2022; 17:57. [PMID: 35378644 PMCID: PMC8979159 DOI: 10.1007/s11657-022-01075-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 02/03/2023]
Abstract
US patients with osteoporosis included in three focus groups identified efficacy, safety, cost, and convenience as important attributes of treatment when choosing between anabolic therapies with high stated preference for the solid Microstructured Transdermal System. OBJECTIVE The current study evaluated patient perspective and relative importance of treatment attributes of in-home daily self-administration of abaloparatide-solid Microstructured Transdermal System (sMTS) compared with other anabolic agents (i.e. in-home daily subcutaneous self-injections, and monthly subcutaneous injections at doctor office) among a group of US patients with osteoporosis. METHODS The current study included systematic literature reviews, experts' consultation and three online patients focus groups (n=27), including patients ≥50 years of age at high risk for fracture. Nominal Group Technique was used by asking patients to (1) Individually identify characteristics that would be important for them when choosing between anabolic treatments, (2) Share ideas and discuss perspectives with other patients, (3) Review additional attributes generated from a systematic literature review, (4) Select and rank individually the 7 most important characteristics from the list and (5) Report their acceptability and stated preference ranking between the three treatment options. RESULTS Twenty women and 7 men with a mean age of 65 (range 51-85 years) participated in the focus groups. Twenty-four treatment characteristics were identified through focus groups and literature review. Efficacy, safety, out-of-pocket costs, strength of evidence and the option to self-administer were ranked as the most important attributes. The majority of patients stated preference for a daily sMTS if prescribed by their doctor. CONCLUSIONS This study revealed that efficacy, safety, costs, and convenience are important attributes of osteoporosis treatment for US patients at high risk for fractures when choosing between anabolic therapies, with a high stated preference for sMTS.
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Eidam A, Roth A, Frick E, Metzner M, Lampert A, Seidling HM, Haefeli WE, Bauer JM. Development of an Electronic Tool to Assess Patient Preferences in Geriatric Polypharmacy (PolyPref). Patient Prefer Adherence 2022; 16:1733-1747. [PMID: 35910298 PMCID: PMC9329442 DOI: 10.2147/ppa.s364681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Medical decision-making in older adults with multiple chronic conditions and polypharmacy should include the individual patient's treatment preferences. We developed and pilot-tested an electronic instrument (PolyPref) to elicit patient preferences in geriatric polypharmacy. PATIENTS AND METHODS PolyPref follows a two-stage direct approach to preference assessment. Stage 1 generates an individual preselection of relevant health outcomes and medication regimen characteristics, followed by stage 2, in which their importance is assessed using the Q-sort methodology. The feasibility of the instrument was tested in adults aged ≥70 years with ≥2 chronic conditions and regular intake of ≥5 medicines. After the assessment with PolyPref, the patients rated the tool with regard to its comprehensibility and usability and assessed the accuracy of the personal result. Evaluators rated the patients' understanding of the task. RESULTS Eighteen short-term health outcomes, 3 long-term health outcomes, and 8 medication regimen characteristics were included in the instrument. The final population for the pilot study comprised 15 inpatients at a clinic for geriatric rehabilitation with a mean age of 80.6 (± 6.0) years, a median score of 28 (range 25-30) points on the Mini-Mental State Examination, and a mean of 11.6 (± 3.6) regularly taken medicines. Feedback by the patients and the evaluators revealed ratings in favor of understanding and comprehensibility of 86.7% to 100%. The majority of the patients stated that their final result summarized the most important aspects of their pharmacotherapy (93.3%) and that its ranking order reflected their personal opinion (100%). Preference assessment took an average of 35 (± 8.5) min, with the instrument being handled by the evaluator in 14 of the 15 participants. CONCLUSION Preference assessment with PolyPref was feasible in older adults with multiple chronic conditions and polypharmacy, offering a new strategy for the standardized evaluation of patient priorities in geriatric pharmacotherapy.
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Affiliation(s)
- Annette Eidam
- Center for Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
- Correspondence: Annette Eidam, Center for Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany, Tel +49 6221-319-1795, Fax +49 6221-319-1505, Email
| | - Anja Roth
- Center for Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Eduard Frick
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany
| | - Michael Metzner
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany
| | - Anette Lampert
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
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Canals-Ruiz L, Comellas M, Lizán L. Preferences, satisfaction and decision-making processes in osteoporosis treatment: a systematic review of the literature. J Comp Eff Res 2021; 10:629-645. [PMID: 33880940 DOI: 10.2217/cer-2020-0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To synthesize information available in the literature on patients' preferences and satisfaction with osteoporosis treatment and their unmet needs on the treatment decision-making process. Materials & methods: Systematic literature review consulting international database and grey literature of articles published between January 1, 2009 and January 1, 2019. Results: Nineteen publications were reviewed, 79% of them focused on evaluating the importance that patients attached to the mode and frequency of administration, adverse events and treatment efficacy. 21% of them provided information about treatment satisfaction and 26% regarding unmet needs on treatment-decision making process. Conclusion: Aligning treatment with patients' preferences, promoting physician-patient communication and identifying patients' concerns with treatment may contribute to improve treatment satisfaction and adherence and ultimately achieve the treatment goal.
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Affiliation(s)
| | | | - Luís Lizán
- Outcomes10, Castellon, Spain.,Department of Medicine, University Jaume I, Castellon, Spain
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7
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Eidam A, Roth A, Lacroix A, Goisser S, Seidling HM, Haefeli WE, Bauer JM. Methods to Assess Patient Preferences in Old Age Pharmacotherapy - A Systematic Review. Patient Prefer Adherence 2020; 14:467-497. [PMID: 32184575 PMCID: PMC7061412 DOI: 10.2147/ppa.s236964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this systematic review was to identify methods used to assess medication preferences in older adults and evaluate their advantages and disadvantages with respect to their applicability to the context of multimorbidity and polypharmacy. MATERIAL AND METHODS Three electronic databases (PubMed, Web of Science, PsycINFO) were searched. Eligible studies elicited individual treatment or outcome preferences in a context that involved long-term pharmacological treatment options. We included studies with a study population aged ≥ 65 years and/or with a mean or median age of ≥ 75 years. Qualitative studies, studies assessing preferences for only two different treatments, and studies targeting preferences for life-sustaining treatments were excluded. The identified preference measurement methods were evaluated based on four criteria (time budget, cognitive demand, variety of pharmacological aspects, and link with treatment strategies) judged to be relevant for the elicitation of patient preferences in polypharmacy. RESULTS Sixty articles met the eligibility criteria and were included in the narrative synthesis. Fifty-five different instruments to assess patient preferences, based on 24 different elicitation methods, were identified. The most commonly applied preference measurement techniques were "medication willingness" (description of a specific medication with inquiry of the participant's willingness to take it), discrete choice experiments, Likert scale-based questionnaires, and rank prioritization. The majority of the instruments were created for disease-specific or context-specific settings. Only three instruments (Outcome Prioritization Tool, a complex intervention, "MediMol" questionnaire) dealt with the broader issue of geriatric multimorbidity. Only seven of the identified tools showed somewhat favorable characteristics for a potential use of the respective method in the context of polypharmacy. CONCLUSION Up to now, few instruments have been specifically designed for the assessment of medication preferences in older patients with multimorbidity. To facilitate valid preference elicitation in the context of geriatric polypharmacy, future research should focus on suitable characteristics of existing techniques to develop new measurement approaches for this increasingly relevant population.
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Affiliation(s)
- Annette Eidam
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
| | - Anja Roth
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
| | - André Lacroix
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
| | - Sabine Goisser
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
- Network Aging Research (NAR), Heidelberg University, Heidelberg69115, Germany
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg69120, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg69120, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg69120, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg69120, Germany
| | - Jürgen M Bauer
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
- Network Aging Research (NAR), Heidelberg University, Heidelberg69115, Germany
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Huang JF, Zheng XQ, Sun XL, Zhou X, Liu J, Li YM, Wang XY, Zhang XL, Wu AM. Association between Bone Mineral Density and Severity of Chronic Kidney Disease. Int J Endocrinol 2020; 2020:8852690. [PMID: 33193760 PMCID: PMC7641666 DOI: 10.1155/2020/8852690] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE We sought to evaluate the association between femoral neck (FN) and lumbar spine (LS) bone mineral densities (BMDs) with severity of chronic kidney disease (CKD) and prevalence of osteopenia or osteoporosis (OP) among the CKD group. METHODS Cross-sectional data from 11050 participants aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) were analyzed. Specifically, Pearson correlation was applied to analyze the relationship between BMD and estimated glomerular filtration rate (eGFR). General linear models (GLMs) were adjusted for potential confounders and used to analyze mean BMD, based on CKD and CKD stages. RESULTS FN BMD was positively correlated with the eGFR in the total and male CKD, but not in the female CKD population. LS BMD was not significantly associated with eGFR. After controlling for partial correlations, FN T-score was positively correlated with the eGFR in the total at-risk population. According to FN BMD, OP prevalence was positively associated with CKD stage. However, according to LS BMD, there was no significant association between OP and CKD stage. CONCLUSION Our results may explain the higher prevalence of hip fracture, relative to that of the spine, among CKD patients and generate meaningful insights to guide care, prevention, and treatment regimens for CKD patients. However, the fact that this was a cross-sectional study may limit the possibility of drawing concrete conclusions. Nevertheless, these findings open up a new frontier for further studies to uncover the higher decrease of FN BMD compared to LS BMD among CKD cases.
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Affiliation(s)
- Jin-Feng Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xuan-Qi Zheng
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xiao-Lei Sun
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Xiao Zhou
- Ruian Institute of Quality and Technical Supervision and Inspection, Wenzhou 325000, China
| | - Jian Liu
- Department of Nephrology, Rui Jin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200025, China
| | - Yan Michael Li
- Department of Neurosurgery and Oncology, University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Xiang-Yang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xiao-Lei Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Ai-Min Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
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Graham-Clarke PL, Hauber B, Boeri M, Leonardi F, Burge RT, Fernandez M, Tockhorn-Heidenreich A, Florez S. Patient Preferences for Biologic and Biosimilar Osteoporosis Treatments in Colombia. Patient Prefer Adherence 2020; 14:1049-1064. [PMID: 32612354 PMCID: PMC7323574 DOI: 10.2147/ppa.s250745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/01/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Teriparatide is used to treat patients with established osteoporosis but is often reserved for patients who have inadequate response to antiresorptive therapy. Biosimilar teriparatide, which is believed to have efficacy and safety similar to the originator product, is now available in Colombia. However, little is known about patients' preferences for originator biologic and biosimilar treatments. Our objective was to quantify the relative importance that patients in Colombia place on features of injectable osteoporosis treatments including whether the treatment is an originator biologic or a biosimilar. PATIENTS AND METHODS We used a discrete choice experiment (DCE) to elicit preferences of patients with osteoporosis treatment devices in Colombia. The survey was completed by 200 respondents at high risk of fracture, with or without teriparatide experience. Each treatment alternative within the DCE was characterized by five attributes: type of medicine (originator biologic, biosimilar), needle length, angle of injection, how to measure the medicine dose, and how long the medicine can be left unrefrigerated. A random parameters logit regression was used to estimate preferences and conditional relative attribute importance, while controlling for preference heterogeneity. RESULTS A total of 200 patients (mean age = 58.3 years) completed the survey. Most were female (84.5%) and married (54.5%); 50.5% had secondary education or less, 21% had current teriparatide exposure. The attribute with the highest conditional relative importance estimate (standard error) was biologic versus biosimilar (10 [1.11]), followed by needle length (8.06 [1.11]), dose measurement (6.38 [0.87]), refrigeration (3.81 [1.18]), and angle of injection (1.30 [0.66]). Unobserved preference heterogeneity was present and controlled for in the analyses. CONCLUSION Despite the availability of biosimilar teriparatide in Colombia, patients expressed a strong preference for an originator biologic osteoporosis medicine over a biosimilar osteoporosis medicine, when the efficacy, safety, and cost of the two options were assumed to be the same.
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Affiliation(s)
- Peita L Graham-Clarke
- Global Patient Outcomes and Real World Evidence, Eli Lilly Australia, West Ryde, NSW2114, Australia
| | - Brett Hauber
- Health Preference Assessment Group, RTI Health Solutions, Research Triangle Park, NC27709, USA
| | - Marco Boeri
- Health Preference Assessment Group, RTI Health Solutions, BelfastBT2 8LA, UK
- Correspondence: Marco Boeri RTI Health Solutions, Forsyth House, Cromac Square Belfast, BelfastBT2 8LA, UKTel +44 (0)161 447 6016Fax +1.919.541.7222 Email
| | | | - Russel T Burge
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Co, Lilly Corporate Center, Indianapolis, IN46285, USA
| | - Maria Fernandez
- Health Preference Assessment Group, RTI Health Solutions, Research Triangle Park, NC27709, USA
| | | | - Sandra Florez
- Eli Lilly Interamerica Inc, Bogotá, Colombia
- Pain and Palliative Care Unit, Universidad De La Sabana, Bogotá, Colombia
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10
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Cornelissen D, Boonen A, Bours S, Evers S, Dirksen C, Hiligsmann M. Understanding patients' preferences for osteoporosis treatment: the impact of patients' characteristics on subgroups and latent classes. Osteoporos Int 2020; 31:85-96. [PMID: 31606825 PMCID: PMC6946725 DOI: 10.1007/s00198-019-05154-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/30/2019] [Indexed: 01/25/2023]
Abstract
UNLABELLED This study revealed patterns in osteoporosis patients' treatment preferences, which cannot be related to socio-demographic or clinical characteristics, implicating unknown underlying reasons. Therefore, to improve quality of care and treatment, patients should have an active role in treatment choice, irrespective of their characteristics. INTRODUCTION Patient centeredness is important to improve the quality of care. Accounting for patient preferences is a key element of patient centeredness, and understanding preferences are important for successful and adherent treatment. This study was designed to identify different preferences profiles and to investigate how patient characteristics influence treatment preferences of patients for anti-osteoporosis drugs. METHODS Data from a discrete choice experiment among 188 osteoporotic patients were used. The hypothetical treatment options were characterized by three attributes: treatment efficacy, side effects, and mode/frequency of administration. A mixed logit model was used to measure heterogeneity across the sample. Subgroup analyses were conducted to identify potential effect of patient characteristics. Latent class modeling (LCM) was applied. Associations between patients' characteristics and the identified latent classes were explored with chi-square. RESULTS All treatment options were important for patients' decision regarding osteoporotic treatment. Significant heterogeneity was observed for most attributes. Subgroup analyses revealed that patients with a previous fracture valued efficacy most, and patients with a fear of needles or aged > 65 years preferred oral tablets. Elderly patients disliked intravenous medication. Three latent classes were identified, in which 6-month subcutaneous injection was preferred in two classes (86%), while oral tablets were preferred in the third class (14%). No statistically significant associations between the profiles regarding socio-demographic or clinical characteristics could be found. CONCLUSIONS This study revealed patterns in patients' preferences for osteoporosis treatment, which cannot be related to specific socio-demographic or clinical characteristics. Therefore, patients should be involved in clinical decision-making to reveal their preferences.
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Affiliation(s)
- D Cornelissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - A Boonen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Internal Medicine, Rheumatology, Maastricht University Medical Centre and CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - S Bours
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Internal Medicine, Rheumatology, Maastricht University Medical Centre and CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - S Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Centre for economic evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - C Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Silverman S, Gold DT. Medication Decision-making in Osteoporosis: Can We Explain Why Patients Do Not Take Their Osteoporosis Medications? Curr Osteoporos Rep 2018; 16:772-774. [PMID: 30374627 DOI: 10.1007/s11914-018-0494-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Patients at high risk of fracture often do not take medication for osteoporosis. Recent literature may give us some insights into why patients at high risk of fracture do not take medications for osteoporosis.
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Affiliation(s)
- Stuart Silverman
- Cedars-Sinai Medical Center and David Geffen School of Medicine, Los Angeles, CA, USA.
- OMC Clinical Research Center, 8641 Wilshire Blvd, suite 301, Beverly Hills, CA, 90211, USA.
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van Overbeeke E, Whichello C, Janssens R, Veldwijk J, Cleemput I, Simoens S, Juhaeri J, Levitan B, Kübler J, de Bekker-Grob E, Huys I. Factors and situations influencing the value of patient preference studies along the medical product lifecycle: a literature review. Drug Discov Today 2018; 24:57-68. [PMID: 30266656 DOI: 10.1016/j.drudis.2018.09.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/28/2018] [Accepted: 09/20/2018] [Indexed: 01/13/2023]
Abstract
Industry, regulators, health technology assessment (HTA) bodies, and payers are exploring the use of patient preferences in their decision-making processes. In general, experience in conducting and assessing patient preference studies is limited. Here, we performed a systematic literature search and review to identify factors and situations influencing the value of patient preference studies, as well as applications throughout the medical product lifecyle. Factors and situations identified in 113 publications related to the organization, design, and conduct of studies, and to communication and use of results. Although current use of patient preferences is limited, we identified possible applications in discovery, clinical development, marketing authorization, HTA, and postmarketing phases.
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Affiliation(s)
- Eline van Overbeeke
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Herestraat 49 Box 521, 3000 Leuven, Belgium.
| | - Chiara Whichello
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Rosanne Janssens
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Herestraat 49 Box 521, 3000 Leuven, Belgium
| | - Jorien Veldwijk
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Irina Cleemput
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Steven Simoens
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Herestraat 49 Box 521, 3000 Leuven, Belgium
| | | | - Bennett Levitan
- Janssen Research & Development, 1125 Trenton-Harbourton Road, P.O. Box 200, Titusville, NJ 08560, USA
| | - Jürgen Kübler
- Quantitative Scientific Consulting, Europabadstr. 8, 35041 Marburg, Germany
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Herestraat 49 Box 521, 3000 Leuven, Belgium
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Hampson LA, Lin TK, Wilson L, Allen IE, Gaither TW, Breyer BN. Understanding patients' preferences for surgical management of urethral stricture disease. World J Urol 2017; 35:1799-1805. [PMID: 28664240 PMCID: PMC6452859 DOI: 10.1007/s00345-017-2066-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/15/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To understand how prioritization of treatment attributes and treatment choice varies by patient characteristics, we sought to specifically determine how demographic variables affect patient treatment preference. PATIENTS AND METHODS Male patients with urethral stricture disease participated in a choice-based conjoint (CBC) analysis exercise evaluating six treatment attributes associated with internal urethrotomy and urethroplasty. Demographic and past symptom data were collected. Stratified analysis of demographic variables, including age, education, income, was conducted using a mixed effect logistic regression model to evaluate the coefficient size and confidence intervals between the treatments attribute preferences of each strata. RESULTS 169 patients completed the CBC exercise and were included in our analysis. Overall success of the procedure is the most important treatment attribute to patients and this persists across strata. Older patients (≥65) express preferences for better success rates and fewer future procedures, whereas younger patients prefer a less invasive approach and are more willing to accept additional procedures if needed. Patients with lower levels of education preferred open reconstruction and had a stronger preference against multiple future procedures, whereas those with higher levels of education preferred endoscopic treatment and had a less strong preference against multiple future procedures. Low-income individuals express statistically significant stronger negative preferences against high copay costs compared to high-income individuals. CONCLUSION These results can help to inform physicians' counseling about surgical management of urethral stricture disease to better align patient preferences with treatment selection and encourage shared decision making.
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Affiliation(s)
- Lindsay A Hampson
- Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, A638, Box 0738, San Francisco, CA, 94143, USA.
| | - Tracy K Lin
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, USA
| | - Leslie Wilson
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, USA
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics, UCSF School of Medicine, San Francisco, USA
| | | | - Benjamin N Breyer
- Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, A638, Box 0738, San Francisco, CA, 94143, USA
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Hiligsmann M, Dellaert BG, Dirksen CD, Watson V, Bours S, Goemaere S, Reginster JY, Roux C, McGowan B, Silke C, Whelan B, Diez-Perez A, Torres E, Papadakis G, Rizzoli R, Cooper C, Pearson G, Boonen A. Patients' preferences for anti-osteoporosis drug treatment: a cross-European discrete choice experiment. Rheumatology (Oxford) 2017; 56:1167-1176. [PMID: 28398547 DOI: 10.1093/rheumatology/kex071] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives To estimate the preferences of osteoporotic patients for medication attributes, and analyse data from seven European countries. Methods A discrete choice experiment was conducted in Belgium, France, Ireland, the Netherlands, Spain, Switzerland and the UK. Patients were asked to choose repeatedly between two hypothetical unlabelled drug treatments (and an opt-out option) that varied with respect to four attributes: efficacy in reducing the risk of fracture, type of potential common side effects, and mode and frequency of administration. In those countries in which patients contribute to the cost of their treatment directly, a fifth attribute was added: out-of-pocket cost. A mixed logit panel model was used to estimate patients' preferences. Results In total, 1124 patients completed the experiment, with a sample of between 98 and 257 patients per country. In all countries, patients preferred treatment with higher effectiveness, and 6-monthly subcutaneous injection was always preferred over weekly oral tablets. In five countries, patients also preferred a monthly oral tablet and yearly i.v. injections over weekly oral tablets. In the three countries where the out-of-pocket cost was included as an attribute, lower costs significantly contributed to the treatment preference. Between countries, there were statistically significant differences for 13 out of 42 attribute/level interactions. Conclusion We found statistically significant differences in patients' preferences for anti-osteoporosis medications between countries, especially for the mode of administration. Our findings emphasized that international treatment recommendations should allow for local adaptation, and that understanding individual preferences is important if we want to improve the quality of clinical care for patients with osteoporosis.
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Affiliation(s)
- Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht
| | - Benedict G Dellaert
- Department of Business Economics, Erasmus School of Economics, Erasmus Rotterdam University, Rotterdam
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Verity Watson
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sandrine Bours
- Department of Internal Medicine, Maastricht University Medical Centre, CAPHRI, Maastricht, The Netherlands
| | - Stefan Goemaere
- Department of Rheumatology and Endocrinology, Ghent University Hospital, Gent
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium
| | - Christian Roux
- Department of Rheumatology, Paris Descartes University, Paris, France
| | - Bernie McGowan
- The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co Leitrim, Ireland
| | - Carmel Silke
- The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co Leitrim, Ireland
| | - Bryan Whelan
- The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co Leitrim, Ireland
| | - Adolfo Diez-Perez
- Musculoskeletal Research Unit and RETICEF, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisa Torres
- Musculoskeletal Research Unit and RETICEF, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgios Papadakis
- Service of Endocrinology, Diabetology and Metabolism, CHUV, Lausanne University Hospital, Lausanne
| | - Rene Rizzoli
- Division of Bone Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Gill Pearson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Annelies Boonen
- Department of Internal Medicine, Maastricht University Medical Centre, CAPHRI, Maastricht, The Netherlands
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Kerr C, Bottomley C, Shingler S, Giangregorio L, de Freitas HM, Patel C, Randall S, Gold DT. The importance of physical function to people with osteoporosis. Osteoporos Int 2017; 28:1597-1607. [PMID: 28265717 PMCID: PMC5391375 DOI: 10.1007/s00198-017-3911-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022]
Abstract
There is increasing need to understand patient outcomes in osteoporosis. This article discusses that fracture in osteoporosis can lead to a cycle of impairment, driven by complex psychosocial factors, having a profound impact on physical function/activity which accumulates over time. More information is required on how treatments impact physical function. INTRODUCTION There is increasing need to understand patient-centred outcomes in osteoporosis (OP) clinical research and management. This multi-method paper provides insight on the effect of OP on patients' physical function and everyday activity. METHODS Data were collected from three sources: (1) targeted literature review on OP and physical function, conducted in MEDLINE, Embase and PsycINFO; (2) secondary thematic analysis of transcripts from patient interviews, conducted to develop a patient-reported outcome instrument. Transcripts were re-coded to focus on OP impact on daily activities and physical function for those with and without fracture history; and (3) discussions of the literature review and secondary qualitative analysis results with three clinical experts to review and interpret the importance and implications of the findings. RESULTS Results suggest that OP, particularly with fracture, can have profound impacts on physical function/activity. These impacts accumulate over time through a cycle of impairment, as fracture leads to longer term detriments in physical function, including loss of muscle, activity avoidance and reduced physical capacity, which in turn leads to greater risk of fracture and potential for further physical restrictions. The cycle of impairment is complex, as other physical, psychosocial and treatment-related factors, such as comorbidities, fears and beliefs about physical activity and fracture risk influence physical function and everyday activity. CONCLUSION More information on how treatments impact physical function would benefit healthcare professionals and persons with OP in making treatment decisions and improving treatment compliance/persistence, as these impacts may be more salient to patients than fracture incidence.
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Affiliation(s)
- C Kerr
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA
| | - C Bottomley
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA
| | - S Shingler
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA
| | - L Giangregorio
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, ON, Canada
- Research Institute for Aging, Waterloo, ON, Canada
| | - H M de Freitas
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA.
- Mapi, Translation and Innovation Hub Building, 80 Wood Lane, White City, London, W12 0BZ, UK.
| | - C Patel
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA
| | - S Randall
- National Osteoporosis Foundation, 251 18th Street South, Suite 630, Arlington, VA, 22202, USA
| | - D T Gold
- Duke University Medical Center, Durham, NC, 27710, USA
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Kim WL, Kim JS, Lee JB, Kim SH, Min DU, Park HY. Survey of Preferences in Patients Scheduled for Carpal Tunnel Release Using Conjoint Analysis. Clin Orthop Surg 2017; 9:96-100. [PMID: 28261434 PMCID: PMC5334034 DOI: 10.4055/cios.2017.9.1.96] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 12/14/2016] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to investigate the preferences of patients scheduled for carpal tunnel release using conjoint analysis and also introduce an example of how to apply a conjoint analysis to the medical field. The use of conjoint analysis in this study is new to the field of orthopedic surgery. Methods A total of 97 patients scheduled for carpal tunnel release completed the survey. The following four attributes were predefined: board certification status, distance from the patient's residency, medical costs, and waiting time for surgery. Two plausible levels for each attribute were assigned. Based on these attributes and levels, 16 scenarios were generated (2 × 2 × 2 × 2). We employed 8 scenarios using a fractional factorial design (orthogonal plan). Preferences for scenarios were then evaluated by ranking: patients were asked to list the 8 scenarios in their order of preference. Outcomes consisted of two results: the average importance of each attribute and the utility score. Results The most important attribute was the physician's board certificate, followed by distance from the patient's residency to the hospital, waiting time, and costs. Utility estimate findings revealed that patients had a greater preference for a hand specialist than a general orthopedic surgeon. Conclusions Patients considered the physician's expertise as the most important factor when choosing a hospital for carpal tunnel release. This suggests that patients are increasingly seeking safety without complications as interest in medical malpractice has increased.
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Affiliation(s)
- Wan Lim Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Sam Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Bum Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Hwa Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Uk Min
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Ho Youn Park
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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Wilson L, Lin TK, Hampson LA, Oh A, Ting J, Gaither T, Allen I, Breyer BN. Use of Conjoint Analysis to Determine Patient Preferences for Surgical Treatment of Urethral Stricture Disease. J Particip Med 2017; 9:e1. [PMID: 32995067 PMCID: PMC7521776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Understanding patient preferences for characteristics of treatments facilitates patient participation and doctor-patient communication and enhances patient-centered care. Patient participation is especially important for urethral stricture disease, which has no definitive treatment guidelines favoring either endoscopic incision or open reconstruction, making patient preference an important factor in treatment choice. However, to date, there have been no studies assessing factors that patients value when choosing a treatment option. METHODS We employ choice-based conjoint analysis to assess patient preferences in the trade-offs of treatment attributes for urethral stricture disease. Male patients undergoing treatment or follow-up examination for urethral stricture disease were recruited through a University Medical Practice. We included 169 patients in the analysis. Six attributes of both risk and benefit were examined: treatment type, success rate, number of future procedures, post-treatment catheter duration, recovery time, and copayment amount. RESULTS The treatment success rate was by far the most important attribute. Relative to a 25% success rate (OR = 1) an 85% success rate (OR = 26.72, p<.01) increased patient preference by approximately 27 times. Furthermore, patients are willing to pay a $10,000 copayment to double the success rate from 25% to 50%. Patients demonstrated a strong aversion to time with a urinary catheter. Catheter duration for 1 week or less (OR = .67, p<.01) reduced patient preference by about 1.5 times when compared to requiring no catheter. We also found that patients place low importance on both how invasive the treatment seems and low copayment amounts but are willing to pay $10,000 copayment for an open reconstruction surgery compared with an endoscopic incision procedure. CONCLUSION The findings highlight the importance of shared and detailed physician/patient discussions of all the risk and benefits of each treatment choice and suggest that conjoint analysis may be helpful as a decision aid to guide discussions with individual patients deciding on a treatment.
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Affiliation(s)
- Leslie Wilson
- University of California, San Francisco, 3333 California St, Suite 420, San Francisco, CA 94118
| | - Tracy Kuo Lin
- University of California, San Francisco, 3333 California St, Suite 420, San Francisco, CA 94118
| | - Lindsay A. Hampson
- University of California, San Francisco, 1001 Potrero Ave, SFGH 3, San Francisco CA 94110
| | - Anna Oh
- University of California, San Francisco, 3333 California St, Suite 420, San Francisco, CA 94118
| | - Jie Ting
- University of California, San Francisco, 3333 California St, Suite 420, San Francisco, CA 94118
| | - Thomas Gaither
- University of California, San Francisco, Department of Urology, School of Medicine
| | - Isabel Allen
- University of California, San Francisco, 550 16th Street, 2nd Floor, San Francisco CA 94158
| | - Benjamin N. Breyer
- University of California, San Francisco, 1001 Potrero Ave, SFGH 3, San Francisco CA 94110
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Hampson LA, Allen IE, Gaither TW, Lin T, Ting J, Osterberg EC, Wilson L, Breyer BN. Patient-centered Treatment Decisions for Urethral Stricture: Conjoint Analysis Improves Surgical Decision-making. Urology 2017; 99:246-253. [PMID: 27645527 PMCID: PMC6425929 DOI: 10.1016/j.urology.2016.07.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine whether the use of a choice-based conjoint analysis (CA) exercise decreased patients' decisional conflict about treatment preferences for surgical management of urethral stricture disease. Understanding patient preferences for treatment decisions assists in shared decision-making and emphasizes patient-centered outcomes. CA offers a method to understand what risks patients are willing to take for what gains. METHODS The CA methodology was used by providing participants with case-based choices to elucidate the relative importance that individuals place on various treatment aspects. Patients' decisional conflict regarding surgery for urethral stricture was assessed before and after the CA exercise to assess the impact the exercise had on their decisional conflict. RESULTS Completion of the CA exercise resulted in a significant decrease in decisional conflict (P < .001). The majority (59.5%) of participants with decisional conflict before the CA exercise experienced a decrease in decisional conflict afterwards, with only a minority (16.5%) experiencing new decisional conflict after the exercise. Participants felt the choice-based CA exercise was helpful in deciding what was important in making treatment decisions (70%) and in expressing their priorities and treatment preferences (82%). The number needed to counsel to achieve a decrease in decisional conflict was 1.69 and to achieve no decisional conflict was 3.65. CONCLUSION Choice-based CA improves patients' ability to express their treatment preferences and decreases decisional conflict. CA may be a new tool that physicians and patients can use to aid in shared decision-making with a focus on patient-centered outcomes.
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Affiliation(s)
- Lindsay A Hampson
- Philip R. Lee Institute for Health Policy Studies, Department of Urology, UCSF School of Medicine, San Francisco, CA.
| | - Isabel E Allen
- Department of Epidemiology & Biostatistics, UCSF School of Medicine, San Francisco, CA
| | | | - Tracy Lin
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, CA
| | - Jie Ting
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, CA
| | | | - Leslie Wilson
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, CA
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Cheung KL, Wijnen BFM, Hollin IL, Janssen EM, Bridges JF, Evers SMAA, Hiligsmann M. Using Best-Worst Scaling to Investigate Preferences in Health Care. PHARMACOECONOMICS 2016; 34:1195-1209. [PMID: 27402349 PMCID: PMC5110583 DOI: 10.1007/s40273-016-0429-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Best-worst scaling (BWS) is becoming increasingly popular to elicit preferences in health care. However, little is known about current practice and trends in the use of BWS in health care. This study aimed to identify, review and critically appraise BWS in health care, and to identify trends over time in key aspects of BWS. METHODS A systematic review was conducted, using Medline (via Pubmed) and EMBASE to identify all English-language BWS studies published up until April 2016. Using a predefined extraction form, two reviewers independently selected articles and critically appraised the study quality, using the Purpose, Respondents, Explanation, Findings, Significance (PREFS) checklist. Trends over time periods (≤2010, 2011, 2012, 2013, 2014 and 2015) were assessed further. RESULTS A total of 62 BWS studies were identified, of which 26 were BWS object case studies, 29 were BWS profile case studies and seven were BWS multi-profile case studies. About two thirds of the studies were performed in the last 2 years. Decreasing sample sizes and decreasing numbers of factors in BWS object case studies, as well as use of less complicated analytical methods, were observed in recent studies. The quality of the BWS studies was generally acceptable according to the PREFS checklist, except that most studies did not indicate whether the responders were similar to the non-responders. CONCLUSION Use of BWS object case and BWS profile case has drastically increased in health care, especially in the last 2 years. In contrast with previous discrete-choice experiment reviews, there is increasing use of less sophisticated analytical methods.
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Affiliation(s)
- Kei Long Cheung
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Ben F M Wijnen
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - Ilene L Hollin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ellen M Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John F Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
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Abstract
Poor medication adherence is a major problem in chronic diseases such as osteoporosis that may partially be due to unaddressed patient values and preferences. Data on patient preferences could help clinicians to improve medication adherence and could also be useful in policy decisions and guideline development. This paper aims to identify literature reporting on the preferences of patients for osteoporosis drug medications. Several methods have been used to elicit patient preferences for medications and their characteristics including qualitative research, survey with ranking/rating exercises, discrete-choice experiments and clinical studies (crossover designs, open-label study). All these studies revealed that osteoporotic patients have preferences for medications and their attributes, in particular for less-frequent dosing regimens. Interestingly, variations in the preferences of patients were observed in most studies, suggesting the importance to take into account individual preference in decision-making to improve osteoporosis care.
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Stewart KD, Johnston JA, Matza LS, Curtis SE, Havel HA, Sweetana SA, Gelhorn HL. Preference for pharmaceutical formulation and treatment process attributes. Patient Prefer Adherence 2016; 10:1385-99. [PMID: 27528802 PMCID: PMC4970633 DOI: 10.2147/ppa.s101821] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Pharmaceutical formulation and treatment process attributes, such as dose frequency and route of administration, can have an impact on quality of life, treatment adherence, and disease outcomes. The aim of this literature review was to examine studies on preferences for pharmaceutical treatment process attributes, focusing on research in diabetes, oncology, osteoporosis, and autoimmune disorders. METHODS The literature search focused on identifying studies reporting preferences for attributes of the pharmaceutical treatment process. Studies were required to use formal quantitative preference assessment methods, such as utility valuation, conjoint analysis, or contingent valuation. Searches were conducted using Medline, EMBASE, Cochrane Library, Health Economic Evaluation Database, and National Health Service Economic Evaluation Database (January 1993-October 2013). RESULTS A total of 42 studies met inclusion criteria: 19 diabetes, nine oncology, five osteoporosis, and nine autoimmune. Across these conditions, treatments associated with shorter treatment duration, less frequent administration, greater flexibility, and less invasive routes of administration were preferred over more burdensome or complex treatments. While efficacy and safety often had greater relative importance than treatment process, treatment process also had a quantifiable impact on preference. In some instances, particularly in diabetes and autoimmune disorders, treatment process attributes had greater relative importance than some or all efficacy and safety attributes. Some studies suggested that relative importance of treatment process depends on disease (eg, acute vs chronic) and patient (eg, injection experience) characteristics. CONCLUSION Despite heterogeneity in study methods and design, some general patterns of preference clearly emerged. Overall, the results of this review suggest that treatment process has a quantifiable impact on preference and willingness to pay for treatment, even in many situations where safety and efficacy were the primary concerns. Patient preferences for treatment process attributes can inform drug development decisions to better meet the needs of patients and deliver improved outcomes.
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Affiliation(s)
- Katie D Stewart
- Outcomes Research, Evidera, Bethesda, MD, USA
- Correspondence: Katie D Stewart, Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814, USA, Tel +1 240 235 2493, Fax +1 301 654 9864, Email
| | | | | | | | - Henry A Havel
- Small Molecule Design and Development, Eli Lilly & Company, Indianapolis, IN, USA
| | - Stephanie A Sweetana
- Small Molecule Design and Development, Eli Lilly & Company, Indianapolis, IN, USA
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Gelhorn HL, Poon JL, Davies EW, Paczkowski R, Curtis SE, Boye KS. Evaluating preferences for profiles of GLP-1 receptor agonists among injection-naïve type 2 diabetes patients in the UK. Patient Prefer Adherence 2015; 9:1611-22. [PMID: 26635470 PMCID: PMC4646588 DOI: 10.2147/ppa.s90842] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To use a discrete choice experiment (DCE) to evaluate preferences for the actual treatment features and overall profiles of two injectable glucagon-like peptide-1 receptor agonists (dulaglutide and liraglutide) among patients with type 2 diabetes mellitus (T2DM) in the UK. METHODS In-person interviews were conducted in the UK to administer a DCE to patients with self-reported T2DM, naïve to treatment with injectable medications. The DCE examined six attributes of T2DM treatment each described by two levels: "dosing frequency," "hemoglobin A1c change," "weight change," "type of delivery system," "frequency of nausea," and "frequency of hypoglycemia." Part-worth utilities were estimated using random effects logit models and were used to calculate relative importance (RI) values for each attribute. A chi-square test was used to determine differences in preferences for dulaglutide versus liraglutide profiles. RESULTS A total of 243 participants [mean age: 60.5 (standard deviation 10.9) years; 76.1% male; mean body mass index: 29.8 (standard deviation 5.4) kg/m(2)] completed the study. RI values for the attributes in rank order were: "dosing frequency" (41.6%), "type of delivery system" (35.5%), "frequency of nausea" (10.4%), "weight change" (5.9%), "hemoglobin A1c change" (3.6%), and "frequency of hypoglycemia" (3.0%). Significantly more participants preferred the dulaglutide profile (83.1%) compared with the liraglutide profile (16.9%; P<0.0001). CONCLUSION This study elicited patients' preferences for attributes and levels representing the actual characteristics of two specific glucagon-like peptide-1 medications. In this context, dosing frequency and type of delivery system were most important, accounting for over 75% of the RI. While previous studies have identified efficacy as highly important in T2DM medication decisions, this study suggests that when differences in efficacy between medications are small, other treatment features (eg, dosing frequency and delivery system) are of much greater importance to patients.
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Affiliation(s)
| | | | | | - Rosirene Paczkowski
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
| | - Sarah E Curtis
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
| | - Kristina S Boye
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
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Wade SW, Satram-Hoang S, Stolshek BS. Long-term persistence and switching patterns among women using osteoporosis therapies: 24- and 36-month results from POSSIBLE US™. Osteoporos Int 2014; 25:2279-90. [PMID: 24942502 DOI: 10.1007/s00198-014-2762-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/28/2014] [Indexed: 01/09/2023]
Abstract
UNLABELLED Persistence with postmenopausal osteoporosis (PMO) medications is not well characterized beyond 12 months. Of 3,011 postmenopausal women treated in primary care, 36.8 % continued baseline PMO medication during 36 months of follow-up. Many factors were associated with nonpersistence, including newly initiating or switching therapy, and reporting moderate to severe side effects. INTRODUCTION Persistence with postmenopausal osteoporosis (PMO) medications is not well characterized beyond 12 months. We describe 24- and 36-month persistence using patient-reported data from women with different PMO treatment histories in the US primary care setting. METHODS Data from 3,011 participants of the Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US™, 10/2005-12/2008) and Kaplan-Meier methods were used to estimate the probability of persisting (i.e., not discontinuing or switching PMO agents) with baseline PMO medication and hazard ratios for predictors of nonpersistence 24 and 36 months after study entry. RESULTS The probability of persisting with the baseline medication was 46.2 % (95 % confidence interval [CI] 44.2-48.1 %) during 24 months of follow-up and 36.8 % (95 % CI 34.7-38.9 %) during 36 months of follow-up. In adjusted analyses, newly initiating therapy or switching to a new agent, reporting moderate to severe side effects, having lower disease-specific quality of life scores, smoking, and residing in the South or West USA (all measured at study entry) were independent predictors of nonpersistence in both time periods. The majority of participants who discontinued therapy and had the opportunity to reinitiate (i.e., discontinued ≥4 months before the end of follow-up) restarted therapy (24 months 69 %; 36 months 75 %). CONCLUSIONS In this primary care cohort, a minority of women continued their baseline PMO therapy during a 24- to 36-month follow-up. Supporting patients during the initiation of a new therapy or if side effects occur may improve persistence and increase the therapeutic benefit of PMO medications.
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Affiliation(s)
- S W Wade
- Wade Outcomes Research and Consulting, 358 South 700 East, Suite B-432, Salt Lake City, UT, 84013, USA,
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24
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Janssen IM, Gerhardus A, Schröer-Günther MA, Scheibler F. A descriptive review on methods to prioritize outcomes in a health care context. Health Expect 2014; 18:1873-93. [PMID: 25156207 DOI: 10.1111/hex.12256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence synthesis has seen major methodological advances in reducing uncertainty and estimating the sizes of the effects. Much less is known about how to assess the relative value of different outcomes. OBJECTIVE To identify studies that assessed preferences for outcomes in health conditions. METHODS SEARCH STRATEGY we searched MEDLINE, EMBASE, PsycINFO and the Cochrane Library in February 2014. INCLUSION CRITERIA eligible studies investigated preferences of patients, family members, the general population or healthcare professionals for health outcomes. The intention of this review was to include studies which focus on theoretical alternatives; studies which assessed preferences for distinct treatments were excluded. DATA EXTRACTION study characteristics as study objective, health condition, participants, elicitation method, and outcomes assessed in the study were extracted. MAIN RESULTS One hundred and twenty-four studies were identified and categorized into four groups: (1) multi criteria decision analysis (MCDA) (n = 71), (2) rating or ranking (n = 25), (3) utility eliciting (n = 5) and (4) studies comparing different methods (n = 23). The number of outcomes assessed by method group varied. The comparison of different methods or subgroups within one study often resulted in different hierarchies of outcomes. CONCLUSIONS A dominant method most suitable for application in evidence syntheses was not identified. As preferences of patients differ from those of other stakeholders (especially medical professionals), the choice of the group to be questioned is consequential. Further research needs to focus on validity and applicability of the identified methods.
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Affiliation(s)
- Inger M Janssen
- Department of Epidemiology & International Public Health, University of Bielefeld, Bielefeld, Germany.,Department of Health Information, Institute for Quality and Efficiency in Healthcare (IQWiG), Köln, Germany
| | - Ansgar Gerhardus
- Department of Health Services Research, Institute for Public Health and Nursing Science, University of Bremen, Bremen, Germany
| | - Milly A Schröer-Günther
- Department of Non-Drug Interventions, Institute for Quality and Efficiency in Healthcare (IQWiG), Köln, Germany
| | - Fülöp Scheibler
- Department of Non-Drug Interventions, Institute for Quality and Efficiency in Healthcare (IQWiG), Köln, Germany
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Hiligsmann M, Dellaert BG, Dirksen CD, van der Weijden T, Goemaere S, Reginster JY, Watson V, Boonen A. Patients' preferences for osteoporosis drug treatment: a discrete-choice experiment. Arthritis Res Ther 2014; 16:R36. [PMID: 24479410 PMCID: PMC3979104 DOI: 10.1186/ar4465] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 01/10/2014] [Indexed: 01/28/2023] Open
Abstract
Introduction The patient’s perspective is becoming increasingly important in clinical and policy decisions. In this study, we aimed to evaluate the preferences of patients with, or at risk of, osteoporosis for medication attributes, and to establish how patients trade between these attributes. Methods A discrete choice experiment survey was designed and patients were asked to choose between two hypothetical unlabelled drug treatments (and an opt-out option) that vary in five attributes: efficacy in reducing the risk of fracture, type of potential common side-effects, mode and frequency of administration and out-of-pocket costs. An efficient experimental design was used to construct the treatment option choice sets and a mixed logit panel data model was used to estimate patients’ preferences and trade-offs between attributes. Results A total of 257 patients with, or at risk of, osteoporosis completed the experiment. As expected, patients preferred treatment with higher effectiveness and lower cost. They also preferred either an oral monthly tablet or 6-month subcutaneous injection above weekly oral tablets, 3-month subcutaneous, 3-month intravenous or yearly intravenous injections. Patients disliked being at risk of gastro-intestinal disorders more than being at risk of skin reactions and flu-like symptoms. There was significant variation in preferences across the sample for all attributes except subcutaneous injection. Conclusions This study revealed that osteoporotic patients preferred 6-month subcutaneous injection and oral monthly tablet, and disliked gastro-intestinal disorders. Moreover, patients were willing to pay a personal contribution or to trade treatment efficacy for better levels of other attributes. Preferences for treatment attributes varied across patients and this highlights the importance of clinical decision-making taking individual preferences into account to improve osteoporosis care.
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