1
|
Ding R, Shao R, Zhang L, Yan J. Preferences and Willingness to Pay for Medication in Patients with Renal Cell Carcinoma in China: A Discrete-Choice Experiment. THE PATIENT 2024; 17:97-108. [PMID: 38030868 DOI: 10.1007/s40271-023-00659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE We aimed to assess the relative importance of attributes and the willingness to pay for pharmacological therapies among patients with renal cell carcinoma in China. METHODS Patients with renal cell carcinoma completed a D-efficient-designed, discrete-choice experiment online survey that presented a series of ten trade-off questions and one examining scenario. Based on the literature review and consultations with patients with renal cell carcinoma and clinicians, each question included a pair of hypothetical renal cell carcinoma medication profiles characterized by seven attributes including progression-free survival, objective response rate, medication regimen, fatigue, gastrointestinal reaction, hand-foot syndrome, and monthly out-of-pocket costs. Relative importance and willingness to pay were calculated using coefficients estimated by mixed logit regression in the main analysis. Subgroup analyses were conducted considering the heterogeneity of the participants, based on sex, education level, and income level, using conditional logit regression. RESULTS The analysis incorporated responses from 182 Chinese respondents. Except for the medication regimen, all attributes were statistically significant. Progression-free survival was the most important attribute, followed by objective response rate, monthly out-of-pocket costs, fatigue, gastrointestinal reaction, and hand-foot syndrome. Patients were willing to pay ¥2010.51 ($298.30), ¥494.93 ($73.43) for 1 unit improvement of progression-free survival, and objective response rate, and¥7558.93 ($1121.50), ¥6927.24 ($1027.78) to avoid experiencing fatigue and gastrointestinal reaction, respectively. Differences in preferences and willingness to pay were found according to patients' gender, income, and education level. CONCLUSIONS In China, patients with renal cell carcinoma preferred medications with better efficacy (objective response rate and progression-free survival) and lower out-of-pocket costs. Heterogeneity can be found in preferences and willingness to pay based on patients' gender, income, and education levels.
Collapse
Affiliation(s)
- Ruilin Ding
- School of International Business, China Pharmaceutical University, No.639 Longmian Avenue, Jiangning District, 211198, Nanjing, Jiangsu, People's Republic of China
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, Jiangsu, People's Republic of China
| | - Rong Shao
- School of International Business, China Pharmaceutical University, No.639 Longmian Avenue, Jiangning District, 211198, Nanjing, Jiangsu, People's Republic of China
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, Jiangsu, People's Republic of China
| | - Lingli Zhang
- School of Pharmacy, Nanjing Medical University, No.101 Longmian Avenue, Jiangning District, 211166, Nanjing, Jiangsu, People's Republic of China.
| | - Jianzhou Yan
- School of International Business, China Pharmaceutical University, No.639 Longmian Avenue, Jiangning District, 211198, Nanjing, Jiangsu, People's Republic of China.
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, Jiangsu, People's Republic of China.
| |
Collapse
|
2
|
Zhang M, He X, Wu J, Xie F. Differences between physician and patient preferences for cancer treatments: a systematic review. BMC Cancer 2023; 23:1126. [PMID: 37980466 PMCID: PMC10657542 DOI: 10.1186/s12885-023-11598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/01/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Shared decision-making is useful to facilitate cancer treatment decisions. However, it is difficult to make treatment decisions when physician and patient preferences are different. This review aimed to summarize and compare the preferences for cancer treatments between physicians and patients. METHODS A systematic literature search was conducted on PubMed, Embase, PsycINFO, CINAHL and Scopus. Studies elicited and compared preferences for cancer treatments between physicians and patients were included. Information about the study design and preference measuring attributes or questions were extracted. The available relative rank of every attribute in discrete choice experiment (DCE) studies and answers to preference measuring questions in non-DCE studies were summarized followed by a narrative synthesis to reflect the preference differences. RESULTS Of 12,959 studies identified, 8290 were included in the title and abstract screening and 48 were included in the full text screening. Included 37 studies measured the preferences from six treatment-related aspects: health benefit, adverse effects, treatment process, cost, impact on quality of life, and provider qualification. The trade-off between health benefit and adverse effects was the main focus of the included studies. DCE studies showed patients gave a higher rank on health benefit and treatment process, while physicians gave a higher rank on adverse effects. Non-DCE studies suggested that patients were willing to take a higher risk of adverse effects or lower health benefit than physicians when accepting a treatment. CONCLUSIONS Physicians and patients had important preference differences for cancer treatment. More sufficient communication is needed in cancer treatment decision-making.
Collapse
Affiliation(s)
- Mengqian Zhang
- School of Pharmaceutical Science and Technology, Tianjin University, No 92 Weijin Road, Nankai District, Tianjin, CO, 300072, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, No 92 Weijin Road, Nankai District, Tianjin, CO, 300072, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, No 92 Weijin Road, Nankai District, Tianjin, CO, 300072, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
3
|
Jiang S, Ren R, Gu Y, Jeet V, Liu P, Li S. Patient Preferences in Targeted Pharmacotherapy for Cancers: A Systematic Review of Discrete Choice Experiments. PHARMACOECONOMICS 2023; 41:43-57. [PMID: 36372823 PMCID: PMC9813042 DOI: 10.1007/s40273-022-01198-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Targeted pharmacotherapy has been increasingly applied in cancer treatment due to its breakthroughs. However, the unmet needs of cancer patients are still significant, highlighting the urgency to investigate patient preferences. It is unclear how patients deliberate their choices between different aspects of targeted therapy, including cost, efficacy, and adverse events. Since discrete choice experiments (DCEs) have been widely applied to patient preference elicitation, we reviewed DCEs on targeted therapy for different cancers. We also synthesized evidence on the factors influencing patients' choices and their willingness-to-pay (WTP) for survival when treated by targeted therapy. METHODS We searched databases, including PubMed, EMBASE and MEDLINE, up to August 16, 2022, supplemented by a reference screening. The attributes from the selected studies were categorized into three groups: outcomes, costs, and process. We also calculated the relative importance of attributes and WTP for survival whenever possible. The purpose, respondents, explanation, findings, significance (PREFS) checklist was used to evaluate the quality of the included DCE studies. RESULTS The review identified 34 eligible studies from 13 countries covering 14 cancers, such as breast, ovarian, kidney, prostate, and skin cancers. It also reveals a rising trend of DCEs on this topic, as most studies were published after 2018. We found that patients placed higher weights on the outcome (e.g., overall survival) and cost attributes than on process attributes. On average, patients were willing to pay $561 (95% confidence interval [CI]: $415-$758) and $716 (95% CI $524-$958) out-of-pocket for a 1-month increase in progression-free survival and overall survival, respectively. PREFS scores of the 34 studies ranged from 2 to 4, with a mean of 3.38 (SD: 0.65), suggesting a reasonable quality based on the checklist. However, most studies (n = 32, 94%) did not assess the impact of non-responses on the results. CONCLUSIONS This is the first systematic review focusing on patient preferences for targeted cancer therapy. We showcased novel approaches for evidence synthesis of DCE results, especially the attribute relative importance and WTP. The results may inform stakeholders about patient preferences toward targeted therapy and their WTP estimates. More studies with improved study design and quality are warranted to generate more robust evidence to assist decision making.
Collapse
Affiliation(s)
- Shan Jiang
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ru Ren
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
- Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247# Beiyuan Street, Jinan, 250033, China
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Varinder Jeet
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
| | - Ping Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| |
Collapse
|
4
|
Seghers PAL(N, Wiersma A, Festen S, Stegmann ME, Soubeyran P, Rostoft S, O’Hanlon S, Portielje JEA, Hamaker ME. Patient Preferences for Treatment Outcomes in Oncology with a Focus on the Older Patient-A Systematic Review. Cancers (Basel) 2022; 14:cancers14051147. [PMID: 35267455 PMCID: PMC8909757 DOI: 10.3390/cancers14051147] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary In oncology, treatment outcomes can be competing, which means that one treatment could benefit one outcome, like survival, and negatively influence another, like independence. The choice of treatment therefore depends on the patient’s preference for outcomes, which needs to be assessed explicitly. Especially in older patients, patient preferences are important. Our systematic review summarizes all studies that assessed patient preferences for various treatment outcome categories. A total of 28 studies with 4374 patients were included, of which only six studies included mostly older patients. Although quality of life was only included in half of the studies, overall quality of life (79%) was most frequently prioritized as highest or second highest, followed by overall survival (67%), progression- and disease-free survival (56%), absence of severe or persistent treatment side effects (54%), treatment response (50%), and absence of transient short-term side effects (16%). In shared decision-making, these results can be used by healthcare professionals to better tailor the information provision and treatment recommendations to the individual patient. Abstract For physicians, it is important to know which treatment outcomes are prioritized overall by older patients with cancer, since this will help them to tailor the amount of information and treatment recommendations. Older patients might prioritize other outcomes than younger patients. Our objective is to summarize which outcomes matter most to older patients with cancer. A systematic review was conducted, in which we searched Embase and Medline on 22 December 2020. Studies were eligible if they reported some form of prioritization of outcome categories relative to each other in patients with all types of cancer and if they included at least three outcome categories. Subsequently, for each study, the highest or second-highest outcome category was identified and presented in relation to the number of studies that included that outcome category. An adapted Newcastle–Ottawa Scale was used to assess the risk of bias. In total, 4374 patients were asked for their priorities in 28 studies that were included. Only six of these studies had a population with a median age above 70. Of all the studies, 79% identified quality of life as the highest or second-highest priority, followed by overall survival (67%), progression- and disease-free survival (56%), absence of severe or persistent treatment side effects (54%), and treatment response (50%). Absence of transient short-term side effects was prioritized in 16%. The studies were heterogeneous considering age, cancer type, and treatment settings. Overall, quality of life, overall survival, progression- and disease-free survival, and severe and persistent side effects of treatment are the outcomes that receive the highest priority on a group level when patients with cancer need to make trade-offs in oncologic treatment decisions.
Collapse
Affiliation(s)
| | - Anke Wiersma
- Department of Internal Medicine, Diakonessenhuis, 3582 KE Utrecht, The Netherlands;
| | - Suzanne Festen
- University Center for Geriatric Medicine, University Medical Hospital Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Mariken E. Stegmann
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Pierre Soubeyran
- Department of Oncology, Institut Bergonié, Université de Bordeaux, 33076 Bordeaux, France;
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, 0424 Oslo, Norway;
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Shane O’Hanlon
- Department of Geriatric Medicine, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland;
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Johanneke E. A. Portielje
- Department of Medical Oncology, Leiden University Medical Center-LUMC, 2333 ZA Leiden, The Netherlands;
| | - Marije E. Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, 3582 KE Utrecht, The Netherlands
- Correspondence: (P.A.L.S.); (M.E.H.)
| |
Collapse
|
5
|
Fernández O, Lázaro-Quintela M, Crespo G, Soto de Prado D, Pinto Á, Basterretxea L, Gómez de Liaño A, Etxaniz O, Blasco S, Gabás-Rivera C, Aceituno S, Palomar V, Polanco-Sánchez C. Preferences for Renal Cell Carcinoma Pharmacological Treatment: A Discrete Choice Experiment in Patients and Oncologists. Front Oncol 2022; 11:773366. [PMID: 35070976 PMCID: PMC8777125 DOI: 10.3389/fonc.2021.773366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction The purpose of this investigation was to explore patients’ and oncologists’ preferences for the characteristics of a pharmacological regimen for patients with advanced renal cell carcinoma (aRCC). Material and Methods Cross-sectional observational study based on a discrete choice experiment (DCE) conducted in Spain. A literature review, a focus group with oncologists and interviews with patients informed the DCE design. Five attributes were included: progression survival gain, risk of serious adverse events (SAEs), health-related quality of life (HRQoL), administration mode, and treatment cost. Preferences were analyzed using a mixed-logit model to estimate relative importance (RI) of attributes (importance of an attribute in relation to all others), which was compared between aRCC patients and oncologists treating aRCC. Willingness to pay (WTP, payer: health system) for a benefit in survival or in risk reduction and maximum acceptable risk (MAR) in SAEs for improving survival were estimated from the DCE. Subgroup analyses were performed to identify factors that influence preference. Results A total of 105 patients with aRCC (77.1% male, mean age 65.9 years [SD: 10.4], mean time since RCC diagnosis 6.3 years [SD: 6.1]) and 67 oncologists (52.2% male, mean age 41.9 years [SD: 8.4], mean duration of experience in RCC 10.2 years [SD: 7.5]) participated in the study. The most important attribute for patients and oncologists was survival gain (RI: 43.6% vs. 54.7% respectively, p<0.05), followed by HRQoL (RI: 35.5% vs. 18.0%, respectively, p<0.05). MAR for SAEs was higher among oncologists than patients, while WTP (for the health system) was higher for patients. Differences in preferences were found according to time since diagnosis and education level (patients) or length of professional experience (oncologists). Conclusion Patients’ and oncologists’ preferences for aRCC treatment are determined mainly by the efficacy (survival gain) but also by the HRQoL provided. The results of the study can help to inform decision-making in the selection of appropriate aRCC treatment.
Collapse
Affiliation(s)
- Ovidio Fernández
- Department of Oncology, Complejo Hospitalario Universitario de Orense, Orense, Spain
| | - Martín Lázaro-Quintela
- Department of Oncology, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain.,Translational Oncology Research Group (ONCO-INVES), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
| | - Guillermo Crespo
- Department of Oncology, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Diego Soto de Prado
- Department of Oncology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Álvaro Pinto
- Department of Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Basterretxea
- Department of Oncology, Donostialdea ESI/OSI Donostialdea, Donostia, Unibertsitate Ospitalea/Hospital Universitario Donostia, Donostia, Spain
| | - Alfonso Gómez de Liaño
- Department of Oncology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Olatz Etxaniz
- Department of Oncology, Institut Català d'Oncologia, Badalona, Spain
| | - Sara Blasco
- Department of Oncology, Hospital de Sagunto, Valencia, Spain
| | | | | | | | | |
Collapse
|
6
|
Collacott H, Soekhai V, Thomas C, Brooks A, Brookes E, Lo R, Mulnick S, Heidenreich S. A Systematic Review of Discrete Choice Experiments in Oncology Treatments. THE PATIENT 2021; 14:775-790. [PMID: 33950476 DOI: 10.1007/s40271-021-00520-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND As the number and type of cancer treatments available rises and patients live with the consequences of their disease and treatments for longer, understanding preferences for cancer care can help inform decisions about optimal treatment development, access, and care provision. Discrete choice experiments (DCEs) are commonly used as a tool to elicit stakeholder preferences; however, their implementation in oncology may be challenging if burdensome trade-offs (e.g. length of life versus quality of life) are involved and/or target populations are small. OBJECTIVES The aim of this review was to characterise DCEs relating to cancer treatments that were conducted between 1990 and March 2020. DATA SOURCES EMBASE, MEDLINE, and the Cochrane Database of Systematic Reviews were searched for relevant studies. STUDY ELIGIBILITY CRITERIA Studies were included if they implemented a DCE and reported outcomes of interest (i.e. quantitative outputs on participants' preferences for cancer treatments), but were excluded if they were not focused on pharmacological, radiological or surgical treatments (e.g. cancer screening or counselling services), were non-English, or were a secondary analysis of an included study. ANALYSIS METHODS Analysis followed a narrative synthesis, and quantitative data were summarised using descriptive statistics, including rankings of attribute importance. RESULT Seventy-nine studies were included in the review. The number of published DCEs relating to oncology grew over the review period. Studies were conducted in a range of indications (n = 19), most commonly breast (n =10, 13%) and prostate (n = 9, 11%) cancer, and most studies elicited preferences of patients (n = 59, 75%). Across reviewed studies, survival attributes were commonly ranked as most important, with overall survival (OS) and progression-free survival (PFS) ranked most important in 58% and 28% of models, respectively. Preferences varied between stakeholder groups, with patients and clinicians placing greater importance on survival outcomes, and general population samples valuing health-related quality of life (HRQoL). Despite the emphasis of guidelines on the importance of using qualitative research to inform attribute selection and DCE designs, reporting on instrument development was mixed. LIMITATIONS No formal assessment of bias was conducted, with the scope of the paper instead providing a descriptive characterisation. The review only included DCEs relating to cancer treatments, and no insight is provided into other health technologies such as cancer screening. Only DCEs were included. CONCLUSIONS AND IMPLICATIONS Although there was variation in attribute importance between responder types, survival attributes were consistently ranked as important by both patients and clinicians. Observed challenges included the risk of attribute dominance for survival outcomes, limited sample sizes in some indications, and a lack of reporting about instrument development processes. PROTOCOL REGISTRATION PROSPERO 2020 CRD42020184232.
Collapse
Affiliation(s)
- Hannah Collacott
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK.
| | - Vikas Soekhai
- Erasmus University, Rotterdam, The Netherlands
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Caitlin Thomas
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK
| | - Anne Brooks
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - Ella Brookes
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK
| | - Rachel Lo
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK
| | - Sarah Mulnick
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | | |
Collapse
|
7
|
Eriksson J, Landfeldt E, Ireland S, Jackson C, Wyatt E, Gaudig M. Stated preferences for relapsed or refractory mantle cell lymphoma treatments in Sweden and Germany. Future Oncol 2020; 16:859-868. [PMID: 32292062 DOI: 10.2217/fon-2020-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: We aimed to elicit treatment preferences in relapsed/refractory mantle cell lymphoma (r/r MCL). Materials & methods: A discrete-choice experiment comprising six attributes ('overall survival', 'progression-free survival', 'fatigue', 'nausea', 'risk of serious infections' and 'treatment administration') was administered to r/r MCL patients, physicians and the general population (GP) in Sweden and Germany. Results: 18 patients, 68 physicians and 191 GP members participated. 'Overall survival' was the most important attribute, followed by 'risk of serious infection' and 'progression-free survival' among physicians and the GP. In contrast, 'treatment administration' was the second most important attribute to patients, followed by 'risk of serious infection.' Conclusion: Preferences for characteristics differentiating treatments of r/r MCL varies between patients, physicians and members of the GP.
Collapse
Affiliation(s)
| | - Erik Landfeldt
- ICON plc, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Steve Ireland
- Janssen EMEA Business Intelligence, High Wycombe, UK
| | | | | | - Maren Gaudig
- Janssen Health Economics & Market Access EMEA, Neuss, Germany
| |
Collapse
|
8
|
Hauber B, Penrod JR, Gebben D, Musallam L. The Value of Hope: Patients' and Physicians' Preferences for Survival in Advanced Non-Small Cell Lung Cancer. Patient Prefer Adherence 2020; 14:2093-2104. [PMID: 33154633 PMCID: PMC7608144 DOI: 10.2147/ppa.s248295] [Citation(s) in RCA: 4] [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: 02/04/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Immuno-oncology treatments offer patients with advanced non-small cell lung cancer (NSCLC) treatment options with greater probability of durable survival and a different toxicity profile compared with traditional chemotherapy. The objective of this study was to explore the importance of increases in the probability of long-term survival versus changes in expected (median) survival and treatment toxicities among patients with advanced NSCLC and physicians. PATIENTS AND METHODS In a discrete-choice experiment, oncologists and patients diagnosed with NSCLC chose between profiles of treatments for advanced NSCLC offering different combinations of benefits (expected, best-case, and worst-case survival) and risks. We analyzed preference data from each sample using a random-parameters logit model that controls for preference heterogeneity and the panel nature of the data. RESULTS Both patients and physicians expressed a strong preference for improving the probability of best-case survival; however, patients viewed increases in the probability of long-term survival as more important than increases in expected survival, while the opposite was true for physicians. Both patients and physicians weighted survival to be more important than toxicities. CONCLUSION This study identified a potentially important divergence between physician and patient perspectives on survival statistics. Physicians placed more importance on increases in expected survival than did patients with NSCLC. The importance patients placed on long-term survival reinforce previous research identifying the primacy of hope as a value among seriously ill patients. The findings underscore the importance of considering patients' priorities and in shared decision-making when choosing treatment.
Collapse
Affiliation(s)
- Brett Hauber
- RTI Health Solutions, Research Triangle Park, NC, USA
- Correspondence: Brett Hauber Email
| | | | - David Gebben
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | |
Collapse
|
9
|
Raphael MJ, Robinson A, Booth CM, O'Donnell J, Palmer M, Eisenhauer E, Brundage M. The Value of Progression-Free Survival as a Treatment End Point Among Patients With Advanced Cancer: A Systematic Review and Qualitative Assessment of the Literature. JAMA Oncol 2019; 5:1779-1789. [PMID: 31556921 DOI: 10.1001/jamaoncol.2019.3338] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE It is unclear whether patients with advanced cancer value surrogate end points, particularly progression-free survival (PFS). Despite this uncertainty, surrogate end points form the basis of regulatory approval for the majority of new cancer treatments. OBJECTIVE To summarize and qualitatively assess studies evaluating whether patients with advanced cancer understand and value PFS. EVIDENCE REVIEW MEDLINE, Embase, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature databases were searched from database inception to November 12, 2018. Articles eligible for inclusion investigated patient understanding, preference, or perceived value of disease progression or PFS in the setting of advanced cancer. Three authors independently reviewed and extracted data from all studies eligible for inclusion. FINDINGS In total, 17 studies representing 3646 patients were included. Of these studies, 15 specifically aimed to assess patients' values toward, and their willingness to trade off toxic effects for gains or losses in the end point of PFS. All studies examined used widely disparate definitions when attempting to describe the meaning of PFS to patients. Ten studies specifically presented patients with the term progression-free survival as an attribute choice. In the words used to define the attribute of PFS, 6 studies used the term survival. Five studies clarified that PFS may not translate into better overall survival, and 5 studies explained that improvements in PFS may not reflect how well the patient may feel. No study clarified that a PFS event could represent either progression or death, and no study defined for the patient what constituted progression. The studies assessed herein underrepresented ethnic and racial minorities (mean percentage of white patients, 88%; range, 77%-96%). Values and preferences may vary across cultural backgrounds given that different relative preferences were assigned to cost and efficacy outcomes in North American vs Asian studies, although only a few studies were evaluated. CONCLUSIONS AND RELEVANCE The existing literature evaluating patients' understanding, preferences, and values toward the end point of PFS was severely limited by the heterogeneity of methods, attribute selection, and descriptions used to define PFS to patients. High-quality studies are needed that clearly define PFS for patients and that systematically document their understanding of the term. Only then can it be assessed whether PFS is an end point of value to patients with advanced cancer.
Collapse
Affiliation(s)
- Michael J Raphael
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Andrew Robinson
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jennifer O'Donnell
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - Michael Palmer
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | | | - Michael Brundage
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
10
|
Clark MD, Szczepura A, Gumber A, Howard K, Moro D, Morton RL. Measuring trade-offs in nephrology: a systematic review of discrete choice experiments and conjoint analysis studies. Nephrol Dial Transplant 2019; 33:348-355. [PMID: 28158746 DOI: 10.1093/ndt/gfw436] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 11/18/2016] [Indexed: 12/27/2022] Open
Abstract
Background Discrete choice experiment (DCE), conjoint analysis or adaptive conjoint analysis methods are increasingly applied to obtain patient, clinician or community preferences in nephrology. This study systematically reviews the above-mentioned published choice studies providing an overview of the issues addressed, methods and findings. Methods Choice studies relating to nephrology were identified using electronic databases, including Medline, Embase, PsychINFO and Econlit from 1990 to 2015. For inclusion in the review, studies had to primarily relate to kidney disease and include results from statistical (econometric) analyses of respondents' choice or preference. Studies meeting the inclusion criteria were assessed against a range of systematic review criteria, and methods and results summarized. Results We identified 14 eligible studies from Europe, Australasia, North America and Asia, reporting preferences for treatment or screening, patient experiences, quality of life (QOL), health outcomes and priority-setting frameworks. Specific contexts included medical interventions in kidney transplantation and renal cell carcinoma, health policies for organ donation and allocation, dialysis modalities and end-of-life care, using a variety of statistical models. The characteristics of 'time' (i.e. transplant waiting time, dialysis hours, transport time) and QOL (pre- and post-transplant, or pre- and post-dialysis) consistently influenced patient and clinician preferences across the choice studies. Conclusions DCE are increasingly used to obtain information about key preferences in kidney transplantation and dialysis. These study methods provide quantitative information about respondents' trade-offs between conflicting clinical and policy objectives, and can establish how preferences vary among stakeholder groups.
Collapse
Affiliation(s)
- Michael D Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ala Szczepura
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - Anil Gumber
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Domenico Moro
- Department of Economics, University of Birmingham, Birmingham, UK
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
11
|
González JM, Doan J, Gebben DJ, Boeri M, Fishman M. Comparing the Relative Importance of Attributes of Metastatic Renal Cell Carcinoma Treatments to Patients and Physicians in the United States: A Discrete-Choice Experiment. PHARMACOECONOMICS 2018; 36:973-986. [PMID: 29869777 DOI: 10.1007/s40273-018-0640-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Value assessments of new treatments for metastatic renal cell carcinoma (RCC) should include outcomes that are most important to patients. This study aimed to quantify and compare the conditional relative importance of the attributes of RCC treatments to patients and physicians in the United States. METHODS Patients with RCC and physicians who treat RCC completed an online discrete-choice experiment survey with a fractional factorial D-optimal experimental design. In a series of 12 questions, respondents chose between two hypothetical treatments defined in terms of six attributes: progression-free survival (PFS), probability of living ≥ 3 years (PL3Y), skin reactions, severity of fatigue, mode of administration, and monthly co-payment. Treatment choices were analyzed using a random-parameters logit model to estimate relative preference weights for the attribute levels and conditional relative attribute importance (i.e. the importance of an attribute relative to all other attributes conditional on the range of levels of that attribute). RESULTS Overall, 201 patients and 142 physicians completed the survey. For both patients and physicians, PL3Y was the attribute with the greatest and statistically significant conditional relative importance. Estimates of the conditional relative importance of PFS, skin reactions, and mode of administration for patients, and for PFS and mode of administration for physicians, were not statistically significant. The preferences for improvements in PFS were independent of the level of PL3Y for both patients and physicians. Conditional relative attribute importance varied by patient disease stage. CONCLUSIONS Patients and physicians indicated that PL3Y was the most important treatment attribute and was significantly more important than PFS. Importance rankings differed between physicians and patients and between all patients and those with advanced/metastatic disease.
Collapse
Affiliation(s)
| | - Justin Doan
- Bristol-Myers Squibb, 3551 Lawrence Rd, Princeton, NJ, 08540, USA
| | - David J Gebben
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Marco Boeri
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Mayer Fishman
- Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| |
Collapse
|
12
|
Bayraktar-Ekincioglu A, Kucuk E. The differences in the assessments of side effects at an oncology outpatient clinic. Int J Clin Pharm 2018; 40:386-393. [DOI: 10.1007/s11096-018-0590-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 01/05/2018] [Indexed: 02/05/2023]
|
13
|
Bien DR, Danner M, Vennedey V, Civello D, Evers SM, Hiligsmann M. Patients' Preferences for Outcome, Process and Cost Attributes in Cancer Treatment: A Systematic Review of Discrete Choice Experiments. THE PATIENT 2017; 10:553-565. [PMID: 28364387 PMCID: PMC5605613 DOI: 10.1007/s40271-017-0235-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION As several studies have been conducted to elicit patients' preferences for cancer treatment, it is important to provide an overview and synthesis of these studies. This study aimed to systematically review discrete choice experiments (DCEs) about patients' preferences for cancer treatment and assessed the relative importance of outcome, process and cost attributes. METHODS A systematic literature review was conducted using PubMed and EMBASE to identify all DCEs investigating patients' preferences for cancer treatment between January 2010 and April 2016. Data were extracted using a predefined extraction sheet, and a reporting quality assessment was applied to all studies. Attributes were classified into outcome, process and cost attributes, and their relative importance was assessed. RESULTS A total of 28 DCEs were identified. More than half of the studies (56%) received an aggregate score lower than 4 on the PREFS (Purpose, Respondents, Explanation, Findings, Significance) 5-point scale. Most attributes were related to outcome (70%), followed by process (25%) and cost (5%). Outcome attributes were most often significant (81%), followed by process (73%) and cost (67%). The relative importance of outcome attributes was ranked highest in 82% of the cases where it was included, followed by cost (43%) and process (12%). CONCLUSION This systematic review suggests that attributes related to cancer treatment outcomes are the most important for patients. Process and cost attributes were less often included in studies but were still (but less) important to patients in most studies. Clinicians and decision makers should be aware that attribute importance might be influenced by level selection for that attribute.
Collapse
Affiliation(s)
- Daniela R Bien
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marion Danner
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Vera Vennedey
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Daniele Civello
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Silvia M Evers
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 6161, 6200 MD, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 6161, 6200 MD, Maastricht, The Netherlands.
| |
Collapse
|
14
|
Kremer IEH, Evers SMAA, Jongen PJ, Hiligsmann M. Comparison of preferences of healthcare professionals and MS patients for attributes of disease-modifying drugs: A best-worst scaling. Health Expect 2017; 21:171-180. [PMID: 28734004 PMCID: PMC5750752 DOI: 10.1111/hex.12599] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 12/19/2022] Open
Abstract
Background The choice between disease‐modifying drugs (DMDs) for the treatment of multiple sclerosis (MS) becomes more often a shared decision between the patient and the neurologist and MS nurse. This study aimed to assess which DMD attributes are most important for the healthcare professionals in selecting a DMD for a patient. Subsequently, within this perspective, the neurologists’ and nurses’ perspectives were compared. Lastly, the healthcare professionals’ perspective was compared with the patients’ perspective to detect any differences that may need attention in the communication about DMDs. Design A best‐worst scaling (BWS) was conducted among 27 neurologists and 33 MS nurses treating patients with MS to determine the importance of 27 DMD attributes. These attributes were identified through three focus groups with MS patients in a previous study (N=19). Relative importance scores (RISs) were estimated for each attribute. Multivariable linear regression analyses were used to compare the different perspectives. Results According to the neurologists and nurses, safety of the DMD was the most important DMD attribute in the treatment decision, closely followed by effect on disability progression, quality of life and relapse rate. Patients with MS agreed with the importance of the last three attributes, but valued safety significantly lower (b=−2.59, P<.001). Conclusions This study suggests that, overall, neurologists and nurses regard the same DMD attributes as important as MS patients with the notable exception of safety. This study provides valuable information for the development of interventions to support shared decision making and highlights which attributes of DMDs may need additional attention.
Collapse
Affiliation(s)
- Ingrid E H Kremer
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Center for Economic Evaluations, Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Peter J Jongen
- MS4 Research Institute, Nijmegen, The Netherlands.,Department of Community & Occupational Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
15
|
Harrison M, Milbers K, Hudson M, Bansback N. Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments. BMJ Open 2017; 7:e014719. [PMID: 28515194 PMCID: PMC5623426 DOI: 10.1136/bmjopen-2016-014719] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To review studies eliciting patient and healthcare provider preferences for healthcare interventions using discrete choice experiments (DCEs) to (1) review the methodology to evaluate similarities, differences, rigour of designs and whether comparisons are made at the aggregate level or account for individual heterogeneity; and (2) quantify the extent to which they demonstrate concordance of patient and healthcare provider preferences. METHODS A systematic review searching Medline, EMBASE, Econlit, PsycINFO and Web of Science for DCEs using patient and healthcare providers. INCLUSION CRITERIA peer-reviewed; complete empiric text in English from 1995 to 31July 2015; discussing a healthcare-related topic; DCE methodology; comparing patients and healthcare providers. DESIGN Systematic review. RESULTS We identified 38 papers exploring 16 interventions in 26 diseases/indications. Methods to analyse results, determine concordance between patient and physician values, and explore heterogeneity varied considerably between studies. The majority of studies we reviewed found more evidence of mixed concordance and discordance (n=28) or discordance of patient and healthcare provider preferences (n=12) than of concordant preferences (n=4). A synthesis of concordance suggested that healthcare providers rank structure and outcome attributes more highly than patients, while patients rank process attributes more highly than healthcare providers. CONCLUSIONS Discordant patient and healthcare provider preferences for different attributes of healthcare interventions are common. Concordance varies according to whether attributes are processes, structures or outcomes, and therefore determining preference concordance should consider all aspects jointly and not a binary outcome. DCE studies provide excellent opportunities to assess value concordance between patients and providers, but assessment of concordance was limited by a lack of consistency in the approaches used and consideration of heterogeneity of preferences. Future DCEs assessing concordance should fully report the framing of the questions and investigate the heterogeneity of preferences within groups and how these compare.
Collapse
Affiliation(s)
- Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, Canada
| | - Katherine Milbers
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montréal, Canada
- Division of Rheumatology, Jewish General Hospital, Montréal, Canada
- Lady Davis Institute for Medical Research, Montréal, Canada
| | - Nick Bansback
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| |
Collapse
|
16
|
Abstract
Background Two previous systematic reviews have summarised the application of discrete choice experiments to value preferences for pharmacy services. These reviews identified a total of twelve studies and described how discrete choice experiments have been used to value pharmacy services but did not describe or discuss the application of methods used in the design or analysis. Aims (1) To update the most recent systematic review and critically appraise current discrete choice experiments of pharmacy services in line with published reporting criteria and; (2) To provide an overview of key methodological developments in the design and analysis of discrete choice experiments. Methods The review used a comprehensive strategy to identify eligible studies (published between 1990 and 2015) by searching electronic databases for key terms related to discrete choice and best-worst scaling (BWS) experiments. All healthcare choice experiments were then hand-searched for key terms relating to pharmacy. Data were extracted using a published checklist. Results A total of 17 discrete choice experiments eliciting preferences for pharmacy services were identified for inclusion in the review. No BWS studies were identified. The studies elicited preferences from a variety of populations (pharmacists, patients, students) for a range of pharmacy services. Most studies were from a United Kingdom setting, although examples from Europe, Australia and North America were also identified. Discrete choice experiments for pharmacy services tended to include more attributes than non-pharmacy choice experiments. Few studies reported the use of qualitative research methods in the design and interpretation of the experiments (n = 9) or use of new methods of analysis to identify and quantify preference and scale heterogeneity (n = 4). No studies reported the use of Bayesian methods in their experimental design. Conclusion Incorporating more sophisticated methods in the design of pharmacy-related discrete choice experiments could help researchers produce more efficient experiments which are better suited to valuing complex pharmacy services. Pharmacy-related discrete choice experiments could also benefit from more sophisticated analytical techniques such as investigations into scale and preference heterogeneity. Employing these sophisticated methods for both design and analysis could extend the usefulness of discrete choice experiments to inform health and pharmacy policy.
Collapse
Affiliation(s)
- Caroline Vass
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, UK
| | - Ewan Gray
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, UK.
| |
Collapse
|
17
|
Mansfield C, Srinivas S, Chen C, Hauber AB, Hariharan S, Matczak E, Sandin R. The effect of information on preferences for treatments of metastatic renal cell carcinoma. Curr Med Res Opin 2016; 32:1827-1838. [PMID: 27404275 DOI: 10.1080/03007995.2016.1211521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Limited information exists regarding the effect of uncertainty in outcomes on patient preferences for metastatic renal cell carcinoma (mRCC) treatments. This study tested the effect on patients' preferences and willingness to tolerate toxicities when patients were provided with information about possible correlations between treatment-related toxicities and efficacy. RESEARCH DESIGN AND METHODS Patients with self-reported RCC diagnosis completed an online survey. Respondents were randomly assigned to the information treatment (i.e. information about the possible correlation). Medicines were defined by progression-free survival (PFS), three toxicities potentially correlated with PFS, and one toxicity uncorrelated with PFS. Direct-elicitation questions measured willingness to tolerate the toxicities, preferences for medicines with higher toxicity but a higher chance of longer PFS, and preferences for medicines with higher toxicity during treatment and a 2 week dosing schedule break. A discrete-choice experiment (DCE) tested the effect of information on relative preferences for medication attributes. RESULTS A total of 378 RCC patients completed the survey. Respondents who received the information reported greater willingness to accept more severe toxicities and preferred treatment with a higher chance of longer PFS but more severe toxicities. The DCE results were consistent with the hypothesis that the information increased willingness to tolerate toxicities; however, the results were only statistically significant for changes in fatigue (none to severe; p < 0.05) and hypertension (none to manageable; p < 0.05). LIMITATIONS Online recruitment through patient support groups may limit generalizability to the population of patients with mRCC who would be candidates for the targeted therapies. CONCLUSIONS The findings suggest that RCC patients have diverse preferences but may be willing to continue targeted therapies, even in the presence of severe toxicities, if there is a chance of improved clinical benefit. Physicians should provide patients with comprehensive information about medication features, including toxicities and efficacy (and their potential correlation), to improve compliance and optimize outcomes.
Collapse
Affiliation(s)
| | - Sandy Srinivas
- b Stanford University Medical Center , Stanford , CA , USA
| | | | - A Brett Hauber
- a RTI Health Solutions , Research Triangle Park , NC , USA
| | | | | | | |
Collapse
|
18
|
Patient, physician, and general population preferences for treatment characteristics in relapsed or refractory chronic lymphocytic leukemia: A conjoint analysis. Leuk Res 2016; 40:17-23. [DOI: 10.1016/j.leukres.2015.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/23/2015] [Accepted: 11/07/2015] [Indexed: 11/19/2022]
|
19
|
Clark MD, Determann D, Petrou S, Moro D, de Bekker-Grob EW. Discrete choice experiments in health economics: a review of the literature. PHARMACOECONOMICS 2014; 32:883-902. [PMID: 25005924 DOI: 10.1007/s40273-014-0170-x] [Citation(s) in RCA: 500] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Discrete choice experiments (DCEs) are increasingly used in health economics to address a wide range of health policy-related concerns. OBJECTIVE Broadly adopting the methodology of an earlier systematic review of health-related DCEs, which covered the period 2001-2008, we report whether earlier trends continued during 2009-2012. METHODS This paper systematically reviews health-related DCEs published between 2009 and 2012, using the same database as the earlier published review (PubMed) to obtain citations, and the same range of search terms. RESULTS A total of 179 health-related DCEs for 2009-2012 met the inclusion criteria for the review. We found a continuing trend towards conducting DCEs across a broader range of countries. However, the trend towards including fewer attributes was reversed, whilst the trend towards interview-based DCEs reversed because of increased computer administration. The trend towards using more flexible econometric models, including mixed logit and latent class, has also continued. Reporting of monetary values has fallen compared with earlier periods, but the proportion of studies estimating trade-offs between health outcomes and experience factors, or valuing outcomes in terms of utility scores, has increased, although use of odds ratios and probabilities has declined. The reassuring trend towards the use of more flexible and appropriate DCE designs and econometric methods has been reinforced by the increased use of qualitative methods to inform DCE processes and results. However, qualitative research methods are being used less often to inform attribute selection, which may make DCEs more susceptible to omitted variable bias if the decision framework is not known prior to the research project. CONCLUSIONS The use of DCEs in healthcare continues to grow dramatically, as does the scope of applications across an expanding range of countries. There is increasing evidence that more sophisticated approaches to DCE design and analytical techniques are improving the quality of final outputs. That said, recent evidence that the use of qualitative methods to inform attribute selection has declined is of concern.
Collapse
Affiliation(s)
- Michael D Clark
- Department of Economics, University of Warwick, Coventry, CV4 7AL, UK,
| | | | | | | | | |
Collapse
|