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Suzumura EA, de Oliveira Ascef B, Maia FHDA, Bortoluzzi AFR, Domingues SM, Farias NS, Gabriel FC, Jahn B, Siebert U, de Soarez PC. Methodological guidelines and publications of benefit-risk assessment for health technology assessment: a scoping review. BMJ Open 2024; 14:e086603. [PMID: 38851235 PMCID: PMC11163601 DOI: 10.1136/bmjopen-2024-086603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/21/2024] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVES To map the available methodological guidelines and documents for conducting and reporting benefit-risk assessment (BRA) during health technologies' life cycle; and to identify methodological guidelines for BRA that could serve as the basis for the development of a BRA guideline for the context of health technology assessment (HTA) in Brazil. DESIGN Scoping review. METHODS Searches were conducted in three main sources up to March 2023: (1) electronic databases; (2) grey literature (48 HTA and regulatory organisations) and (3) manual search and contacting experts. We included methodological guidelines or publications presenting methods for conducting or reporting BRA of any type of health technologies in any context of the technology's life cycle. Selection process and data charting were conducted by independent reviewers. We provided a structured narrative synthesis of the findings. RESULTS From the 83 eligible documents, six were produced in the HTA context, 30 in the regulatory and 35 involved guidance for BRA throughout the technology's life cycle. We identified 129 methodological approaches for BRA in the documents. The most commonly referred to descriptive frameworks were the Problem, Objectives, Alternatives, Consequences, Trade-offs, Uncertainty, Risk and Linked decisions and the Benefit-Risk Action Team. Multicriteria decision analysis was the most commonly cited quantitative framework. We also identified the most cited metric indices, estimation and utility survey techniques that could be used for BRA. CONCLUSIONS Methods for BRA in HTA are less established. The findings of this review, however, will support and inform the elaboration of the Brazilian methodological guideline on BRA for HTA. TRIAL REGISTRATION NUMBER https://doi.org/10.17605/OSF.IO/69T3V.
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Affiliation(s)
- Erica Aranha Suzumura
- Departamento de Medicina Preventiva, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Bruna de Oliveira Ascef
- Departamento de Medicina Preventiva, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Sidney Marcel Domingues
- Departamento de Medicina Preventiva, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Natalia Santos Farias
- Departamento de Medicina Preventiva, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Beate Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
- Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Program on Cardiovascular Research, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Patricia Coelho de Soarez
- Departamento de Medicina Preventiva, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Veldwijk J, DiSantostefano RL, Janssen E, Simons G, Englbrecht M, Schölin Bywall K, Radawski C, Raza K, Hauber B, Falahee M. Maximum Acceptable Risk Estimation Based on a Discrete Choice Experiment and a Probabilistic Threshold Technique. THE PATIENT 2023; 16:641-653. [PMID: 37647010 PMCID: PMC10570171 DOI: 10.1007/s40271-023-00643-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE We aimed to empirically compare maximum acceptable risk results estimated using both a discrete choice experiment (DCE) and a probabilistic threshold technique (PTT). METHODS Members of the UK general public (n = 982) completed an online survey including a DCE and a PTT (in random order) measuring their preferences for preventative treatment for rheumatoid arthritis. For the DCE, a Bayesian D-efficient design consisting of four blocks of 15 choice tasks was constructed including six attributes with varying levels. The PTT used identical risk and benefit attributes. For the DCE, a panel mixed-logit model was conducted, both mean and individual estimates were used to calculate maximum acceptable risk. For the PTT, interval regression was used to calculate maximum acceptable risk. Perceived complexity of the choice tasks and preference heterogeneity were investigated for both methods. RESULTS Maximum acceptable risk confidence intervals of both methods overlapped for serious infection and serious side effects but not for mild side effects (maximum acceptable risk was 32.7 percent-points lower in the PTT). Although, both DCE and PTT tasks overall were considered easy or very easy to understand and answer, significantly more respondents rated the DCE choice tasks as easier to understand compared with those who rated the PTT as easier (7-percentage point difference; p < 0.05). CONCLUSIONS Maximum acceptable risk estimate confidence intervals based on a DCE and a PTT overlapped for two out of the three included risk attributes. More respondents rated the DCE as easier to understand. This may suggest that the DCE is better suited in studies estimating maximum acceptable risk for multiple risk attributes of differing severity, while the PTT may be better suited when measuring heterogeneity in maximum acceptable risk estimates or when investigating one or more serious adverse events.
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Affiliation(s)
- Jorien Veldwijk
- School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, The Netherlands.
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | | | | | - Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Matthias Englbrecht
- Freelance Healthcare Data Scientist, Greven, Germany
- Department of Internal Medicine and Institute for Clinical Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and Research into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Brett Hauber
- Pfizer, Inc., New York, NY, USA
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington School or Pharmacy, Seattle, WA, USA
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Valentine KD, Shaffer VA, Hauber B. Eliciting preferences for cancer screening tests: Comparison of a discrete choice experiment and the threshold technique. PATIENT EDUCATION AND COUNSELING 2023; 115:107898. [PMID: 37467593 DOI: 10.1016/j.pec.2023.107898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To compare results of three preference elicitation methods for a cancer screening test. METHODS Participants (undergraduate students) completed a discrete choice experiment (DCE) and a threshold technique (TT) task. Accuracy (false positives, false negatives), benefits (lives saved), and cost for a cancer screening test were used as attributes in the DCE and branching logic for the TT. Participants were also asked a direct elicitation question regarding a hypothetical screening test for breast (women) or prostate (men) cancer without mortality benefit. Correlations assessed the relationship between DCE and TT thresholds. Thresholds were standardized and ranked for both methods to compare. A logistic regression used the thresholds to predict results of the direct elicitation. RESULTS DCE and TT estimates were not meaningfully correlated (max ρ = 0.17). Participant rankings of attributes matched only 20% of the time (58/292). Neither method predicted preference for being screened (ps > 0.21). CONCLUSIONS The DCE and TT yielded different preference estimates (and rank orderings) for the same participant. Neither method predicted patients' desires for a screening test. PRACTICE IMPLICATIONS Clinicians, patients, policy makers, and researchers should be aware that patient preference results may be sensitive to the method of eliciting preferences.
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Affiliation(s)
- K D Valentine
- Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | | | - Brett Hauber
- Pfizer, Inc., New York, NY 10017, USA; The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA 98107, USA
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Zeng L, Li SA, Yang M, Yan L, Helsingen LM, Bretthauer M, Agoritsas T, Vandvik PO, Mustafa RA, Busse J, Siemieniuk RAC, Lytvyn L, Zhang L, Brignardello-Petersen R, Guyatt GH. Qualitative study of guideline panelists: innovative surveys provided valuable insights regarding patient values and preferences. J Clin Epidemiol 2023; 161:173-180. [PMID: 37517505 DOI: 10.1016/j.jclinepi.2023.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To explore guideline panelists' understanding of panel surveys for eliciting panels' inferences regarding patient values and preferences, and the influence of the surveys on making recommendations. STUDY DESIGN AND SETTING We performed sampling and data collection from all four guideline panels that had conducted the surveys through October 2020. We collected the records of all panel meetings and interviewed some panelists in different roles. We applied inductive thematic analysis for analyzing and interpreting data. RESULTS We enrolled four guideline panels with 99 panelists in total and interviewed 25 of them. Most panelists found the survey was easy to follow and facilitated the incorporation of patient values and preferences in the tradeoffs between benefits and harms or burdens. The variation of patient preferences and uncertainty regarding patient values and preferences reflected in the surveys helped the panels ponder the strength of recommendations. In doing so, the survey results enhanced a rationale for panels' decision on the recommendations. CONCLUSION The panel surveys have proved to help guideline panels explicitly consider and incorporate patient values and preferences in making recommendations. Guideline panels would benefit from widespread use of the panel surveys, particularly when primary evidence regarding patient values and preferences is scarce.
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Affiliation(s)
- Linan Zeng
- Evidence-based Pharmacy Centre/Pharmacy Department, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mengting Yang
- Evidence-based Pharmacy Centre/Pharmacy Department, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Lijiao Yan
- Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Lise M Helsingen
- Clinical Effectiveness Research, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Michael Bretthauer
- Clinical Effectiveness Research, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division General Internal Medicine & Division of Clinical Epidemiology, University Hospital of Geneva, Geneva, Switzerland
| | - Per O Vandvik
- Department of Medicine, Lovisenberg Hospital Trust, Oslo, Norway
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jason Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Reed A C Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lingli Zhang
- Evidence-based Pharmacy Centre/Pharmacy Department, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | | | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Zeng L, Helsingen LM, Bretthauer M, Agoritsas T, Vandvik PO, Mustafa RA, Busse J, Siemieniuk RAC, Lytvyn L, Li SA, Yang M, Yan L, Zhang L, Brignardello-Petersen R, Guyatt GH. A novel framework for incorporating patient values and preferences in making guideline recommendations: guideline panel surveys. J Clin Epidemiol 2023; 161:164-172. [PMID: 37453455 DOI: 10.1016/j.jclinepi.2023.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/13/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Universally acknowledged standards for trustworthy guidelines include the necessity to ground recommendations in patient values and preferences. When information is limited-which is typically the case-guideline panels often find it difficult to explicitly integrate patient values and preferences into their recommendations. Our objective was to develop and evaluate a framework for systematically navigating guideline panels in incorporating patient values and preferences in making recommendations. STUDY DESIGN AND SETTING In the context of developing a guideline for colorectal cancer screening, we generated an initial framework for creating panel surveys to elicit guideline panelists' views of patient values and preferences and to inform panel discussions on recommendations. With further applications in guidelines of diverse topic areas, we dynamically refined the framework through iterative discussions and consensus. RESULTS The finial framework consists of five steps for creating and implementing panel surveys. The surveys can serve three objectives following from the quantitative information regarding patient values and preferences that guideline panels usually require. An accompanying video provides detailed instructions of the survey. CONCLUSION The framework for creating and implementing panel surveys offers explicit guidance for guideline panels considering transparently and systematically incorporating patient values and preferences into guideline recommendations.
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Affiliation(s)
- Linan Zeng
- Evidence-based Pharmacy Centre/Pharmacy Department, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Lise M Helsingen
- Clinical Effectiveness Research, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Michael Bretthauer
- Clinical Effectiveness Research, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division General Internal Medicine & Division of Clinical Epidemiology, University Hospital of Geneva, Geneva, Switzerland
| | - Per O Vandvik
- Department of Medicine, Lovisenberg Hospital Trust, Oslo, Norway
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jason Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Reed A C Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mengting Yang
- Evidence-based Pharmacy Centre/Pharmacy Department, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Lijiao Yan
- Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Lingli Zhang
- Evidence-based Pharmacy Centre/Pharmacy Department, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | | | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Janssens R, Barbier L, Muller M, Cleemput I, Stoeckert I, Whichello C, Levitan B, Hammad TA, Girvalaki C, Ventura JJ, Bywall KS, Pinto CA, Schoefs E, Katz EG, Kihlbom U, Huys I. How can patient preferences be used and communicated in the regulatory evaluation of medicinal products? Findings and recommendations from IMI PREFER and call to action. Front Pharmacol 2023; 14:1192770. [PMID: 37663265 PMCID: PMC10468983 DOI: 10.3389/fphar.2023.1192770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/12/2023] [Indexed: 09/05/2023] Open
Abstract
Objective: Patients have unique insights and are (in-)directly affected by each decision taken throughout the life cycle of medicinal products. Patient preference studies (PPS) assess what matters most to patients, how much, and what trade-offs patients are willing to make. IMI PREFER was a six-year European public-private partnership under the Innovative Medicines Initiative that developed recommendations on how to assess and use PPS in medical product decision-making, including in the regulatory evaluation of medicinal products. This paper aims to summarize findings and recommendations from IMI PREFER regarding i) PPS applications in regulatory evaluation, ii) when and how to consult with regulators on PPS, iii) how to reflect PPS in regulatory communication and iv) barriers and open questions for PPS in regulatory decision-making. Methods: PREFER performed six literature reviews, 143 interviews and eight focus group discussions with regulators, patient representatives, industry representatives, Health Technology Assessment bodies, payers, academics, and clincians between October 2016 and May 2022. Results: i) With respect to PPS applications, prior to the conduct of clinical trials of medicinal products, PPS could inform regulators' understanding of patients' unmet needs and relevant endpoints during horizon scanning activities and scientific advice. During the evaluation of a marketing authorization application, PPS could inform: a) the assessment of whether a product meets an unmet need, b) whether patient-relevant clinical trial endpoints and outcomes were studied, c) the understanding of patient-relevant effect sizes and acceptable trade-offs, and d) the identification of key (un-)favorable effects and uncertainties. ii) With respect to consulting with regulators on PPS, PPS researchers should ideally have early discussions with regulators (e.g., during scientific advice) on the PPS design and research questions. iii) Regarding external PPS communication, PPS could be reflected in the assessment report and product information (e.g., the European Public Assessment Report and the Summary of Product Characteristics). iv) Barriers relevant to the use of PPS in regulatory evaluation include a lack of PPS use cases and demonstrated impact on regulatory decision-making, and need for (financial) incentives, guidance and quality criteria for implementing PPS results in regulatory decision-making. Open questions concerning regulatory PPS use include: a) should a product independent broad approach to the design of PPS be taken and/or a product-specific one, b) who should optimally be financing, designing, conducting, and coordinating PPS, c) when (within and/or outside clinical trials) to perform PPS, and d) how can PPS use best be operationalized in regulatory decisions. Conclusion: PPS have high potential to inform regulators on key unmet needs, endpoints, benefits, and risks that matter most to patients and their acceptable trade-offs. Regulatory guidelines, templates and checklists, together with incentives are needed to foster structural and transparent PPS submission and evaluation in regulatory decision-making. More PPS case studies should be conducted and submitted for regulatory assessment to enable regulatory discussion and increase regulators' experience with PPS implementation and communication in regulatory evaluations.
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Affiliation(s)
- Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Liese Barbier
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Irina Cleemput
- Belgian Healthcare Knowledge Centre (KCE), Brussels, Belgium
| | | | | | - Bennett Levitan
- Global Epidemiology, Janssen R&D, LLC, Pennsylvania, PA, United States
| | | | | | | | - Karin Schölin Bywall
- School of Health, Care and Social Welfare, Division of Health and Welfare Technology, Mälardalen University, Västerås, Sweden
- Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | | | - Elise Schoefs
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Eva G. Katz
- Janssen Global Services, LLC, Raritan, NJ, United States
| | - Ulrik Kihlbom
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Liu Y, Su M, Lei Y, Tian J, Xue L, Zhang L. Patient Preferences for Cardiac Rehabilitation - A Systematic Review. Patient Prefer Adherence 2023; 17:75-88. [PMID: 36636288 PMCID: PMC9831083 DOI: 10.2147/ppa.s392417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/30/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although a large number of studies have demonstrated the effectiveness of cardiac rehabilitation(CR), patient preferences for CR remain unclear. Knowing patient preferences may contribute to increasing patient participation and adherence, thus improving patient prognosis. METHODS A systematic search was carried out using electronic databases and manual reference checks from inception until 15th June 2022. Quantitative studies, qualitative studies and mixed methods studies assessing patient preferences for CR were included. Two researchers independently conducted study selectionand data extraction. CR preferences were divided into three categories: CR settings, CR components, and CR contents. A narrative synthesis was applied to integrate the results of the included studies. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of included studies. RESULTS Ultimately, 17 publications were included in this study. Regarding CR settings, most patients preferred the hospital to home, some considered both, and a few were willing to accept the local CR club as an alternative setting to the hospital. For CR components, regardless of age and gender, patients considered exercise training and nutrition counseling to be the most important and smoking cessation to be the least important. In exercise intervention of CR contents, progress discussion and encouragement were rated as most critical, and non-conflicting with other activities was rated as least critical. In psychological intervention of CR contents, most patients were willing to accept psychological intervention, and a few patients wanted to heal the trauma with the passage of time. CONCLUSION This systematic review provides important insights into patient preferences for CR, clarifying patient preferences for CR settings, components, and contents, along with possible influencing factors. Patient preferences may change due to the COVID-19 epidemic, and there is still a need to focus on patient preferences for CR and conduct more relevant primary research to validate the findings of this paper in the future.
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Affiliation(s)
- Yunyue Liu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Mengyu Su
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Yang Lei
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
- Correspondence: Yang Lei, School of Nursing, Nanjing Medical University, No. 101, Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province, People’s Republic of China, Tel +86 19955062997, Fax +86 258 6869 555, Email
| | - Jinping Tian
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
- Department of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
- Jinping Tian, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, People’s Republic of China, Tel +86 13851550156, Fax +86 519 6809 1881, Email
| | - Leng Xue
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Lin Zhang
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
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Rincon-Gonzalez L, Selig WKD, Hauber B, Reed SD, Tarver ME, Chaudhuri SE, Lo AW, Bruhn-Ding D, Liden B. Leveraging Patient Preference Information in Medical Device Clinical Trial Design. Ther Innov Regul Sci 2023; 57:152-159. [PMID: 36030334 PMCID: PMC9755102 DOI: 10.1007/s43441-022-00450-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/12/2022] [Indexed: 02/01/2023]
Abstract
Use of robust, quantitative tools to measure patient perspectives within product development and regulatory review processes offers the opportunity for medical device researchers, regulators, and other stakeholders to evaluate what matters most to patients and support the development of products that can best meet patient needs. The medical device innovation consortium (MDIC) undertook a series of projects, including multiple case studies and expert consultations, to identify approaches for utilizing patient preference information (PPI) to inform clinical trial design in the US regulatory context. Based on these activities, this paper offers a cogent review of considerations and opportunities for researchers seeking to leverage PPI within their clinical trial development programs and highlights future directions to enhance this field. This paper also discusses various approaches for maximizing stakeholder engagement in the process of incorporating PPI into the study design, including identifying novel endpoints and statistical considerations, crosswalking between attributes and endpoints, and applying findings to the population under study. These strategies can help researchers ensure that clinical trials are designed to generate evidence that is useful to decision makers and captures what matters most to patients.
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Affiliation(s)
- Liliana Rincon-Gonzalez
- Medical Device Innovation Consortium, 1655 N Ft. Myer Drive, 12th Floor, Arlington, VA 22209 USA
| | | | - Brett Hauber
- Pfizer, New York, NY USA ,CHOICE Institute, University of Washington School of Pharmacy, Seattle, WA USA
| | - Shelby D. Reed
- Duke Clinical Research Institute, Duke University, Durham, NC USA
| | - Michelle E. Tarver
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, MD USA
| | | | - Andrew W. Lo
- Laboratory for Financial Engineering Department of Electrical, Engineering and Computer Science Sloan School of Management; and Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA USA ,Santa Fe Institute, Santa Fe, NM USA
| | | | - Barry Liden
- USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA USA
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Huls SPI, de Bekker-Grob EW. Can healthcare choice be predicted using stated preference data? The role of model complexity in a discrete choice experiment about colorectal cancer screening. Soc Sci Med 2022; 315:115530. [PMID: 36434890 DOI: 10.1016/j.socscimed.2022.115530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/17/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The validity of discrete choice experiments (DCEs) is crucial to its usage in healthcare decision-making, but there is only a limited number of health contexts in which external validity is demonstrated. This study aims to assess the internal and external validity of the DCE in the context of colorectal cancer (CRC) screening, and gather insights into the discrepancy between stated and revealed preferences. METHODS Stated and revealed preferences were elicited on an individual level from Dutch residents eligible for CRC screening in a DCE and a field experiment, respectively (N = 568). To identify the determinants of CRC screening participation and their relative importance, five random utility maximisation models that varied in complexity were used. We assessed the accuracy with which the models based on stated preferences predict individual-level screening choice in a holdout task (internal validity) and in the actual screening choice (external validity). Insights into the discrepancy between stated and revealed preferences were gathered by comparing groups of respondents. RESULTS Our findings show high internal and external validity. Choices could be accurately predicted for 95% of the respondents in the holdout task, and 90% in the actual screening choice. When scale and preference heterogeneity were taken into account model fit improved; individual-level prediction accuracy slightly increased for the holdout task but not for the actual screening choice. Respondents for whom stated preferences matched revealed preferences were generally in better health and found the GP's support for their screening decision more important. DISCUSSION Evidence was found that revealed preferences can be predicted accurately on an individual level. Incorporating heterogeneity improved internal validity but not external validity. Differences between stated and revealed preferences can be attributed to respondents' health and the support of their GP. We suggest researchers to continue investigating the internal and external validity of discrete choice experiments, and the role of model complexity.
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Affiliation(s)
- Samare P I Huls
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, the Netherlands.
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, the Netherlands
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Zhang M, He X, Wu J, Wang X, Jiang Q, Xie F. How Do Treatment Preferences of Patients With Cancer Compare With Those of Oncologists and Family Members? Evidence From a Discrete Choice Experiment in China. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1768-1777. [PMID: 35710892 DOI: 10.1016/j.jval.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/29/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to compare the treatment preference among oncologists, patients with lung cancer, and their family members in China. METHODS A face-to-face discrete choice experiment survey was conducted among oncologists, patients, and their family members. Participants completed 13 choice sets describing 6 key attributes, namely, overall survival time, risk of severe adverse effect, severity of pain, appetite, physical functioning status, and monthly cost. Mixed logit model and latent class analysis were used to estimate attribute level preference weights and the relative importance (RI) for attributes. The willingness to pay (WTP) and maximum acceptable risk (MAR) were also estimated. The RI, WTP, and MAR of oncologists, patients, and family members were compared. RESULTS A total of 121 oncologists and 161 dyads of patients and family members completed the survey. Overall survival time, physical functioning status, and pain were the 3 most important attributes across all 3 groups. Oncologists and family members had higher RI on overall survival time than patients (48% and 51% vs 38%). Patients had higher RI on physical functioning status and pain (23% and 14%) than oncologists (13% and 12%) and family members (16% and 11%). For extending survival, patients had the least WTP, and family members had the highest MAR. The latent class analysis identified 2 classes in the patient group and 3 classes in oncologist and family member groups. CONCLUSIONS There were differences in preferences for survival, risk, quality of life, and costs associated with cancer treatments among patients, oncologists, and family members. This finding highlights the need of involving patients in treatment decision making in China.
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Affiliation(s)
- Mengqian Zhang
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China; Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China; Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China; Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Xinyue Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin, China; Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Qian Jiang
- Department of Clinical Pharmacy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact and Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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Fatehi A, Ring D, Reichel LM, Vagner GA. Psychosocial Factors Are Associated With Risk Acceptance in Upper Extremity Patients. Hand (N Y) 2022; 17:988-992. [PMID: 33356574 PMCID: PMC9465787 DOI: 10.1177/1558944720974123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients who help choose their health strategies are more adherent and achieve better health. An important role of the clinician is to verify that a patient's expressed preferences are consistent with what matters most to the patient and not muddled by common misconceptions about symptoms or conditions. Patient choices are influenced by estimation of the potential benefits and potential harms of a given intervention. One method for quantifying these estimations is the concept of maximum acceptable risk (MAR), or the maximum risk that subjects are willing to accept in exchange for a given therapeutic benefit. This study addressed the hypothesis that misconceptions due to unhelpful cognitive bias regarding pain are associated with risk acceptance among people seeking care for an upper extremity condition. METHODS We invited 140 new adult patients visiting an upper extremity specialist to complete a survey including demographics, pain intensity, depression and anxiety symptoms, catastrophic thinking, activity limitations, and MAR. Trauma or nontrauma diagnosis was obtained from the treating clinician and recorded by the research assistant. We used bivariate and linear regression analyses to identify factors associated with MAR among this population. RESULTS Accounting for potential confounding in multivariable analysis, higher MAR was associated with older age and greater catastrophic thinking. CONCLUSIONS Specialists can be aware that people with more unhelpful cognitive biases may be willing to take more risk. Vigilance for common misconceptions and gentle, incremental reorientation of those misconceptions can increase the probability that people will choose options consistent with what matters most to them.
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Crossnohere NL, Fischer R, Vroom E, Furlong P, Bridges JFP. A Comparison of Caregiver and Patient Preferences for Treating Duchenne Muscular Dystrophy. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:577-588. [PMID: 35243571 PMCID: PMC8894129 DOI: 10.1007/s40271-022-00574-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives Caregivers routinely inform medical and regulatory decision making in rare pediatric diseases. While differences in treatment preferences across caregivers and patients have been observed for Duchenne muscular dystrophy, this evidence was limited by small samples of patients and results were confounded by patient age and disease progression. We tested caregiver and patient preference concordance for treating Duchenne. Methods Preferences and demographic/clinical information from 115 caregivers and 107 patients were collected in an international study (response = 80%) using a previously developed discrete-choice experiment consisting of 12 experimentally controlled choice tasks. Each task presented two profiles that varied across four attributes: disease progression, drug failure probability, kidney damage risk, and fracture risk. Caregivers and patients were matched 1:1 based on patient age. We tested for concordance across each task and by comparing caregivers’ and patients’ maximum acceptable risk of drug failure, kidney damage, and fracture for a slowing of disease progression. Results The final analysis included 77 caregivers and 77 patients. No differences were observed in nationality (p = 0.969), disease stage (p = 0.180), or demographic/clinical factors (p = 0.093–0.857); however, patients were more optimistic (p = 0.030). Caregivers and patients chose similarly across tasks (p = 0.101–0.993). To slow disease progression by 1 year, caregivers and patients would tolerate a 9% and 11% increase in drug failure probability, respectively (p = 0.267). Alternatively, they would accept a 3% and 4% increase in the risk of kidney damage (p = 0.719) or a 15% and 20% increase in the risk of fracture (p = 0.534). Conclusions Caregivers and patients had concordant preferences for treating Duchenne. Providers and regulators can trust both caregiver and patient report of preferences to inform medical decision making. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-022-00574-y.
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Mansfield C, Bullok K, Fuhs JV, Tockhorn-Heidenreich A, Andrews JS, DiBenedetti D, Matthews BR, Darling JC, Sutphin J, Hauber B. The Patient Voice: Exploring Treatment Preferences in Participants with Mild Cognitive Concerns to Inform Regulatory Decision Making. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:551-564. [PMID: 35435572 PMCID: PMC9365745 DOI: 10.1007/s40271-022-00576-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/25/2022]
Abstract
Objective We aimed to assess the feasibility of developing a discrete-choice experiment survey to elicit preferences for a treatment to delay cognitive decline among people with a clinical syndrome consistent with early Alzheimer’s disease, including the development of self-reported screening criteria to recruit the sample. Methods Using input from qualitative interviews, we developed a discrete-choice experiment survey containing a multifaceted beneficial treatment attribute related to slowing cognitive decline for respondents with self-reported cognitive concerns. In two rounds of in-person pretest interviews, we tested and revised the survey text and discrete-choice experiment questions, including examples, language, and levels associated with the Alzheimer’s Disease Assessment Scale-Cognitive Subscale, along with a set of de novo self-reported questions for identifying respondents who had neither too mild nor too advanced cognitive decline. Self-reported memory and thinking problems were compared with symptoms from studies of patients with early Alzheimer’s disease (e.g., mild cognitive impairment, mild Alzheimer’s disease) to determine whether those studies’ recruited patients were similar to our anticipated target population. Round 1 pretest interviews resulted in significant simplifications in the survey instrument, revisions to the inclusion and exclusion criteria, and revisions to the screening process. In round 2 of the pretest interviews, the ability of participants to provide consistent responses to the self-reported screening questions was further assessed. In addition, to evaluate participants’ ability to understand and independently complete the discrete-choice experiment survey, two interviewers independently evaluated each participant’s ability to make trade-offs in the discrete-choice experiment questions and to understand the content of the survey. Results Round 1 (15 pretest interviews) identified challenges with the survey instrument related to the complexity of the choice questions. The screening process did not screen out seven respondents with more advanced cognitive decline, as determined qualitatively by the interviewers and by these participants’ inability to complete the survey. The survey instrument and screening criteria were revised, and an initial online screener was added to the screening process before round 2 pretests. In round 2 pretests, 12 participants reported cognitive problems similar to the target population for the survey but were judged able to understand and independently complete the discrete-choice experiment survey. Conclusions We developed self-reported screening criteria that identified a sample of individuals with memory and thinking concerns who were similar to individuals with clinical symptoms of early Alzheimer’s disease and who were able to independently complete a simplified discrete-choice experiment survey. Quantitative patient preference studies provide important information on patients’ willingness to trade off treatment benefits/risks. Adapting the technique for patients with cognitive decline requires careful testing and adjustments to survey instruments. This work suggests it is the severity of cognitive impairment, rather than its presence, that determines the ability to complete a simplified discrete-choice experiment survey. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-022-00576-w.
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Affiliation(s)
- Carol Mansfield
- Department of Health Preference Assessment, RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Kristin Bullok
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | | | | | - J Scott Andrews
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
- Takeda Pharmaceuticals, Cambridge, MA, USA
| | - Dana DiBenedetti
- Department of Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Brandy R Matthews
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Joshua C Darling
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
- Seagen Inc, Bothell, WA, USA
| | - Jessie Sutphin
- Department of Health Preference Assessment, RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Brett Hauber
- Department of Health Preference Assessment, RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
- Pfizer, Inc., and the Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, WA, USA
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Bergner A, Maier AD, Mirian C, Mathiesen TI. Adjuvant radiotherapy and stereotactic radiosurgery in grade 3 meningiomas - a systematic review and meta-analysis. Neurosurg Rev 2022; 45:2639-2658. [PMID: 35543810 DOI: 10.1007/s10143-022-01773-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/01/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
Malignant meningioma is a rare, aggressive form of meningioma. Radiation is commonly included in treatment guidelines either as adjuvant radiotherapy (RT) or stereotactic radiosurgery (SRS). Nevertheless, the treatment recommendations are not supported by prospective comparative trials and systematical, critical evaluation of supportive evidence is lacking. For this systematic review, studies analyzing the effectiveness of adjuvant RT and SRS in grade 3 (gr. 3) meningioma were reviewed. Thirty studies met the inclusion criteria for qualitative synthesis, and 6 studies were assessed in quantitative analysis. In quantitative analysis, the weighted average of hazard ratios for adjuvant RT in univariate analyses of overall survival (OS) was 0.55 (CI: 0.41; 0.69). The median 5-year OS after adjuvant RT in gr. 3 meningiomas was 56.3%, and the median OS ranged from 24 to 80 months for patients treated with adjuvant RT versus 13 to 41.2 months in patients not treated. For SRS, the 3-year progression free survival was 0% in one study and 57% in another. The 2-year OS ranged from 25 to 75% in 2 studies. The quality of evidence was rated as "very low" in 14 studies analyzed, and considerable allocation bias was detected. Treatment toxicity was reported in 47% of the studies. The severity, according to the CTCAE, ranged from grades I-V and 5.3 to 100% of patients experienced complications. Adjuvant RT is usually considered standard of care for WHO grade 3 meningiomas, although supporting evidence was of low quality. Better evidence from registries and prospective trials can improve the evidence base for adjuvant fractionated RT in malignant meningiomas.
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Affiliation(s)
- Amon Bergner
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Andrea Daniela Maier
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Christian Mirian
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tiit Illimar Mathiesen
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen, Denmark.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Fung LWY, Zhao J, Yan VKC, Blais JE, Chan JCH, Li STH, Shami JJP, Kwan C, Wei Y, Wong CKH, Li X, Chui CSL, Wan EYF, Lai FTT, Tse S, Cowling BJ, Wong ICK, Chan EW. COVID-19 Vaccination Preferences of University Students and Staff in Hong Kong. JAMA Netw Open 2022; 5:e2212681. [PMID: 35579895 PMCID: PMC9115609 DOI: 10.1001/jamanetworkopen.2022.12681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Importance COVID-19 has required universities to rapidly develop vaccination policies for students and staff, yet little is known about the preferences of these individuals toward vaccination. Objective To quantify student and staff preferences for COVID-19 vaccination at a university in Hong Kong. Design, Setting, and Participants A cross-sectional online survey study was conducted from July 20 to September 21, 2021, before the announcement of a campus-wide vaccine mandate. A survey of 42 451 eligible university students and staff used discrete-choice experiment methods to quantify 7 attributes of COVID-19 vaccination: risk of a mild or moderate adverse event after vaccination, risk of a severe adverse event after vaccination, efficacy against COVID-19 infection, efficacy against severe manifestation of COVID-19 infection, duration of protection after vaccination, incentive for completing vaccination, and out-of-pocket costs. Main Outcomes and Measures A mixed logit regression model was used to estimate the preferences of attributes for COVID-19 vaccines and marginal willingness to pay (mWTP) adjusted for background characteristics, role, vaccination, and COVID-19 infection status of family or friends, adverse event status after vaccination among family and friends of participants, and scenario block. Results Among 42 451 eligible university students and staff invited, 3423 individuals completed the survey (mean [SD] age, 27.1 [9.9] years; 2053 [60.0%] women). Participants included 2506 students (73.2%) and 917 staff (26.8%), with a response rate of 8.1%. Quarantine-free travel was preferred (β = 0.86; 95% CI, 0.72-0.99; mWTP: $235.9; 95% CI, $190.3-$294.2), followed by efficacy against any COVID-19 infection (β = 0.30; 95% CI, 0.29-0.32; mWTP: $84.1; 95% CI, $71.8-$100.8), against severe manifestation of COVID-19 infection (β = 0.25; 95% CI, 0.24-0.27; mWTP: $69.7; 95% CI, $465-$653), and risk of severe adverse events following vaccination (β = -0.24; 95% CI, -0.27 to -0.21; mWTP: -$66.8; 95% CI, -$81.5 to -$55.3). Participants were less concerned about protection duration (β = 0.17; 95% CI, 0.15-0.18; mWTP: $46.0; 95% CI, $38.6-$56.2) and risk of mild to moderate adverse events (β = -0.12; 95% CI, -0.13 to -0.10; mWTP: -$32.7; 95% CI, -$41.2 to -$26.4). Conclusions and Relevance Preference of all attributes were significant and were considered important by the participants for vaccine decision-making. Insights drawn could assist policy makers in future vaccination decisions, such as campus vaccine mandate and requirement of a third dose.
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Affiliation(s)
- Lydia W. Y. Fung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - Jiaxi Zhao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Digital and Data Innovation, AstraZeneca Global R&D (China) Co Ltd, Shanghai, China
| | - Vincent K. C. Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Joseph E. Blais
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jacky C. H. Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Silvia T. H. Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jessica J. P. Shami
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Christine Kwan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong SAR, China
| | - Yue Wei
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos K. H. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Celine S. L. Chui
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Y. F. Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Francisco T. T. Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - Samson Tse
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Benjamin J. Cowling
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C. K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Research Department of Practice and Policy, University College London, London, United Kingdom
| | - Esther W. Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
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Partnering with Patients in Clinical Trials of Pain Treatments. Pain 2022; 163:1862-1873. [DOI: 10.1097/j.pain.0000000000002600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022]
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Marsh K, Ho KA, Lo R, Zaour N, George AT, Cook NS. Assessing Patient Preferences in Rare Diseases: Direct Preference Elicitation in the Rare Chronic Kidney Disease, Immunoglobulin A Nephropathy. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2021; 14:837-847. [PMID: 34008165 PMCID: PMC8131174 DOI: 10.1007/s40271-021-00521-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/06/2022]
Abstract
Background Patient preference information is increasingly being used to inform decision making; however, further work is required to support the collection of preference information in rare diseases. This study illustrates the use of direct preference elicitation methods to collect preference data from small samples in the context of early decision making to inform the development of a product for the treatment of immunoglobulin A nephropathy. Method An interview-based swing weighting approach was used to elicit preferences from 40 patients in the US and China. Attributes were identified through a background review, expert engagement and patient focus groups. Participants completed a series of tasks that involved ranking, rating and scoring improvements in the attributes to obtain attribute swing weights and partial value functions. The preference results were then incorporated into a benefit-risk assessment simulation tool. Results Participants placed the greatest value on avoiding end-stage renal/kidney disease. Similar weight was given to short-term quality-of-life improvements and avoiding infections. Treatment burden (number of vaccinations) received the least weight. Heterogeneity in preferences was also observed. Consistency tests did not identify statistically significant variation in preferences, and qualitative data suggested that the elicitation exercise was sensitive to participants’ interpretation of attributes and that participants were able to express their preferences. Conclusion Direct preference elicitation methods can be used to collect preference data from small samples. Further work should continue to test the validity of the estimate generated by such methods. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00521-3.
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Szinay D, Cameron R, Naughton F, Whitty JA, Brown J, Jones A. Understanding Uptake of Digital Health Products: Methodology Tutorial for a Discrete Choice Experiment Using the Bayesian Efficient Design. J Med Internet Res 2021; 23:e32365. [PMID: 34633290 PMCID: PMC8546533 DOI: 10.2196/32365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/24/2021] [Accepted: 09/18/2021] [Indexed: 02/06/2023] Open
Abstract
Understanding the preferences of potential users of digital health products is beneficial for digital health policy and planning. Stated preference methods could help elicit individuals' preferences in the absence of observational data. A discrete choice experiment (DCE) is a commonly used stated preference method-a quantitative methodology that argues that individuals make trade-offs when engaging in a decision by choosing an alternative of a product or a service that offers the greatest utility, or benefit. This methodology is widely used in health economics in situations in which revealed preferences are difficult to collect but is much less used in the field of digital health. This paper outlines the stages involved in developing a DCE. As a case study, it uses the application of a DCE to reveal preferences in targeting the uptake of smoking cessation apps. It describes the establishment of attributes, the construction of choice tasks of 2 or more alternatives, and the development of the experimental design. This tutorial offers a guide for researchers with no prior knowledge of this research technique.
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Affiliation(s)
- Dorothy Szinay
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Rory Cameron
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- National Institute for Health Research, Applied Research Collaboration East of England, Cambridge, United Kingdom
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Jennifer A Whitty
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- National Institute for Health Research, Applied Research Collaboration East of England, Cambridge, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Andy Jones
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Tsai JH, Crossnohere NL, Strong T, Bridges JFP. Measuring Meaningful Benefit-Risk Tradeoffs to Promote Patient-Focused Drug Development in Prader-Willi Syndrome: A Discrete-Choice Experiment. MDM Policy Pract 2021; 6:23814683211039457. [PMID: 34497876 PMCID: PMC8419554 DOI: 10.1177/23814683211039457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 06/28/2021] [Indexed: 01/06/2023] Open
Abstract
Background. Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder causing quality of life impairments such as insatiable hunger (hyperphagia) and obesity. We explored caregivers’ willingness to assume treatment risk in exchange for reduced hyperphagia according to a PWS-validated observer-reported outcome measure. Methods. We partnered with PWS patient organizations to develop a discrete-choice experiment exploring caregivers’ benefit-risk tradeoffs for emerging PWS treatments. The treatment benefit was a reduction in hyperphagia (as measured by a 0-, 5-, or 10-point change on the Hyperphagia Questionnaire for Clinical Trials [HQ-CT]). Treatment risks included weight gain (none, 5%, 10%), added risk of skin rash (none, 10%, 20%), and risk of liver damage (none, 1 in 1000, 10 in 1000). Preference models were estimated using mixed logistic regression and maximum acceptable risk. We explored differences in preferences across familial caregivers of patients with and without hyperphagia. Results. Four hundred sixty-eight caregivers completed the online survey. The majority of caregivers reported that patients experienced hyperphagia (68%) and half of patients experienced obesity (52%). Caregivers of patients without hyperphagia were willing to accept greater weight gain (16.4% v. 8.1%, P = 0.004) and a higher risk of skin rash (11.7% v. 6.2% P = 0.008) as compared to caregivers of patients with hyperphagia. Caregivers of patients with hyperphagia would accept a higher risk of liver damage as compared to caregivers of patients without hyperphagia (11.9 out of 1000 v. 6.4 out of 1000, P = 0.04). Conclusions. This research demonstrates that caregivers are willing to accept risk in exchange for a five-point improvement on the HQ-CT, a smaller marginal improvement than had been previously classified as meaningful. Patient experience with hyperphagia is a modifier in how much risk caregivers will accept.
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Affiliation(s)
| | - Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Theresa Strong
- Foundation for Prader-Willi Research, Walnut, California
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
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Jimenez-Moreno AC, van Overbeeke E, Pinto CA, Smith I, Sharpe J, Ormrod J, Whichello C, de Bekker-Grob EW, Bullok K, Levitan B, Huys I, de Wit GA, Gorman G. Patient Preferences in Rare Diseases: A Qualitative Study in Neuromuscular Disorders to Inform a Quantitative Preference Study. THE PATIENT 2021; 14:601-612. [PMID: 33660162 PMCID: PMC8357717 DOI: 10.1007/s40271-020-00482-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION It has become increasingly important to include patient preference information in decision-making processes for drug development. As neuromuscular disorders represent multisystem, debilitating, and progressive rare diseases with few treatment options, this study aimed to explore unmet health care needs and patient treatment preferences for two neuromuscular disorders, myotonic dystrophy type 1 (DM1) and mitochondrial myopathies (MM) to inform early stages of drug development. METHODS Fifteen semi-structured interviews and five focus group discussions (FGDs) were held with DM1 and MM adult patients and caregivers. Topics discussed included (1) reasons for study participation; (2) disease signs/symptoms and their impact on daily lives; (3) top desired benefits; and (4) acceptability of risks and tolerance levels for a hypothetical new treatment. Data were analyzed following a thematic 'code' approach. RESULTS A total of 52 participants representing a wide range of disease severities participated. 'Muscle strength' and 'energy and endurance' were the disease-related unmet needs most often mentioned. Additionally, improved 'balance', 'cognition' and 'gut function' were the top desired treatment benefits, while 'damage to the liver, kidneys or eyes' was the most concerning risk. Factors influencing their tolerance to risks related to previously having experienced the risk and differentiation between permanent and temporary risks. A few differences were elicited between patients and caregivers. CONCLUSIONS This qualitative study provided an open forum to elicit treatment-desired benefits and acceptable risks to be established by patients themselves. These findings can inform decisions for developing new treatments and the design of clinical trials for DM1 and MM.
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Affiliation(s)
- A Cecilia Jimenez-Moreno
- Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK.
- Evidera, London, UK.
| | - Eline van Overbeeke
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Leuven, Belgium
| | - Cathy Anne Pinto
- Pharmacoepidemiology Department, Center for Observational and Real-world Evidence, Merck & Co, Inc., Rahway, NJ, USA
| | - Ian Smith
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - James Ormrod
- School of Applied Social Science, University of Brighton, East Sussex, UK
| | - Chiara Whichello
- Erasmus School of Health Policy and Management, and Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, The Netherlands
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy and Management, and Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, The Netherlands
| | - Kristin Bullok
- Global Patient Safety Department, Eli Lilly & Co., Indianapolis, IN, USA
| | | | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Leuven, Belgium
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Grainne Gorman
- Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK
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21
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Gonzalez JM, Boeri M. The Impact of the Risk Functional Form Assumptions on Maximum Acceptable Risk Measures. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 14:827-836. [PMID: 33961275 DOI: 10.1007/s40271-021-00518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Discrete-choice experiments (DCEs) are increasingly conducted to quantify risk tolerance by computing maximum acceptable risk (MAR) for improvements in efficacy or other benefits gained from new medical treatments. To compute MARs from DCE data, respondents are asked to make choices under uncertainty between treatments. Specific treatment-related harms are included in the choice questions as probabilistic adverse events (AEs), and choice variation with the probability of these outcomes is assumed to indicate their effect on the expected utility of treatments. With a limited number of comparisons between profiles, calculation of MARs requires understanding how outcome probabilities that are not explicitly considered in the DCE can change the value of medical technologies. This study aims to examine how various assumptions on the expected disutility of these excluded probabilities can result in different MAR measures. METHODS We summarize commonly used empirical specifications for the expected disutility of AEs and derive the resulting MAR functions. We then discuss an empirical application on treatments to delay bone metastases in oncology patients with solid tumors. RESULTS A total of 187 respondents completed the DCE. Results show the impact of making various assumptions about the expected disutility of AEs, and the resulting MAR values for specific health benefits. As expected, different assumptions resulted in variations in MAR values for specific health benefits. Even with small differences in MAR measures, our results suggest that the assumptions evaluated here can lead to different conclusions about the acceptability of a medical technology. CONCLUSION Results show possible systematic variations in MARs caused by the assumed form of the effect of changes in the probability of AEs. Furthermore, we find that different assumptions can lead to different conclusions about the acceptability of a medical technology, even when MAR distributions overlap. This result suggests that researchers should evaluate the assumptions they are making for these effects and use sensitivity analysis to evaluate the robustness of risk-tolerance measures from stated-preference data.
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22
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Methodological Priorities for Patient Preferences Research: Stakeholder Input to the PREFER Public-Private Project. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 14:449-453. [PMID: 33721265 PMCID: PMC8357654 DOI: 10.1007/s40271-021-00502-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 11/05/2022]
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Hollin IL, Janssen E, Kelley MA, Bridges JFP. Do people have differing motivations for participating in a stated-preference study? Results from a latent-class analysis. BMC Med Inform Decis Mak 2021; 21:44. [PMID: 33549068 PMCID: PMC7868025 DOI: 10.1186/s12911-021-01412-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Researchers and policy makers have long suspected that people have differing, and potentially nefarious, motivations for participating in stated-preference studies such as discrete-choice experiments (DCE). While anecdotes and theories exist on why people participate in surveys, there is a paucity of evidence exploring variation in preferences for participating in stated-preference studies. METHODS We used a DCE to estimate preferences for participating in preference research among an online survey panel sample. Preferences for the characteristics of a study to be conducted at a local hospital were assessed across five attributes (validity, relevance, bias, burden, time and payment) and described across three levels using a starring system. A D-efficient experimental design was used to construct three blocks of 12 choice tasks with two profiles each. Respondents were also asked about factors that motivated their choices. Mixed logistic regression was used to analyze the aggregate sample and latent class analysis identified segments of respondents. RESULTS 629 respondents completed the experiment. In aggregate "study validity" was most important. Latent class results identified two segments based on underlying motivations: a quality-focused segment (76%) who focused most on validity, relevance, and bias and a convenience-focused segment (24%) who focused most on reimbursement and time. Quality-focused respondents spent more time completing the survey (p < 0.001) and were more likely to identify data quality (p < 0.01) and societal well-being (p < 0.01) as motivations to participate. CONCLUSIONS This information can be used to better understand variability in motivations to participate in stated-preference surveys and the impact of motivations on response quality.
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Affiliation(s)
- Ilene L Hollin
- Department of Health Services Administration and Policy, Temple University College of Public Health, Ritter Annex, 1301 Cecil B. Moore Ave Rm. 537, Philadelphia, PA, 19122, USA.
| | - Ellen Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marcella A Kelley
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Hauber B, Mange B, Zhou M, Chaudhuri S, Benz HL, Caldwell B, Ruiz JP, Saha A, Ho M, Christopher S, Bardot D, Sheehan M, Donnelly A, McLaughlin L, Gwinn K, Lo A, Sheldon M. Parkinson's Patients' Tolerance for Risk and Willingness to Wait for Potential Benefits of Novel Neurostimulation Devices: A Patient-Centered Threshold Technique Study. MDM Policy Pract 2021; 6:2381468320978407. [PMID: 33521289 PMCID: PMC7818008 DOI: 10.1177/2381468320978407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background. Parkinson’s disease (PD) is neurodegenerative, causing
motor, cognitive, psychological, somatic, and autonomic symptoms. Understanding
PD patients’ preferences for novel neurostimulation devices may help ensure that
devices are delivered in a timely manner with the appropriate level of evidence.
Our objective was to elicit preferences and willingness-to-wait for novel
neurostimulation devices among PD patients to inform a model of optimal trial
design. Methods. We developed and administered a survey to PD
patients to quantify the maximum levels of risks that patients would accept to
achieve potential benefits of a neurostimulation device. Threshold technique was
used to quantify patients’ risk thresholds for new or worsening depression or
anxiety, brain bleed, or death in exchange for improvements in “on-time,” motor
symptoms, pain, cognition, and pill burden. The survey elicited patients’
willingness to wait to receive treatment benefit. Patients were recruited
through Fox Insight, an online PD observational study. Results. A
total of 2740 patients were included and a majority were White (94.6%) and had a
4-year college degree (69.8%). Risk thresholds increased as benefits increased.
Threshold for depression or anxiety was substantially higher than threshold for
brain bleed or death. Patient age, ambulation, and prior neurostimulation
experience influenced risk tolerance. Patients were willing to wait an average
of 4 to 13 years for devices that provide different levels of benefit.
Conclusions. PD patients are willing to accept substantial
risks to improve symptoms. Preferences are heterogeneous and depend on treatment
benefit and patient characteristics. The results of this study may be useful in
informing review of device applications and other regulatory decisions and will
be input into a model of optimal trial design for neurostimulation devices.
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Affiliation(s)
- Brett Hauber
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Brennan Mange
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Mo Zhou
- FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | | | - Heather L Benz
- FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - Brittany Caldwell
- FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - John P Ruiz
- FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - Anindita Saha
- FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - Martin Ho
- FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | | | - Dawn Bardot
- Medical Device Innovation Consortium, Arlington, Virginia
| | - Margaret Sheehan
- The Michael J. Fox Foundation for Parkinson's Research, Patient Council, New York, New York
| | - Anne Donnelly
- The Michael J. Fox Foundation for Parkinson's Research, Patient Council, New York, New York
| | - Lauren McLaughlin
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Katrina Gwinn
- FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - Andrew Lo
- MIT Sloan School of Management, Cambridge, Massachusetts
| | - Murray Sheldon
- FDA Center for Devices and Radiological Health, Silver Spring, Maryland
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Morphett K, Hall W, Gartner C. The Misuse of the Precautionary Principle in Justifying Australia's Ban on the Sale of Nicotine Vaping Products. Nicotine Tob Res 2021; 23:14-20. [PMID: 32909044 DOI: 10.1093/ntr/ntaa173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/06/2020] [Indexed: 01/21/2023]
Abstract
In Australia, the precautionary principle has been used to justify an effective sales ban on nicotine vaping products (NVPs) by requiring all NVPs to be approved as medicines. Australia's policy is out of step with other English-speaking countries, which allow the sale of NVPs as consumer products. We provide a brief history of the precautionary principle, discuss guidelines on how it should be used, and examine key documents from Australian policy debates to describe how the precautionary principle has been misapplied in justifying Australian NVP policy. We argue that the precautionary principle has been inappropriately applied to NVP regulation in Australia in that it has: failed to consider the regulation of similar products, imposed regulations that are disproportionate to the level of risk, failed to assess the costs of its regulatory approach, and failed to undertake a cost/benefit analysis of a range of available regulatory options. Australian policy illustrates the risks of regulating nicotine products in isolation rather than considering NVPs as falling on a continuum of harmful nicotine products. Implications: The precautionary principle has been misapplied to NVP regulation in Australia. We recommend that the precautionary principle be used in a way that regulates nicotine products in proportion to their risks.
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Affiliation(s)
- Kylie Morphett
- Faculty of Medicine, School of Public Health, The University of Queensland, St Lucia, Australia
| | - Wayne Hall
- Faculty of Health and Behavioural Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, St Lucia, Australia.,National Addiction Centre, King's College London, London, UK
| | - Coral Gartner
- Faculty of Medicine, School of Public Health, The University of Queensland, St Lucia, Australia
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Beusterien K, Maculaitis MC, Hallissey B, Gaschler MM, Smith ML, Law EH. Patient, Oncologist, and Payer Preferences for Adjuvant Endocrine Therapy and CDK4/6 Inhibitor Regimens in Early-Stage Breast Cancer: A Discrete Choice Experiment. Patient Prefer Adherence 2021; 15:611-623. [PMID: 33776424 PMCID: PMC7987325 DOI: 10.2147/ppa.s298670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/06/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Several adjuvant phase III trials are evaluating cyclin-dependent kinase 4/6 inhibitors (CDK4/6is) in combination with endocrine therapy (ET) in hormonal receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2-) early-stage breast cancer (eBC). This study examines preferences for this combination regimen and ET alone among patients, oncologists, and payers in the United States. METHODS A web-based questionnaire, including a discrete choice experiment (DCE), was administered to patients, practicing oncologists, and payers. In the DCE, respondents selected between hypothetical treatment profiles with attributes associated with ET monotherapy and CDK4/6i + ET regimens. Each treatment alternative was defined by the following attributes: 5-year invasive disease-free survival (iDFS), nausea, diarrhea, neutropenia, alopecia, dosing schedule, and electrocardiogram (ECG) monitoring. Payers had the additional attribute of annual per-patient treatment cost. Hierarchical Bayesian models were used to estimate relative preference weights for each attribute-level and relative attribute importance. RESULTS For patients (n=300) and oncologists (n=200), iDFS was most important (2 to 3 times more important than the next most important attribute), followed by neutropenia and diarrhea risks for patients and oncologists, respectively. Patients and oncologists required an improvement in iDFS of 8.0 and 5.6 percentage-points, respectively, to accept an increase in diarrhea risk from 11% to 81%. Payers (n=60) viewed annual per-patient cost as most important for treatment access decision-making, closely followed by iDFS. Payers required an improvement in iDFS of 21.8 percentage-points to accept an increase in cost from $5,100 to $149,400. Across all stakeholder groups, dosing schedule, alopecia risk, and ECG monitoring were perceived as least important. CONCLUSION Patients, oncologists, and payers expect a large absolute risk reduction in efficacy to offset the potential risks and costs of adding a CDK4/6i to current standard of care. An open discussion between all stakeholders is necessary to ensure that decision-making, whether at patient- or system-level, is informed by preferences for novel treatments, like CDK4/6is.
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Affiliation(s)
| | | | | | | | | | - Ernest H Law
- Pfizer Oncology, Pfizer Inc, New York, NY, USA
- Correspondence: Ernest H Law Global Health Economics & Outcomes Research (Breast) Oncology, Patient & Health Impact, Pfizer Inc., 235 E 42nd Street (Office: 219/06/86), New York, NY, 10017, USATel +1 212 733-0785 Email
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Katoch D, Krishnamurti L. Assessing Patient Preferences for Treatment Options for Pediatric Sickle Cell Disease: A Critical Review of Quantitative and Qualitative Studies. Patient Prefer Adherence 2021; 15:2221-2229. [PMID: 34629865 PMCID: PMC8493010 DOI: 10.2147/ppa.s264918] [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: 05/21/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022] Open
Abstract
Sickle cell disease (SCD) resulting from a mutation of the β-globin gene results in sickle deformation of the red blood cell with consequent vaso-occlusion and intravascular hemolysis. SCD results in substantial morbidity, with impaired quality of life and premature mortality. Comprehensive and supportive care, disease modifying therapies and treatments with curative intent are each associated with asymmetrical costs, burden of care, and impact on survival and quality of life. There is thus a considerable decisional dilemma regarding treatment among patients and caregivers. The objective of this review is to evaluate the literature regarding quantitative and qualitative studies of patient preferences in therapy for SCD. Numerous survey-based studies have been performed evaluating SCD patients' treatment preferences. These studies are limited, however, as they are purely descriptive in nature with limited quantitative information on the relative value of treatment alternatives. Time trade-off and standard gamble studies and health state utility studies have also been utilized to quantify patient utility especially for curative hematopoietic cell transplant. However, these studies suffer from inaccurate assumptions regarding patient preferences. Qualitative studies have garnered the patient and caregiver perspective. Qualitative studies may be limited by selective and purposive sampling, and lack of representativeness due to sample size.
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Affiliation(s)
- Deeksha Katoch
- Department of Pediatrics, SUNY Downstate Medical Center, New York, NY, USA
| | - Lakshmanan Krishnamurti
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Correspondence: Lakshmanan Krishnamurti Aflac Cancer and Blood Disorders Centers, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA Email
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Vina ER, Quinones C. Understanding the Role and Challenges of Patient Preferences in Disparities in Rheumatologic Disease Care. Rheum Dis Clin North Am 2020; 47:83-96. [PMID: 34042056 DOI: 10.1016/j.rdc.2020.09.003] [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: 11/27/2022]
Abstract
Evidence suggests patient preferences, including values and perspectives, have affected clinical outcomes, such as compliance, patient well-being, and satisfaction with care. A literature review was conducted with the purpose of exploring the tools used to elicit patients' treatment preferences and their roles in clinical outcomes. This review revealed racial differences in treatment preferences among patients with rheumatic and musculoskeletal diseases. The use of decision aids is a proactive intervention with potential for reducing race disparities and improving clinical outcomes. The utilization of patient preferences and values can improve outcomes by complementing the shared decision-making approach between patients and rheumatologists.
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Affiliation(s)
- Ernest R Vina
- University of Arizona Arthritis Center, 1501 North Campbell Avenue, PO Box 245093, Tucson, AZ 85724-5093, USA; Department of Medicine, Division of Rheumatology, University of Arizona, College of Medicine, 1501 North Campbell Avenue, PO Box 245093, Tucson, AZ 85724-5093, USA.
| | - Cristian Quinones
- University of Arizona Arthritis Center, 1501 North Campbell Avenue, PO Box 245093, Tucson, AZ 85724-5093, USA; Department of Medicine, Division of Rheumatology, University of Arizona, College of Medicine, 1501 North Campbell Avenue, PO Box 245093, Tucson, AZ 85724-5093, USA
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29
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Tamber MS, Naftel RP. Patient and parental assessment of factors influencing the choice of treatment in pediatric hydrocephalus. J Neurosurg Pediatr 2020; 26:490-494. [PMID: 32764167 DOI: 10.3171/2020.5.peds2095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Choosing between competing options (shunt or endoscopic third ventriculostomy) for the management of hydrocephalus requires patients and caregivers to make a subjective judgment about the relative importance of risks and benefits associated with each treatment. In the context of this particular decision, little is known about what treatment-related factors are important and how they are prioritized in order to arrive at a treatment preference. METHODS The Hydrocephalus Association electronically distributed a survey to surgically treated hydrocephalus patients or their families. Respondents rated the importance of various surgical attributes in their decision-making about treatment choice, and also indicated their preference in hypothetical scenarios involving a trade-off between potential risks and benefits of treatment. Rank-order correlations were used to determine whether certain predictor variables affected the rating of factors or hypothetical treatment choice. RESULTS Eighty percent of 414 respondents rated procedural risks, minimizing repeat surgery, and improving long-term brain function as being very or extremely important factors when deciding on a treatment; 69% rated the need to implant a permanent device similarly. Parent-respondents rated procedural risks higher than patient-respondents. A majority of respondents (n = 209, 54%) chose a procedure with higher surgical risk if it meant that implantation of a permanent device was not required, and respondents were more likely to choose this option if they discussed both treatment options with their surgeon prior to their initial intervention (Spearman rho 0.198, p = 0.001).Although only 144 of 384 total respondents (38%) chose a less established operation if it meant less repeat surgery, patient-respondents were more likely to choose this option compared to parent-respondents (Spearman rho 0.145, p = 0.005). Likewise, patient-respondents were more likely than parent-respondents to choose an operation that involved less repeat surgery and led to worse long-term brain function (Spearman rho 0.160, p = 0.002), an option that was chosen by only 23 (6%) of respondents overall. CONCLUSIONS This study is the first exploration of patient/parental factors that influence treatment preference in pediatric hydrocephalus. Procedural risks, minimizing repeat operations, and the desire to maximize long-term cognitive function appeared to be the most important attributes that influenced treatment decisions that the survey respondents had made in the past. Patients and/or their caregivers appear to see some inherent benefit in being shunt free. It appears that fear of multiple revision operations may drive treatment choice in some circumstances.
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Affiliation(s)
- Mandeep S Tamber
- 1British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and
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Marsh K, van Til JA, Molsen-David E, Juhnke C, Hawken N, Oehrlein EM, Choi YC, Duenas A, Greiner W, Haas K, Hiligsmann M, Hockley KS, Ivlev I, Liu F, Ostermann J, Poder T, Poon JL, Muehlbacher A. Health Preference Research in Europe: A Review of Its Use in Marketing Authorization, Reimbursement, and Pricing Decisions-Report of the ISPOR Stated Preference Research Special Interest Group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:831-841. [PMID: 32762984 DOI: 10.1016/j.jval.2019.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/07/2019] [Accepted: 11/27/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study examines European decision makers' consideration and use of quantitative preference data. METHODS The study reviewed quantitative preference data usage in 31 European countries to support marketing authorization, reimbursement, or pricing decisions. Use was defined as: agency guidance on preference data use, sponsor submission of preference data, or decision-maker collection of preference data. The data could be collected from any stakeholder using any method that generated quantitative estimates of preferences. Data were collected through: (1) documentary evidence identified through a literature and regulatory websites review, and via key opinion leader outreach; and (2) a survey of staff working for agencies that support or make healthcare technology decisions. RESULTS Preference data utilization was identified in 22 countries and at a European level. The most prevalent use (19 countries) was citizen preferences, collected using time-trade off or standard gamble methods to inform health state utility estimation. Preference data was also used to: (1) value other impact on patients, (2) incorporate non-health factors into reimbursement decisions, and (3) estimate opportunity cost. Pilot projects were identified (6 countries and at a European level), with a focus on multi-criteria decision analysis methods and choice-based methods to elicit patient preferences. CONCLUSION While quantitative preference data support reimbursement and pricing decisions in most European countries, there was no utilization evidence in European-level marketing authorization decisions. While there are commonalities, a diversity of usage was identified between jurisdictions. Pilots suggest the potential for greater use of preference data, and for alignment between decision makers.
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Affiliation(s)
| | - Janine A van Til
- Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | | | | | | | | | - Y Christy Choi
- University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | | | - Wolfgang Greiner
- Department of Health Economics, Bielefeld University, Bielefeld, Germany
| | | | - Mickael Hiligsmann
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | | | - Ilya Ivlev
- Center for Health Research, Kaiser Permanente, Portland, OR, USA
| | | | - Jan Ostermann
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | | | - Jiat L Poon
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Axel Muehlbacher
- Hochschule Neubrandenburg, Neubrandenburg, Germany; Department of Population Health Sciences, Duke University, Durham, NC, USA
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Speech Perception Outcomes for Adult Cochlear Implant Recipients Using a Lateral Wall or Perimodiolar Array. Otol Neurotol 2020; 40:608-616. [PMID: 31083082 DOI: 10.1097/mao.0000000000002189] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To assess the speech perception outcomes of adult CI recipients with significant preimplant low frequency hearing, examining differences between perimodiolar and lateral wall electrode placement in order to provide clinical guidance for clinicians and surgeons. METHODS A prospective cohort study was undertaken identifying all adults who received a thin straight electrode array (TSEA) at the Royal Victorian Eye & Ear Hospital (RVEEH) from 2010 to 2015 and who had a preimplant low frequency pure tone median ≤70 dB HL (n = 63). A retrospective review was completed of the RVEEH database to identify a comparison group who had been implanted with a perimodiolar electrode array, comprising adults implanted between 2004 and 2011 (PM Group) with preimplant hearing equivalent to the TSEA group (n = 70). The TSEA Group were further divided into subgroups in which n = 19 used EAS (TSEA-EAS) and n = 44 who used electric-only hearing (TSEA-Standard). RESULTS There was no significant difference in median speech perception outcomes between the TSEA and PM Groups (TSEA 61.7%, PM 67.3%, p = 0.954). A significant difference was found between the TSEA-EAS and TSEA-Standard subgroups for median speech perception outcome (TSEA-EAS median 73.5%, TSEA-Standard median 58.3%, p = 0.043). CONCLUSIONS Significant speech perception benefit following cochlear implantation was achieved with both the perimodiolar and lateral wall electrode arrays and no significant difference was found between outcomes with those array types in this population of adults with functional low frequency hearing pre-implant. Those that received a TSEA, had preserved hearing, and utilised an EAS sound processor performed better than their peers with a TSEA and electric-only hearing.
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Reed SD, McLeod L. Moving Beyond the Tip of the Iceberg to Incorporate Patients' Perspectives and Outcomes in the Medical Device Regulatory Process. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:298-299. [PMID: 32197724 DOI: 10.1016/j.jval.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Shelby D Reed
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Lori McLeod
- RTI Health Solutions, Research Triangle Park, NC, USA.
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Hauber B, Coulter J. Using the Threshold Technique to Elicit Patient Preferences: An Introduction to the Method and an Overview of Existing Empirical Applications. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:31-46. [PMID: 31541362 DOI: 10.1007/s40258-019-00521-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patient preference information (PPI) is a topic of interest to regulators and industry. One of many known methods for eliciting PPI is the threshold technique (TT). However, empirical studies of the TT differ from each other in many ways and no effort to date has been made to summarize them or the evidence regarding the performance of the method. We sought to describe the TT and summarize the empirical applications of the method. Forty-three studies were reviewed. Most studies estimated the minimum level of benefit required to make a treatment worthwhile, and over half estimated the maximum level of risk patients would accept to achieve a treatment benefit. The evidence demonstrates that the TT can be used to elicit multiple types of thresholds and can be used to explore preference heterogeneity and preference non-linearity. Some evidence suggests that the method may be sensitive to anchoring and shift-framing effects; however, no evidence suggests that the method is more or less sensitive to these potential biases than other stated-preference methods. The TT may be a viable method for eliciting PPI to support regulatory decision-making; however, additional understanding of the performance of this method may be needed. Future research should focus on TT performance compared with other stated-preference methods, the extent to which results predict patient choice, and the ability of the TT to inform individual treatment decisions at the point of healthcare delivery.
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Affiliation(s)
- Brett Hauber
- RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Joshua Coulter
- RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
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van Overbeeke E, Janssens R, Whichello C, Schölin Bywall K, Sharpe J, Nikolenko N, Phillips BS, Guiddi P, Pravettoni G, Vergani L, Marton G, Cleemput I, Simoens S, Kübler J, Juhaeri J, Levitan B, de Bekker-Grob EW, Veldwijk J, Huys I. Design, Conduct, and Use of Patient Preference Studies in the Medical Product Life Cycle: A Multi-Method Study. Front Pharmacol 2019; 10:1395. [PMID: 31849657 PMCID: PMC6902285 DOI: 10.3389/fphar.2019.01395] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/31/2019] [Indexed: 12/30/2022] Open
Abstract
Objectives: To investigate stakeholder perspectives on how patient preference studies (PPS) should be designed and conducted to allow for inclusion of patient preferences in decision-making along the medical product life cycle (MPLC), and how patient preferences can be used in such decision-making. Methods: Two literature reviews and semi-structured interviews (n = 143) with healthcare stakeholders in Europe and the US were conducted; results of these informed the design of focus group guides. Eight focus groups were conducted with European patients, industry representatives and regulators, and with US regulators and European/Canadian health technology assessment (HTA) representatives. Focus groups were analyzed thematically using NVivo. Results: Stakeholder perspectives on how PPS should be designed and conducted were as follows: 1) study design should be informed by the research questions and patient population; 2) preferred treatment attributes and levels, as well as trade-offs among attributes and levels should be investigated; 3) the patient sample and method should match the MPLC phase; 4) different stakeholders should collaborate; and 5) results from PPS should be shared with relevant stakeholders. The value of patient preferences in decision-making was found to increase with the level of patient preference sensitivity of decisions on medical products. Stakeholders mentioned that patient preferences are hardly used in current decision-making. Potential applications for patient preferences across industry, regulatory and HTA processes were identified. Four applications seemed most promising for systematic integration of patient preferences: 1) benefit-risk assessment by industry and regulators at the marketing-authorization phase; 2) assessment of major contribution to patient care by European regulators; 3) cost-effectiveness analysis; and 4) multi criteria decision analysis in HTA. Conclusions: The value of patient preferences for decision-making depends on the level of collaboration across stakeholders; the match between the research question, MPLC phase, sample, and preference method used in PPS; and the sensitivity of the decision regarding a medical product to patient preferences. Promising applications for patient preferences should be further explored with stakeholders to optimize their inclusion in decision-making.
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Affiliation(s)
| | - Rosanne Janssens
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Chiara Whichello
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | | | | | - Nikoletta Nikolenko
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle, United Kingdom
| | | | - Paolo Guiddi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Giulia Marton
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | | | - Steven Simoens
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Jürgen Kübler
- Quantitative Scientific Consulting, Marburg, Germany
| | | | - Bennett Levitan
- Janssen Research & Development, Titusville, NJ, United States
| | | | - Jorien Veldwijk
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
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Le JT, Bicket AK, Janssen EM, Grover D, Radhakrishnan S, Vold S, Tarver ME, Eydelman M, Bridges JF, Li T. Prioritizing outcome preferences in patients with ocular hypertension and open-angle glaucoma using best-worst scaling. Ophthalmol Glaucoma 2019; 2:367-373. [PMID: 32355909 PMCID: PMC7192342 DOI: 10.1016/j.ogla.2019.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose To quantify patients' preferences for glaucoma outcomes and use this information to prioritize outcomes that are important to patients. Design A cross-sectional study using best-worst scaling object case (BWS). Participants Two hundred seventy-four participants newly diagnosed with ocular hypertension or mild to moderate open angle glaucoma from three private practices and one academic medical center in the United States. Methods We designed a preference-elicitation survey based on findings from 25 semi-structured, qualitative interviews with patients with glaucoma (reported elsewhere). The survey asked participants to rate the importance of 13 glaucoma outcomes on a Likert scale as a warm-up exercise followed by completion of 13 BWS tasks. For each task, we presented participants a subset of four outcomes from the possible thirteen, and participants chose the most important and least important outcome. Outcomes included in the survey pertain to maintaining ability to perform vision-dependent activities of daily living (e.g., driving), maintaining visual function and perception (e.g., depth perception), minimizing need to take glaucoma drops, not experiencing ocular surface symptoms (e.g., red eyes, teary eyes), and having adequate control of intraocular pressure (IOP). We administered the survey online and analyzed response patterns using conditional logistic regression to determine the relative importance of different outcomes. Main outcome Ordinal ranking of glaucoma outcomes based on preference weights. Results Between September 1, 2017 and February 28, 2018, we invited 1035 patients to complete our survey, among whom 274 (26%) responded. Most participants were older than 65 years of age (146/274, 53%) and currently on IOP-lowering drops (179/274, 65%). Participants identified that outcomes with the largest relative importance weight were having "adequate IOP control" and ability to "drive a car during the day," and the outcomes with the smallest relative importance weights were "maintaining appearance of the eye" and "reducing the number of IOP-lowering drops". Conclusions Determining the relative importance of glaucoma outcomes to patients can help researchers design studies that may better inform clinical and regulatory decision-making. Although IOP is an outcome that researchers often measure in glaucoma clinical trials, patients also prioritized outcomes related to the ability to perform vision-dependent activities such as driving.
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Affiliation(s)
- Jimmy T. Le
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amanda K. Bicket
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ellen M. Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Sunita Radhakrishnan
- Glaucoma Research and Education Group, Glaucoma Center of San Francisco and, San Francisco, California, USA
| | - Steven Vold
- Vold Vision, PLLC, Fayetteville, Arkansas, USA
| | - Michelle E. Tarver
- Departments of Biomedical Informatics and Surgery, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Malvina Eydelman
- Office of the Center Director, Center for Devices and Radiological Health, United States Food and Drug Administration, White Oak, Maryland, USA
| | - John F.P. Bridges
- Division of Ophthalmic and Ear, Nose and Throat Devices, Center for Devices and Radiological Health, United States Food and Drug Administration, White Oak, Maryland, USA
| | - Tianjing Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Janssens R, Huys I, van Overbeeke E, Whichello C, Harding S, Kübler J, Juhaeri J, Ciaglia A, Simoens S, Stevens H, Smith M, Levitan B, Cleemput I, de Bekker-Grob E, Veldwijk J. Opportunities and challenges for the inclusion of patient preferences in the medical product life cycle: a systematic review. BMC Med Inform Decis Mak 2019; 19:189. [PMID: 31585538 PMCID: PMC6778383 DOI: 10.1186/s12911-019-0875-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 07/23/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The inclusion of patient preferences (PP) in the medical product life cycle is a topic of growing interest to stakeholders such as academics, Health Technology Assessment (HTA) bodies, reimbursement agencies, industry, patients, physicians and regulators. This review aimed to understand the potential roles, reasons for using PP and the expectations, concerns and requirements associated with PP in industry processes, regulatory benefit-risk assessment (BRA) and marketing authorization (MA), and HTA and reimbursement decision-making. METHODS A systematic review of peer-reviewed and grey literature published between January 2011 and March 2018 was performed. Consulted databases were EconLit, Embase, Guidelines International Network, PsycINFO and PubMed. A two-step strategy was used to select literature. Literature was analyzed using NVivo (QSR international). RESULTS From 1015 initially identified documents, 72 were included. Most were written from an academic perspective (61%) and focused on PP in BRA/MA and/or HTA/reimbursement (73%). Using PP to improve understanding of patients' valuations of treatment outcomes, patients' benefit-risk trade-offs and preference heterogeneity were roles identified in all three decision-making contexts. Reasons for using PP relate to the unique insights and position of patients and the positive effect of including PP on the quality of the decision-making process. Concerns shared across decision-making contexts included methodological questions concerning the validity, reliability and cognitive burden of preference methods. In order to use PP, general, operational and quality requirements were identified, including recognition of the importance of PP and ensuring patient understanding in PP studies. CONCLUSIONS Despite the array of opportunities and added value of using PP throughout the different steps of the MPLC identified in this review, their inclusion in decision-making is hampered by methodological challenges and lack of specific guidance on how to tackle these challenges when undertaking PP studies. To support the development of such guidance, more best practice PP studies and PP studies investigating the methodological issues identified in this review are critically needed.
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Affiliation(s)
- Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000 Leuven, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000 Leuven, Belgium
| | - Eline van Overbeeke
- Department of Pharmaceutical and Pharmacological Sciences, KU 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
| | - Sarah Harding
- Takeda International, UK Branch, 61 Aldwych, London, WC2B 4AE UK
| | | | - Juhaeri Juhaeri
- Sanofi, 55 Corporate Drive, Bridgewater Township, NJ 08807 USA
| | - Antonio Ciaglia
- International Alliance of Patients’ Organizations, 49-51 East Rd, Hoxton, London, N1 6AH UK
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000 Leuven, Belgium
| | - Hilde Stevens
- Institute for Interdisciplinary Innovation in healthcare (I3h), Université libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium
| | | | - Bennett Levitan
- Global R&D Epidemiology, Janssen Research & Development, 1125 Trenton-Harbourton Road, PO Box 200, Titusville, NJ 08560 USA
| | - Irina Cleemput
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - 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
| | - 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
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Lau R, Crump RT, Brousseau DC, Panepinto JA, Nicholson M, Engel J, Lagatta J. Parent Preferences Regarding Home Oxygen Use for Infants with Bronchopulmonary Dysplasia. J Pediatr 2019; 213:30-37.e3. [PMID: 31256913 PMCID: PMC6765432 DOI: 10.1016/j.jpeds.2019.05.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/07/2019] [Accepted: 05/29/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine parent preferences for discharge with home oxygen in infants with bronchopulmonary dysplasia. STUDY DESIGN This was a prospective study of parents of infants born at <32 weeks' gestation with established bronchopulmonary dysplasia and approaching neonatal intensive care unit (NICU) discharge. Parents were presented a hypothetical scenario of an infant who failed weaning to room air and 2 options: discharge with home oxygen or try longer to wean oxygen. The initial scenario risks reflected a 1.5-week difference in NICU length of stay and no differences in other outcomes. Length of stay and readmission outcomes were increased or decreased until the parent switched preference. Three months after discharge, parents were asked to reconsider their preference. Differences were analyzed by χ2 or Kruskal-Wallis tests. RESULTS Of 125 parents, 50% preferred home oxygen. For parents preferring home oxygen, the most important reason was comfort at home (79%). Forty percent switched preference when the length of stay difference decreased by 1 week; 35% switched when readmission increased by 5%. For parents preferring to stay in NICU, the most important reason was fear of taking care of the child at home (73%). Thirty-two percent switched preference when the length of stay difference increased by 1 week; 31% switched when readmission decreased by 5%. One hundred ten parents completed the 3-month follow-up; 80 were discharged with home oxygen. Seventy-eight percent would prefer home oxygen (97% who initially preferred home oxygen and 60% who initially preferred to stay in the NICU). CONCLUSIONS Parents weigh differences in NICU length of stay and readmission risk similarly. After discharge, most prefer earlier discharge with home oxygen. Earlier education to increase comfort with home technology may facilitate NICU discharge planning.
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Affiliation(s)
- Ryan Lau
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | | | | | | | - Mateo Nicholson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | | | - Joanne Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
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Tervonen T, Pignatti F, Postmus D. From Individual to Population Preferences: Comparison of Discrete Choice and Dirichlet Models for Treatment Benefit-Risk Tradeoffs. Med Decis Making 2019; 39:879-885. [PMID: 31496357 PMCID: PMC6843605 DOI: 10.1177/0272989x19873630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction. The Dirichlet distribution has been proposed for representing preference heterogeneity, but there is limited evidence on its suitability for modeling population preferences on treatment benefits and risks. Methods. We conducted a simulation study to compare how the Dirichlet and standard discrete choice models (multinomial logit [MNL] and mixed logit [MXL]) differ in their convergence to stable estimates of population benefit-risk preferences. The source data consisted of individual-level tradeoffs from an existing 3-attribute patient preference study (N = 560). The Dirichlet population model was fit directly to the attribute weights in the source data. The MNL and MXL population models were fit to the outcomes of a simulated discrete choice experiment in the same sample of 560 patients. Convergence to the parameter values of the Dirichlet and MNL population models was assessed with sample sizes ranging from 20 to 500 (100 simulations per sample size). Model variability was also assessed with coefficient P values. Results. Population preference estimates of all models were very close to the sample mean, and the MNL and MXL models had good fit (McFadden's adjusted R2 = 0.12 and 0.13). The Dirichlet model converged reliably to within 0.05 distance of the population preference estimates with a sample size of 100, where the MNL model required a sample size of 240 for this. The MNL model produced consistently significant coefficient estimates with sample sizes of 100 and higher. Conclusion. The Dirichlet model is likely to have smaller sample size requirements than standard discrete choice models in modeling population preferences for treatment benefit-risk tradeoffs and is a useful addition to health preference analyst's toolbox.
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Affiliation(s)
| | | | - Douwe Postmus
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, the Netherlands
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Patient and caregiver preferences for the potential benefits and risks of a seizure forecasting device: A best-worst scaling. Epilepsy Behav 2019; 96:183-191. [PMID: 31150998 DOI: 10.1016/j.yebeh.2019.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Epilepsy is the 4th most common neurological disorder and is characterized by recurrent, unpredictable seizures. The ability to forecast seizures is a significant unmet need and would have a transformative effect on the lives of people living with epilepsy. In an effort to address this need, the Epilepsy Foundation has committed effort and resources to promote the development of seizure forecasting devices (SFD). OBJECTIVE To promote user-centered design of future SFD, we sought to quantify patient and caregiver preferences for the potential benefits and risks of SFD. METHODS A community-centered approach was used to develop a survey incorporating a novel best-worst scaling (BWS) to assess preferences for SFD. A main-effect orthogonal array was used to design and generate 18 "prototypes" that systematically varied across six attributes: seizure forecasting probability, seizure forecasting range, inaccuracy of forecasting, amount of time required to use the device, how the device is worn, and cost. The dependent variable was the attributes that respondents selected the best and worst in each profile, and a choice model was estimated using conditional logistic regression, which was also stratified and compared across patients and caregivers. Respondents also indicated that they would accept each of the prototype SFDs if it were real. These acceptance data and net monetary benefits (relative to the least preferred SFD) were explored. RESULTS There were 633 eligible respondents; 493 (78%) completed at least one task. Responses indicated that 346 (68%) had epilepsy, and 147 (29%) were primary caregivers or family members of someone with epilepsy. The data show that short forecasting range is the most favored among experimental attributes, followed by mid forecasting range and notification of high chance of seizure. Having the device implanted is the least favorable attribute. Stated preferences differed between patients and caregivers (p < 0.001) for range of forecasting and inaccuracy of device. Caregivers preferred any range of forecasting, regardless of length, more than patients. Patients cared less about inaccuracy of the device compared to caregivers. The groups also differ in impact of fear of having seizures (versus actually having seizures) (p = 0.034) and on device acceptance. The acceptance of devices ranged from 42.3% to 95%, with caregivers being more likely to use a device (p < 0.05) for the majority of device profiles. Acceptance of devices varied with net monetary benefit of the best device being $717.44 more per month relative to the least preferred device. CONCLUSION Our finding extends previous calls for seizure forecasting devices by demonstrating the value that they might provide to patients and caregivers affected by epilepsy and the feature that might be most and least desirable. In addition to guiding device development, the data can help inform regulatory decisions makers.
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MacEwan JP, Doctor J, Mulligan K, May SG, Batt K, Zacker C, Lakdawalla D, Goldman D. The Value of Progression-Free Survival in Metastatic Breast Cancer: Results From a Survey of Patients and Providers. MDM Policy Pract 2019; 4:2381468319855386. [PMID: 31259249 PMCID: PMC6589981 DOI: 10.1177/2381468319855386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/05/2019] [Indexed: 01/27/2023] Open
Abstract
Background. Value assessments and treatment decision making typically focus on clinical endpoints, especially overall survival (OS). However, OS data are not always available, and surrogate markers may also have some value to patients. This study sought to estimate preferences for progression-free survival (PFS) relative to OS in metastatic breast cancer (mBC) among a diverse set of stakeholders—patients, oncologists, and oncology nurses—and estimate the value patients and providers place on other attributes of treatment. Methods. Utilizing a combined conjoint analysis and discrete choice experiment approach, we conducted an online prospective survey of mBC patients and oncology care providers who treat mBC patients across the United States. Results. A total of 299 mBC patients, 100 oncologists, and 99 oncology nurses completed the survey. Virtually all patients preferred health state sequences with contiguous periods of PFS, compared with approximately 85% and 75% of nurses and oncologists, respectively. On average, longer OS was significantly (P < 0.01) preferred by the majority (75%) patients, but only 15% of nurses preferred longer OS, and OS did not significantly affect oncologists’ preferred health state. However, in the context of a treatment decision, whether a treatment offered continuous periods of stable disease holding OS constant significantly affected nurses’ treatment choices. Patients and providers alike valued reductions in adverse event risk and evidence from high-quality randomized controlled clinical trials. Conclusions. The strong preference for observed PFS suggests more research is warranted to better understand the reasons for PFS having positive value to patients. The results also suggest a range of endpoints in clinical trials may have importance to patients.
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Affiliation(s)
| | - Jason Doctor
- Precision Health Economics, Los Angeles, California
| | | | | | | | | | | | - Dana Goldman
- Precision Health Economics, Los Angeles, California
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Vass C, Rigby D, Tate K, Stewart A, Payne K. An Exploratory Application of Eye-Tracking Methods in a Discrete Choice Experiment. Med Decis Making 2019; 38:658-672. [PMID: 30074879 PMCID: PMC6088456 DOI: 10.1177/0272989x18782197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background. Discrete choice experiments (DCEs) are increasingly
used to elicit preferences for benefit-risk tradeoffs. The primary aim of this
study was to explore how eye-tracking methods can be used to understand DCE
respondents’ decision-making strategies. A secondary aim was to explore if the
presentation and communication of risk affected respondents’ choices.
Method. Two versions of a DCE were designed to understand the
preferences of female members of the public for breast screening that varied in
how risk attributes were presented. Risk was communicated as either 1)
percentages or 2) icon arrays and percentages. Eye-tracking equipment recorded
eye movements 1000 times a second. A debriefing survey collected
sociodemographics and self-reported attribute nonattendance (ANA) data. A
heteroskedastic conditional logit model analyzed DCE data. Eye-tracking data on
pupil size, direction of motion, and total visual attention (dwell time) to
predefined areas of interest were analyzed using ordinary least squares
regressions. Results. Forty women completed the DCE with
eye-tracking. There was no statistically significant difference in attention
(fixations) to attributes between the risk communication formats. Respondents
completing either version of the DCE with the alternatives presented in columns
made more horizontal (left-right) saccades than vertical (up-down). Eye-tracking
data confirmed self-reported ANA to the risk attributes with a 40% reduction in
mean dwell time to the “probability of detecting a cancer” (P =
0.001) and a 25% reduction to the “risk of unnecessary follow-up”
(P = 0.008). Conclusion. This study is one of
the first to show how eye-tracking can be used to understand responses to a
health care DCE and highlighted the potential impact of risk communication on
respondents’ decision-making strategies. The results suggested self-reported ANA
to cost attributes may not be reliable.
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Affiliation(s)
- Caroline Vass
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Dan Rigby
- Department of Economics, University of Manchester, Manchester, UK
| | - Kelly Tate
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Andrew Stewart
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
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Rensel M. Long-Term Treatment Strategies of Pediatric Multiple Sclerosis, Including the use of Disease Modifying Therapies. CHILDREN-BASEL 2019; 6:children6060073. [PMID: 31159312 PMCID: PMC6617229 DOI: 10.3390/children6060073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 01/20/2023]
Abstract
Multiple sclerosis (MS) presenting in the pediatric years can lead to landmark disability levels younger in life than adult onset MS and so therefore early and effective treatment remains paramount for long-term outcomes. The goals of MS therapeutics in adults have widened to address multiple mechanisms: anti-inflammatory, neuroprotective, and myelin repair, yet the optimal paradigm for MS therapies in the pediatric population is not known. Pediatric onset MS add complexities due to the ongoing development of the central nervous system and the immune system. Clinical trials have led to an increasing number of pharmaceutical therapies for adult onset MS (AOMS), one POMS randomized controlled trial is completed and other trials are ongoing, yet due to the low prevalence of POMS, the dynamic landscape and risk management of the MS disease modifying therapies (DMT) it remains more difficult to complete trials in POMS. There is consensus that controlled clinical trials leading to appropriate and safe therapies for POMS are important for a multitude of reasons that include unique pediatric pharmacokinetics, short and long-term safety, developmental issues, clinical benefits, and regulatory approval. This review will focus on new treatment goals, paradigm, strategies, monitoring, compliance, and products in the long-term treatment of POMS. The discussion will focus on these new concepts and the published data related to DMT use in POMS. This review provides significant insight into new concepts of treatment goals and current approaches to enhance the lives of the POMS patients now and in the future.
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Affiliation(s)
- Mary Rensel
- The Mellen Center, Department of Neurology, Cleveland Clinic, Cleveland, OH 44195, USA.
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Vass C, Rigby D, Payne K. "I Was Trying to Do the Maths": Exploring the Impact of Risk Communication in Discrete Choice Experiments. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:113-123. [PMID: 30099692 DOI: 10.1007/s40271-018-0326-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Risk is increasingly used as an attribute in discrete choice experiments (DCEs). However, risk and probabilities are complex concepts that can be open to misinterpretation, potentially undermining the robustness of DCEs as a valuation method. This study aimed to understand how respondents made benefit-risk trade-offs in a DCE and if these were affected by the communication of the risk attributes. METHODS Female members of the public were recruited via local advertisements to participate in think-aloud interviews when completing a DCE eliciting their preferences for a hypothetical breast screening programme described by three attributes: probability of detecting a cancer; risk of unnecessary follow-up; and cost of screening. Women were randomised to receive risk information as either (1) percentages or (2) percentages and icon arrays. Interviews were digitally recorded then transcribed to generate qualitative data for thematic analysis. RESULTS Nineteen women completed the interviews (icon arrays n = 9; percentages n = 10). Analysis revealed four key themes where women made references to (1) the nature of the task; (2) their feelings; (3) their experiences, for instance making analogies to similar risks; and (4) economic phenomena such as opportunity costs and discounting. CONCLUSION Most women completed the DCE in line with economic theory; however, violations were identified. Women appeared to visualise risk whether they received icon arrays or percentages only. Providing clear instructions and graphics to aid interpretation of risk and qualitative piloting to verify understanding is recommended. Further investigation is required to determine if the process of verbalising thoughts changes the behaviour of respondents.
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Affiliation(s)
- Caroline Vass
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Dan Rigby
- Department of Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Jackson Y, Janssen E, Fischer R, Beaverson K, Loftus J, Betteridge K, Rhoten S, Flood E, Lundie M. The evolving role of patient preference studies in health-care decision-making, from clinical drug development to clinical care management. Expert Rev Pharmacoecon Outcomes Res 2019; 19:383-396. [PMID: 31070048 DOI: 10.1080/14737167.2019.1612242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: There is a growing trend of using patient preference studies to help incorporate the patient perspective into clinical drug development, care management, and health-care decision-making. Collecting and interpreting patient preference data is integral to multi-stakeholder engagement, patient-centric drug development, and clinical care management. Operationally, challenges exist in understanding 'when' and 'how' to embark on patient preference studies. This review will provide a brief overview of stated-preference methods, discuss applications throughout the clinical drug development and care management, and highlight how preference studies serve as a powerful tool for quantifying patient experiences for better outcomes. Areas covered: We present case studies to complement the different applications of stated-preference methods in clinical drug development and care management. We discuss the applications of preference data to help inform evidence-based patient advocacy, clinical development strategy, operational feasibility, regulator benefit-risk assessments, health technology assessments, and clinical decision-making. Expert commentary: Patient preference studies can serve as a powerful tool to engage patients and their communities as well as quantify the patient voice across different stages of clinical drug development and care management to support patient-centric health-care decision-making. It is expected that the application of these strategies will quickly advance in the coming years.
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Affiliation(s)
| | | | - Ryan Fischer
- c Parent Project Muscular Dystrophy , Hackensack, USA
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Tervonen T, Angelis A, Hockley K, Pignatti F, Phillips LD. Quantifying Preferences in Drug Benefit-Risk Decisions. Clin Pharmacol Ther 2019; 106:955-959. [PMID: 30929257 DOI: 10.1002/cpt.1447] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/21/2019] [Indexed: 01/13/2023]
Abstract
Benefit-risk assessment is used in various phases along the drug lifecycle, such as marketing authorization and surveillance, health technology assessment (HTA), and clinical decisions, to understand whether, and for which patients, a drug has a favorable or more valuable profile with reference to one or more comparators. Such assessments are inherently preference-based as several clinical and nonclinical outcomes of varying importance might act as evaluation criteria, and decision makers must establish acceptable trade-offs between these outcomes. Different healthcare stakeholder perspectives, such as those from patients and healthcare professionals, are key for informing benefit-risk trade-offs. However, the degree to which such preferences inform the decision is often unclear as formal preference-based evaluation frameworks are generally not used for regulatory decisions, and, if used, rarely communicated in HTA decisions. We argue that for better decisions, as well as for reasons of transparency, preferences in benefit-risk decisions should more often be quantified and communicated explicitly.
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Affiliation(s)
| | - Aris Angelis
- Department of Health Policy and LSE Health, London School of Economics and Political Science, London, UK
| | | | | | - Lawrence D Phillips
- Department of Management, London School of Economics and Political Science, London, UK
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Boqué C, Abad MR, Agustín MJ, García-Goñi M, Moreno C, Gabás-Rivera C, Granados E, Castro-Gómez A, Pardo C, Lizán L. Treatment decision-making in chronic lymphocytic leukaemia: Key factors for healthcare professionals. PRELIC study. J Geriatr Oncol 2019; 11:24-30. [PMID: 30954406 DOI: 10.1016/j.jgo.2019.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/13/2019] [Accepted: 03/16/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the preferences of Spanish healthcare professionals (haematologists and hospital pharmacists) for the treatment selection of active Chronic Lymphocytic Leukaemia (CLL) patients at first relapse, condition that mainly afflicts older adults. METHODS A discrete choice experiment (DCE) was conducted among haematologists and hospital pharmacists. A literature review and a focus group informed the DCE design. CLL treatment settings were defined by seven attributes: four patient/disease-related attributes (age, functional status, comorbidities, and risk of the disease) and three treatment-related attributes (efficacy [hazard ratio of progression-free survival, HR-PFS], rate of discontinuations due to adverse events and cost). A mixed-logit model was used to determine choice-based preferences. Relative importance (RI) of attributes was calculated and compared between stakeholders. Willingness-to-pay (WTP) was estimated through the DCE. Besides, nine ad-hoc questions were posed, to explore more in depth CLL treatment decision making. RESULTS A total of 130 participants (72 haematologists and 58 hospital pharmacists) answered the DCE. All attributes were significant predictors of preferences (p < 0.05) in the multinomial model. Higher RI was obtained for treatment-related attributes: the highest rated being 'cost' (23.8%) followed by 'efficacy' (20.9%). Regarding patient-related attributes, the highest RI was obtained for 'age' (18.1%). No significant differences (p > 0.05) in RI between haematologists and pharmacists were found. WTP for the treatment was higher for younger CLL patients. Ad-hoc questions showed that patient age and functional status influence treatment decisions. CONCLUSIONS For healthcare professionals, 'cost' and 'efficacy' (treatment-related attributes) and age (patient-related attribute) are the main factors that determine CLL treatment selection at first relapse. WTP decreases as patient's age increases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Luis Lizán
- Outcomes'10, Castellón, Spain; Departamento de Medicina, Universitat Jaume I, Castellón, Spain
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Mansfield C, Gebben DJ, Sutphin J, Tepper SJ, Schwedt TJ, Sapra S, Shah N. Patient Preferences for Preventive Migraine Treatments: A Discrete‐Choice Experiment. Headache 2019; 59:715-726. [DOI: 10.1111/head.13498] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Carol Mansfield
- Health Preference Assessment RTI Health Solutions Research Triangle Park NC USA
| | - David J. Gebben
- Health Preference Assessment RTI Health Solutions Research Triangle Park NC USA
| | - Jessie Sutphin
- Health Preference Assessment RTI Health Solutions Research Triangle Park NC USA
| | - Stewart J. Tepper
- Department of Neurology Geisel School of Medicine at Dartmouth, Dartmouth‐Hitchcock Medical Center Hanover NH USA
| | | | - Sandhya Sapra
- Global Health Economics Amgen Inc. Thousand Oaks CA USA
| | - Neel Shah
- Global Health Economics Amgen Inc. Thousand Oaks CA USA
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PREFERENCES OF PATIENTS WITH MULTIPLE SCLEROSIS FOR ATTRIBUTES OF INJECTABLE MULTIPLE SCLEROSIS TREATMENTS IN THE UNITED KINGDOM AND FRANCE. Int J Technol Assess Health Care 2019; 34:425-433. [PMID: 30251947 PMCID: PMC6190072 DOI: 10.1017/s0266462318000491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: Adherence to injectable disease-modifying treatments in patients with multiple sclerosis (MS) impacts outcomes and can be influenced by perceptions of treatment efficacy, side effects, injection frequency, and the duration of injection. This study aimed to quantify preferences for selected attributes of injectable treatments among individuals with MS in the United Kingdom and France. Methods: Respondents with a self-reported diagnosis of MS completed an online discrete-choice-experiment survey, consisting of a series of treatment-choice questions. Each choice question presented two hypothetical treatments, each with six attributes (years until disability progression, relapses in the next 4 years, injection time, injection frequency, flu-like symptoms (FLS), and injection-site reactions), each with various levels. Mixed-logit regression analysis was used to estimate preference weights for attribute levels and to calculate the relative importance of changes in treatment attributes (vertical distance between preference weights). Minimum acceptable efficacy estimates indicate improvement in efficacy that respondents would require in exchange for worsening injection frequency and FLS. Results: In both countries, 100 respondents completed the survey. In the United Kingdom and France, respectively, improving the time until disability progression from 2 to 4 years, reducing injection frequency from “daily” to “every 2 weeks”, and reducing FLS from 3 days after every injection to none had a relative importance of 2.9 and 2.6, 3.0 and 3.5, and 2.5 and 3.1. Given the ranges included in the study, changes in these attributes were more important than most changes in other attributes assessed. Conclusions: Reductions in the injection frequency of MS treatments and FLS can be as important to patients as improvements in treatment efficacy.
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Broekhuizen H, Groothuis-Oudshoorn CGM, Vliegenthart R, Groen HJM, IJzerman MJ. Assessing Lung Cancer Screening Programs under Uncertainty in a Heterogeneous Population. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1269-1277. [PMID: 30442273 DOI: 10.1016/j.jval.2018.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Lung cancer screening can reduce cancer mortality. Most implementation studies focus only on low-dose computed tomography (LDCT) and clinical attributes of screening and do not include preferences of potential participants. In this study we evaluated the perceived value of screening programs based on LDCT, breath analysis (BA), or blood biomarkers (BB) according to the perspective of the target population. METHODS A multi-criteria decision analysis framework was adopted. The weights of seven attributes of screening (sensitivity, specificity, radiation burden, duration of screening process, waiting time until results are communicated, location of screening, and mode of screening) were obtained from an earlier study that included a broad sample from the Netherlands. Performance data for the screening modalities was obtained from clinical trials and expert opinion. Parameter uncertainty about clinical performances was incorporated probabilistically, while heterogeneity in preferences was analyzed through subgroup analyses. RESULTS The mean overall values were 0.58 (CI: 0.57 to 0.59), 0.57 (CI: 0.56 to 0.59), and 0.44 (CI: 0.43 to 0.45) for BB, BA, and LDCT, respectively. Seventy-seven per cent of respondents preferred BB or BA. For most subgroups, the overall values were similar to those of the entire sample. BA had the highest value for respondents who would have been eligible for earlier screening trials. DISCUSSION BB and BA seem valuable to participants because they can be applied in a primary care setting. Although LDCT still seems preferable given its strong and positive evidence base, it is important to take non-clinical attributes into account to maximize attendance.
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Affiliation(s)
- Henk Broekhuizen
- Radboud University Medical Center, Department of Health Evidence, Nijmegen, The Netherlands.
| | - Catharina G M Groothuis-Oudshoorn
- University of Twente, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, Department of Health Technology and Services Research, Enschede, The Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Harry J M Groen
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Maarten J IJzerman
- Radboud University Medical Center, Department of Health Evidence, Nijmegen, The Netherlands; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences and Victorian Comprehensive Cancer Centre, Melbourne, Australia
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50
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Holmes EAF, Plumpton C, Baker GA, Jacoby A, Ring A, Williamson P, Marson A, Hughes DA. Patient-Focused Drug Development Methods for Benefit-Risk Assessments: A Case Study Using a Discrete Choice Experiment for Antiepileptic Drugs. Clin Pharmacol Ther 2018; 105:672-683. [PMID: 30204252 PMCID: PMC6491963 DOI: 10.1002/cpt.1231] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/24/2018] [Indexed: 12/31/2022]
Abstract
Regulatory decisions may be enhanced by incorporating patient preferences for drug benefit and harms. This study demonstrates a method of weighting clinical evidence by patients’ benefit–risk preferences. Preference weights, derived from discrete choice experiments, were applied to clinical trial data to estimate the expected utility of alternative drugs. In a case study, the rank ordering of antiepileptic drugs (AEDs), as indicated from clinical studies, was compared with ordering based on weighting clinical evidence by patients’ preferences. A statistically significant change in rank ordering of AEDs was observed for women of childbearing potential who were prescribed monotherapy for generalized or unclassified epilepsy. Rank ordering inferred from trial data, valproate > topiramate > lamotrigine, was reversed. Modeling the expected utility of drugs might address the need to use more systematic, methodologically sound approaches to collect patient input that can further inform regulatory decision making.
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Affiliation(s)
- Emily A F Holmes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Catrin Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Gus A Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Ann Jacoby
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Adele Ring
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Paula Williamson
- Medical Research Council North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Anthony Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK.,Walton Centre National Health Service Foundation Trust, Liverpool, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK.,Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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