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Feldman SR, Thyssen JP, Boeri M, Gerber R, Neary MP, Cha A, Hauber B, Cappelleri JC, Xenakis J, Leach C, Zeichner J. Adult, adolescent, and caregiver preferences for attributes of topical treatments for mild-to-moderate atopic dermatitis: a discrete-choice experiment. J DERMATOL TREAT 2024; 35:2304020. [PMID: 38221777 DOI: 10.1080/09546634.2024.2304020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
Purpose: Topical treatments for mild-to-moderate (MM) atopic dermatitis (AD) include emollients, corticosteroids, calcineurin inhibitors, a Janus kinase inhibitor, and a phosphodiesterase 4 inhibitor, which differ in multiple ways. This study aimed to quantify the conditional relative importance (CRI) of attributes of topical treatments for MM AD among adult and adolescent patients and caregivers of children with MM AD.Materials and methods: A discrete-choice experiment (DCE) survey was administered to US adults and adolescents with MM AD and caregivers of children with MM AD. Each choice task comprised 2 hypothetical topical treatments characterized by efficacy, adverse events, vehicle, and application frequency. Data were analyzed using a random-parameters logit model to calculate the CRI of each attribute.Results and conclusions: 300 adults, 331 adolescents, and 330 caregivers completed the DCE. Avoiding changes in skin color (CRI 29.0) and time until itch improves (26.6) were most important to adults, followed by time until clear/almost clear skin (17.8). Application frequency (3.0) did not have a statistically significant impact on adults' choices. Adolescents were less concerned about changes in skin color than adults or caregivers; caregivers were less concerned about time until clear/almost clear skin than patients. Physicians should consider age-relevant aspects of preferences in treatment discussions with patients and caregivers.
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Affiliation(s)
- Steven R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jacob P Thyssen
- Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Marco Boeri
- RTI Health Solutions, Belfast, UK
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | | | | | - Amy Cha
- Pfizer Inc, New York, NY, USA
| | | | | | | | | | - Joshua Zeichner
- Department of Dermatology, Mount Sinai Hospital, New York, NY, USA
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Connor MJ, Genie M, Dudderidge T, Wu H, Sukumar J, Beresford M, Bianchini D, Goh C, Horan G, Innominato P, Khoo V, Klimowska-Nassar N, Madaan S, Mangar S, McCracken S, Ostler P, Paisey S, Robinson A, Rai B, Sarwar N, Srihari N, Jayaprakash KT, Varughese M, Winkler M, Ahmed HU, Watson V. Patients' Preferences for Cytoreductive Treatments in Newly Diagnosed Metastatic Prostate Cancer: The IP5-MATTER Study. Eur Urol Oncol 2024:S2588-9311(24)00158-5. [PMID: 38972831 DOI: 10.1016/j.euo.2024.06.010] [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: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity. Our objective was to determine patients' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions. METHODS A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes. KEY FINDINGS AND LIMITATIONS A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a "day-case" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively. CONCLUSIONS AND CLINICAL IMPLICATIONS Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue. PATIENT SUMMARY We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue.
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Affiliation(s)
- Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Mesfin Genie
- Health Economics Research Unit (HERU), Institute of Applied Health Science, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK; Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia; Department of Population Health Sciences, Duke University, Durham, USA
| | - Tim Dudderidge
- Urology, University Hospital Southampton, Southampton, UK
| | - Hangjian Wu
- Health Economics Research Unit (HERU), Institute of Applied Health Science, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Johanna Sukumar
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial College Clinical Trials Unit, Imperial College London, London, UK
| | - Mark Beresford
- Department of Oncology, Royal United Hospitals Bath, Bath, UK
| | - Diletta Bianchini
- Department of Oncology and Urology, Medway Maritime Hospital, Kent, UK
| | - Chee Goh
- Department of Oncology, East Surrey Hospital, Redhill, UK
| | - Gail Horan
- Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust & The Cancer Centre, Addenbrooke's Hospital, Cambridge, UK
| | | | - Vincent Khoo
- Department of Oncology, The Royal Marsden Hospital, London, UK
| | | | - Sanjeev Madaan
- Department of Urology, Dartford and Gravesham NHS Trust, Kent, UK
| | - Stephen Mangar
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Stuart McCracken
- Department of Urology, Sunderland Royal Hospital, Sunderland, UK
| | - Peter Ostler
- Department of Oncology, Luton and Dunstable University Hospital, Luton, UK
| | - Sangeeta Paisey
- Department of Oncology, Hampshire Hospitals NHS Foundation Trust, Basingstoke and Winchester, UK
| | - Angus Robinson
- Department of Oncology, Royal Sussex County Hospital, Brighton, UK
| | - Bhavan Rai
- Department of Urology, Newcastle Freeman Hospital, Newcastle, UK
| | - Naveed Sarwar
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Kamal Thippu Jayaprakash
- Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust & The Cancer Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Mohini Varughese
- Department of Oncology, Royal Devon and Exeter NHS Foundation Trust, Oncology, Exeter, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Urology, West Middlesex University Hospital, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Verity Watson
- Health Economics Research Unit (HERU), Institute of Applied Health Science, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
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3
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Mah J, Magari R, Lo KK, Winden N, Xu G. A benefit risk approach in cutoff determination for diagnostic tests. Clin Chim Acta 2024; 559:117887. [PMID: 38643818 DOI: 10.1016/j.cca.2024.117887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/08/2024] [Accepted: 03/22/2024] [Indexed: 04/23/2024]
Abstract
A crucial step in the design of a diagnostic test is determining the cutoff point, the threshold which separates a negative measurement from a positive one. The results of a diagnostic test have clinical consequences: only when disease is accurately detected, proper treatments be administered, and vice versa. Benefit-Risk (BR) analysis should be used to determine the optimal cutoff point that optimizes the consequence. Quantitative BR analysis requires measurable benefit and risk and a function, e.g., linear or ratio, to combine all the components. When BR corresponding to the four possible diagnostic test outcomes are all scaled in units of risk resulting from an untreated disease, we propose a net BR (linear BR) equation as a function of diagnostic parameters, disease prevalence, benefit of correct diagnosis and risk of false diagnostic results. Optimal cutoff of a diagnostic test can be obtained using this function. Comparison of diagnostic tests based on their benefit and risk of tests is also discussed. Use of this function is illustrated with a biosensor rapid antigen test for SARS-CoV-2.
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Affiliation(s)
- Jeng Mah
- Department of Biostatistics and Data Management, Beckman Coulter, Inc. Chaska, MN, USA.
| | - Robert Magari
- Department of Biostatistics and Data Management, Beckman Coulter, Inc. Miami, Florida, USA.
| | - Karen Kw Lo
- Department of Biostatistics and Data Management, Beckman Coulter, Inc. Miami, Florida, USA.
| | - Nicole Winden
- Department of Biostatistics and Data Management, Beckman Coulter, Inc. Chaska, MN, USA.
| | - Gang Xu
- Department of Biostatistics, Vertex Pharmaceuticals, Inc. Boston, MA, USA.
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Simonetti A, Colilla S, Edwards B, Kübler J, Lackey L, Rodriguez L, Talbot S, Yang H, Wang W, Williams D, Higginson JM. Key Opinion Leaders' Interviews to Inform the Future of Benefit-Risk Planning in the Medical Total Product Life Cycle of Global Pharmaceutical and Medical Device Organizations. Drug Saf 2024:10.1007/s40264-024-01442-4. [PMID: 38824267 DOI: 10.1007/s40264-024-01442-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Key opinion leader (KOL) interviews were conducted by the Benefit-Risk Assessment Planning (BRAP) Taskforce to seek expert opinion mainly from industry and regulatory bodies, about the current status and future direction of benefit-risk assessment (BRA) planning in the lifecycle of medical product development. The findings from these interviews are intended to help communication concerning planning for BRA between industry and regulators and shape future guidance. METHODS Key opinion leader interviews consisted of 5 questions related to BRA planning, which were administered to volunteers (mainly clinicians and statisticians) within a pool of experienced pharmaceutical and medical device professionals representing academia, industry, regulatory agencies and a patient group. The interviewees' responses to the 5 questions were summarized. To analyze the qualitative data, a Coding System was developed to label themes arising from the interviews. The key findings from the interviews were summarized into a Master Template. A quantitative analysis based on descriptive statistics was also conducted. RESULTS Of the 27 interviewees, there were 11 professionals from regulatory agencies, 11 from industry, 4 from academia and 1 from a patient advocacy group. Key findings based on the comments provided by 48% of the interviewees indicated the need of incorporating BRA into other (e.g., existing) processes with the importance of alignment between processes being stressed in the comments provided by 59% of the interviewees. Commencing BRA early in the product lifecycle was emphasized in comments provided by 44% of the interviewees. Among other needs identified were an appropriate contextualization of benefits and risks (based on comments provided by 41% of interviewees) through adoption of an integrated approach with structured support by regulatory agencies and a need for understanding the audience with better communication of benefit-risk (BR) among all stakeholders (based on comments provided by 44% of the interviewees). Almost all comments provided by interviewees (96%) highlighted the importance of utilizing patient experience/preference to guide new product development and BRA. Comments provided by 74% of the interviewees expressed the need to understand patient tolerance for risk and trade-offs, with a majority (78%) of interviewees highlighting how to gather information, and 59% stressing the need for the selection and development of appropriate methodologies as important considerations for enhancing the quality and relevance of the data collected from patients. CONCLUSIONS Interviewees indicated that BRA should commence early in the medical product development and inform decision-making throughout the product lifecycle. Better planning and integration of BRA into existing processes within industry would be valuable. The importance of incorporating the patient voice into BRA and medical product development was emphasized. Other key findings from the KOL interviews included a need for improved communication of BR information, and establishment of methodologies for performing BRA and soliciting patient input.
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Affiliation(s)
- Arianna Simonetti
- Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA.
| | | | | | - Jürgen Kübler
- Quantitative Scientific Consulting, Marburg, Germany
| | - Leila Lackey
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Lisa Rodriguez
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Hong Yang
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - William Wang
- Biostatistics and Research Decision Sciences, Merck Sharp & Dohme LLC, Rahway, NJ, USA
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Almeida D, Umuhire D, Gonzalez-Quevedo R, António A, Burgos JG, Verpillat P, Bere N, Sepodes B, Torre C. Leveraging patient experience data to guide medicines development, regulation, access decisions and clinical care in the EU. Front Med (Lausanne) 2024; 11:1408636. [PMID: 38846141 PMCID: PMC11153762 DOI: 10.3389/fmed.2024.1408636] [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: 03/28/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Patient experience data (PED), provided by patients/their carers without interpretation by clinicians, directly capture what matters more to patients on their medical condition, treatment and impact of healthcare. PED can be collected through different methodologies and these need to be robust and validated for its intended use. Medicine regulators are increasingly encouraging stakeholders to generate, collect and submit PED to support both scientific advice in development programs and regulatory decisions on the approval and use of these medicines. This article reviews the existing definitions and types of PED and demonstrate the potential for use in different settings of medicines' life cycle, focusing on Patient-Reported Outcomes (PRO) and Patient Preferences (PP). Furthermore, it addresses some challenges and opportunities, alluding to important regulatory guidance that has been published, methodological aspects and digitalization, highlighting the lack of guidance as a key hurdle to achieve more systematic inclusion of PED in regulatory submissions. In addition, the article discusses opportunities at European and global level that could be implemented to leverage PED use. New digital tools that allow patients to collect PED in real time could also contribute to these advances, but it is equally important not to overlook the challenges they entail. The numerous and relevant initiatives being developed by various stakeholders in this field, including regulators, show their confidence in PED's value and create an ideal moment to address challenges and consolidate PED use across medicines' life cycle.
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Affiliation(s)
- Diogo Almeida
- Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science, Research Institute for Medicines (iMed.ULisboa), Lisbon, Portugal
- Faculdade de Farmácia, Universidade de Lisboa, Lisbon, Portugal
| | - Denise Umuhire
- Data Analytics and Methods Task Force, European Medicines Agency, Amsterdam, Netherlands
| | - Rosa Gonzalez-Quevedo
- Public and Stakeholders Engagement Department, European Medicines Agency, Amsterdam, Netherlands
| | - Ana António
- Referrals Office, Quality and Safety of Medicines Department, European Medicines Agency, Amsterdam, Netherlands
| | - Juan Garcia Burgos
- Public and Stakeholders Engagement Department, European Medicines Agency, Amsterdam, Netherlands
| | - Patrice Verpillat
- Data Analytics and Methods Task Force, European Medicines Agency, Amsterdam, Netherlands
| | - Nathalie Bere
- Regulatory Practice and Analysis, Medsafe—New Zealand Medicines and Medical Devices Safety Authority, Wellington, New Zealand
| | - Bruno Sepodes
- Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science, Research Institute for Medicines (iMed.ULisboa), Lisbon, Portugal
- Faculdade de Farmácia, Universidade de Lisboa, Lisbon, Portugal
| | - Carla Torre
- Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science, Research Institute for Medicines (iMed.ULisboa), Lisbon, Portugal
- Faculdade de Farmácia, Universidade de Lisboa, Lisbon, Portugal
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Oliveira M, Navarro M, Costa E, Kremer D, Pinheiro R, Freitas V, Modesto I, Macedo E, Ferreira J, Andrade D, Damasceno L, Joseneas E. Potential risk assessment: a model for quality evaluation in fluoroscopy-guided interventional procedures. RADIATION PROTECTION DOSIMETRY 2024; 200:693-699. [PMID: 38679858 DOI: 10.1093/rpd/ncae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/06/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
This study presented a model applied for potential risk assessment in an interventional radiology setting. The model of potential risk assessment (MARP) consisted of the creation of a scale of indicators ranging from 0 to 5. The radiation levels were categorized according to gender, kind of procedure, value of kerma air product (Pka), and accumulated radiation dose (mGy). The MARP model was applied in 121 institutions over 8 y. A total of 201 656 patient radiation doses (Dose-area product and accumulated kerma) data were launched into the system over time, with an average of 22 406 doses per year. In the context of the workers (cardiologists, radiographers, and nurses) monitored during the MARP application, 8007 cases (with an average of 890 per year) of occupational radiation doses were recorded. This study showed a strategy for quality evaluation in fluoroscopy using a model with a compulsory information system for monitoring safety.
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Affiliation(s)
- Marcus Oliveira
- Department of Health Technology and Biology, Federal Institute of Bahia, Salvador, 40301-015, Brazil
- Labprosaud, Laboratório de Produtos para a Saúde do IFBA, Salvador, BA 41745-715, Brazil
| | - Marcus Navarro
- Department of Health Technology and Biology, Federal Institute of Bahia, Salvador, 40301-015, Brazil
- Labprosaud, Laboratório de Produtos para a Saúde do IFBA, Salvador, BA 41745-715, Brazil
| | - Eliana Costa
- Universidade do Estado da Bahia, Departamento de Ciências da vida, Salvador, BA 41.150-000, Brasil
| | - Djeimis Kremer
- Vigilância Sanitária do Estado de Santa Catarina, Gerência de Saúde do Trabalhador - GESAT, Florianópolis, Santa Catarina, 88015-200, Brasil
| | - Regina Pinheiro
- Vigilância Sanitária do Estado de Santa Catarina, Gerência de Saúde do Trabalhador - GESAT, Florianópolis, Santa Catarina, 88015-200, Brasil
| | - Vanessa Freitas
- Sociedade Brasileira de Avaliação de Risco, Salvador, Bahia 40.279-120, Brasil
| | - Igor Modesto
- Labprosaud, Laboratório de Produtos para a Saúde do IFBA, Salvador, BA 41745-715, Brazil
| | - Erik Macedo
- Labprosaud, Laboratório de Produtos para a Saúde do IFBA, Salvador, BA 41745-715, Brazil
| | - Jeovana Ferreira
- Labprosaud, Laboratório de Produtos para a Saúde do IFBA, Salvador, BA 41745-715, Brazil
| | - Daniele Andrade
- Labprosaud, Laboratório de Produtos para a Saúde do IFBA, Salvador, BA 41745-715, Brazil
| | - Lauro Damasceno
- Sociedade Brasileira de Avaliação de Risco, Salvador, Bahia 40.279-120, Brasil
| | - Enoque Joseneas
- Sociedade Brasileira de Avaliação de Risco, Salvador, Bahia 40.279-120, Brasil
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Khadem Charvadeh Y, Yi GY. Accommodating misclassification effects on optimizing dynamic treatment regimes with Q-learning. Stat Med 2024; 43:578-605. [PMID: 38213277 DOI: 10.1002/sim.9973] [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: 11/01/2022] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024]
Abstract
Research on dynamic treatment regimes has enticed extensive interest. Many methods have been proposed in the literature, which, however, are vulnerable to the presence of misclassification in covariates. In particular, although Q-learning has received considerable attention, its applicability to data with misclassified covariates is unclear. In this article, we investigate how ignoring misclassification in binary covariates can impact the determination of optimal decision rules in randomized treatment settings, and demonstrate its deleterious effects on Q-learning through empirical studies. We present two correction methods to address misclassification effects on Q-learning. Numerical studies reveal that misclassification in covariates induces non-negligible estimation bias and that the correction methods successfully ameliorate bias in parameter estimation.
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Affiliation(s)
- Yasin Khadem Charvadeh
- Department of Statistical and Actuarial Sciences, University of Western Ontario, London, Ontario, Canada
| | - Grace Y Yi
- Department of Statistical and Actuarial Sciences, University of Western Ontario, London, Ontario, Canada
- Department of Computer Science, University of Western Ontario, London, Ontario, Canada
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8
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Tervonen T, Whichello C, Law E, Mauer J, Mitra D, Trapali M, Krucien N, Hauber B. Treatment preferences of adults and adolescents with alopecia areata: A discrete choice experiment. J Dermatol 2024; 51:243-252. [PMID: 38087841 DOI: 10.1111/1346-8138.17056] [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: 08/26/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 02/04/2024]
Abstract
PRODUCTS with janus kinase (JAK) inhibition have been shown to promote hair regrowth in patients with alopecia areata (AA). To guide drug-approval and treatment decisions, it is important to understand patients' willingness to accept the potential risks of JAK inhibition in exchange for potential benefits. We quantified the treatment preferences of adult (≥18 years) and adolescent patients (12-17 years) with AA in the US and Europe to determine the trade-offs they are willing to make between benefits and risks. Preferences for oral AA treatment attributes were elicited using a discrete choice experiment consisting of 12 tasks in which patients chose between two hypothetical treatment alternatives and no treatment. Benefits included the probability of 80%-100% scalp hair regrowth (Severity of Alopecia Tool score ≤ 20) and achieving moderate-to-normal eyebrow and eyelash hair. Treatment-related risks included 3-year probabilities of serious infection, cancer, and blood clots. Preference estimates were used to calculate the maximum level of each risk that patients were willing to accept for increases in treatment benefits. The most important attribute to both adults (n = 201) and adolescents (n = 120) was a 50% probability of achieving hair regrowth on most or all the scalp; however, adolescents placed greater relative importance on this attribute than did adults. Adults were averse to the risks of serious infection, cancer, and blood clots, whereas adolescents were averse to the risk of cancer. For a 20% increase in the probability of 80%-100% scalp hair regrowth, adults were willing to accept a mean (95% confidence interval) 3-year risk of serious infection, cancer, and blood clots of 7.4% (5.5-9.3), 2.5% (1.9-3.1), and 9.3% (6.4-12.2). Adolescents were willing to accept a 3-year risk of cancer of 3.3% (2.4-4.2). Patients with AA in the US and Europe are willing to accept substantial risks to obtain an effective treatment.
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Affiliation(s)
| | | | - Ernest Law
- Pfizer Inc., New York City, New York, USA
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9
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DiSantostefano RL, Simons G, Englbrecht M, Humphreys JH, Bruce IN, Bywall KS, Radawski C, Raza K, Falahee M, Veldwijk J. Can the General Public Be a Proxy for an "At-Risk" Group in a Patient Preference Study? A Disease Prevention Example in Rheumatoid Arthritis. Med Decis Making 2024; 44:189-202. [PMID: 38240281 PMCID: PMC10865770 DOI: 10.1177/0272989x231218265] [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: 12/06/2022] [Accepted: 11/02/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND When selecting samples for patient preference studies, it may be difficult or impractical to recruit participants who are eligible for a particular treatment decision. However, a general public sample may not be an appropriate proxy. OBJECTIVE This study compares preferences for rheumatoid arthritis (RA) preventive treatments between members of the general public and first-degree relatives (FDRs) of confirmed RA patients to assess whether a sample of the general public can be used as a proxy for FDRs. METHODS Participants were asked to imagine they were experiencing arthralgia and had screening tests indicating a 60% chance of developing RA within 2 yrs. Using a discrete choice experiment, participants were offered a series of choices between no treatment and 2 unlabeled hypothetical treatments to reduce the risk of RA. To assess data quality, time to complete survey sections and comprehension questions were assessed. A random parameter logit model was used to obtain attribute-level estimates, which were used to calculate relative importance, maximum acceptable risk (MAR), and market shares of hypothetical preventive treatments. RESULTS The FDR sample (n = 298) spent more time completing the survey and performed better on comprehension questions compared with the general public sample (n = 982). The relative importance ranking was similar between the general public and FDR participant samples; however, other relative preference measures involving weights including MARs and market share differed between groups, with FDRs having numerically higher MARs. CONCLUSION In the context of RA prevention, the general public (average risk) may be a reasonable proxy for a more at-risk sample (FDRs) for overall relative importance ranking but not weights. The rationale for a proxy sample should be clearly justified. HIGHLIGHTS Participants from the general public were compared to first-degree relatives on their preferences for rheumatoid arthritis (RA) preventive treatments using a discrete choice experiment.Preferences were similar between groups in terms of the most important and least important attributes of preventive treatments, with effectiveness being the most important attribute. However, relative weights differed.Attention to the survey and predicted market shares of hypothetical RA preventive treatments differed between the general public and first-degree relatives.The general public may be a reasonable proxy for an at-risk group for patient preferences ranks but not weights in the disease prevention context; however, care should be taken in sample selection for patient preference studies when choosing nonpatients.
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Affiliation(s)
| | - G. Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - M. Englbrecht
- freelance healthcare data scientist, Eckental, Germany
- Department of Internal Medicine and Institute for Clinical Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jennifer H. Humphreys
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ian N. Bruce
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - C. Radawski
- Eli Lilly and Company, Indianapolis, IN, USA
| | - K. 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
| | - M. Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - J. Veldwijk
- School of Health Policy & Management, Erasmus University Rotterdam, 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, the Netherlands
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10
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Mühlbacher AC, Sadler A, Juhnke C. Preferences for Monitoring Comprehensive Heart Failure Care: A Latent Class Analysis. THE PATIENT 2024; 17:83-95. [PMID: 38017336 PMCID: PMC10770186 DOI: 10.1007/s40271-023-00656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To measure preference heterogeneity for monitoring systems among patients with a chronic heart failure. METHODS A best-worst scaling experiment (BWS case 3) was conducted among patients with chronic heart failure to assess preferences for hypothetical monitoring care scenarios. These were characterized by the attributes mobility, risk of death, risk of hospitalization, type and frequency of monitoring, risk of medical device, and system-relevant complications. A latent class analysis (LCA) was used to analyze and interpret the data. In addition, a market simulator was used to examine which treatment configurations participants in the latent classes preferred. RESULTS Data from 278 respondents were analyzed. The LCA identified four heterogeneous classes. For class 1, the most decisive factor was mobility with a longer distance covered being most important. Class 2 respondents directed their attention toward attribute "monitoring," with a preferred monitoring frequency of nine times per year. The attribute risk of hospitalization was most important for respondents of class 3, closely followed by risk of death. For class 4, however, risk of death was most important. A market simulation showed that, even with high frequency of monitoring, most classes preferred therapy with high improvement in mobility, mortality, and hospitalization. CONCLUSION Using LCA, variations in preferences among different groups of patients with chronic heart failure were examined. This allows treatment alternatives to be adapted to individual needs of patients and patient groups. The findings of the study enhance clinical and allocative decision-making while elevating the quality of clinical data interpretation.
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Affiliation(s)
- Axel C Mühlbacher
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany.
- Gesellschaft für empirische Beratung GmbH (GEB), Freiburg, Germany.
- Duke Department of Population Health Sciences and Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Andrew Sadler
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany
| | - Christin Juhnke
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany
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11
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Gonzalez JM, Ganguli A, Morgans AK, Tombal BF, Hotte SJ, Suzuki H, Bhadauria H, Oh M, Scales CD, Wallace MJ, Yang JC, George DJ. Discrete-Choice Experiment to Understand the Preferences of Patients with Hormone-Sensitive Prostate Cancer in the USA, Canada, and the UK. THE PATIENT 2023; 16:607-623. [PMID: 37566214 PMCID: PMC10570152 DOI: 10.1007/s40271-023-00638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Treatment options for patients with metastatic hormone-sensitive prostate cancer (mHSPC) have broadened, and treatment decisions can have a long-lasting impact on patients' quality of life. Data on patient preferences can improve therapeutic decision-making by helping physicians suggest treatments that align with patients' values and needs. OBJECTIVE This study aims to quantify patient preferences for attributes of chemohormonal therapies among patients with mHSPC in the USA, Canada, and the UK. METHODS A discrete-choice experiment survey instrument was developed and administered to patients with high- and very-high-risk localized prostate cancer and mHSPC. Patients chose between baseline androgen-deprivation therapy (ADT) alone and experimentally designed, hypothetical treatment alternatives representing chemohormonal therapies. Choices were analyzed using logit models to derive the relative importance of attributes for each country and to evaluate differences and similarities among patients across countries. RESULTS A total of 550 respondents completed the survey (USA, 200; Canada, 200; UK, 150); the mean age of respondents was 64.3 years. Treatment choices revealed that patients were most concerned with treatment efficacy. However, treatment-related convenience factors, such as route of drug administration and frequency of monitoring visits, were as important as some treatment-related side effects, such as skin rash, nausea, and fatigue. Patient preferences across countries were similar, although patients in Canada appeared to be more affected by concomitant steroid use. CONCLUSION Patients with mHSPC believe the use of ADT alone is insufficient when more effective treatments are available. Efficacy is the most significant driver of patient choices. Treatment-related convenience factors can be as important as safety concerns for patients.
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Affiliation(s)
- Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University School of Medicine, 300 W. Morgan Street, 27701, Durham, NC, USA.
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Arijit Ganguli
- Medical Affairs, Astellas Pharma Inc., Northbrook, IL, USA
| | | | - Bertrand F Tombal
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Sebastien J Hotte
- Department of Oncology, McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Sakura City, Chiba, Japan
| | | | - Mok Oh
- Medical Affairs, Astellas Pharma Inc., Northbrook, IL, USA
| | - Charles D Scales
- Department of Population Health Sciences, Duke University School of Medicine, 300 W. Morgan Street, 27701, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Urology, Duke University School of Medicine, Durham, NC, USA
| | - Matthew J Wallace
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jui-Chen Yang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Daniel J George
- Department of Population Health Sciences, Duke University School of Medicine, 300 W. Morgan Street, 27701, Durham, NC, USA
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12
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Totton N, Julious SA, Coates E, Hughes DA, Cook JA, Biggs K, Hewitt C, Day S, Cook A. Appropriate design and reporting of superiority, equivalence and non-inferiority clinical trials incorporating a benefit-risk assessment: the BRAINS study including expert workshop. Health Technol Assess 2023; 27:1-58. [PMID: 37982521 PMCID: PMC11017151 DOI: 10.3310/bhqz7691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Background Randomised controlled trials are designed to assess the superiority, equivalence or non-inferiority of a new health technology, but which trial design should be used is not always obvious in practice. In particular, when using equivalence or non-inferiority designs, multiple outcomes of interest may be important for the success of a trial, despite the fact that usually only a single primary outcome is used to design the trial. Benefit-risk methods are used in the regulatory clinical trial setting to assess multiple outcomes and consider the trade-off of the benefits against the risks, but are not regularly implemented in publicly funded trials. Objectives The aim of the project is to aid the design of clinical trials with multiple outcomes of interest by defining when each trial design is appropriate to use and identifying when to use benefit-risk methods to assess outcome trade-offs (qualitatively or quantitatively) in a publicly funded trial setting. Methods A range of methods was used to elicit expert opinion to answer the project objectives, including a web-based survey of relevant researchers, a rapid review of current literature and a 2-day consensus workshop of experts (in 2019). Results We created a list of 19 factors to aid researchers in selecting the most appropriate trial design, containing the following overarching sections: population, intervention, comparator, outcomes, feasibility and perspectives. Six key reasons that indicate a benefit-risk method should be considered within a trial were identified: (1) when the success of the trial depends on more than one outcome; (2) when important outcomes within the trial are in competing directions (i.e. a health technology is better for one outcome, but worse for another); (3) to allow patient preferences to be included and directly influence trial results; (4) to provide transparency on subjective recommendations from a trial; (5) to provide consistency in the approach to presenting results from a trial; and (6) to synthesise multiple outcomes into a single metric. Further information was provided to support the use of benefit-risk methods in appropriate circumstances, including the following: methods identified from the review were collated into different groupings and described to aid the selection of a method; potential implementation of methods throughout the trial process were provided and discussed (with examples); and general considerations were described for those using benefit-risk methods. Finally, a checklist of five pieces of information that should be present when reporting benefit-risk methods was defined, with two additional items specifically for reporting the results. Conclusions These recommendations will assist research teams in selecting which trial design to use and deciding whether or not a benefit-risk method could be included to ensure research questions are answered appropriately. Additional information is provided to support consistent use and clear reporting of benefit-risk methods in the future. The recommendations can also be used by funding committees to confirm that appropriate considerations of the trial design have been made. Limitations This research was limited in scope and should be considered in conjunction with other trial design methodologies to assess appropriateness. In addition, further research is needed to provide concrete information about which benefit-risk methods are best to use in publicly funded trials, along with recommendations that are specific to each method. Study registration The rapid review is registered as PROSPERO CRD42019144882. Funding Funded by the Medical Research Council UK and the National Institute for Health and Care Research as part of the Medical Research Council-National Institute for Health and Care Research Methodology Research programme.
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Affiliation(s)
- Nikki Totton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Steven A Julious
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Elizabeth Coates
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Jonathan A Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katie Biggs
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Simon Day
- Clinical Trials Consulting & Training Limited, Buckingham, UK
| | - Andrew Cook
- Wessex Institute, University of Southampton, Southampton, UK
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Menges D, Piatti MC, Omlin A, Cathomas R, Benamran D, Fischer S, Iselin C, Küng M, Lorch A, Prause L, Rothermundt C, O'Meara Stern A, Zihler D, Lippuner M, Braun J, Cerny T, Puhan MA. Patient and General Population Preferences Regarding the Benefits and Harms of Treatment for Metastatic Prostate Cancer: A Discrete Choice Experiment. EUR UROL SUPPL 2023; 51:26-38. [PMID: 37187724 PMCID: PMC10175729 DOI: 10.1016/j.euros.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 05/17/2023] Open
Abstract
Background Patient preferences for treatment outcomes are important to guide decision-making in clinical practice, but little is known about the preferences of patients with metastatic hormone-sensitive prostate cancer (mHSPC). Objective To evaluate patient preferences regarding the attributed benefits and harms of systemic treatments for mHSPC and preference heterogeneity between individuals and specific subgroups. Design setting and participants We conducted an online discrete choice experiment (DCE) preference survey among 77 patients with metastatic prostate cancer (mPC) and 311 men from the general population in Switzerland between November 2021 and August 2022. Outcome measurements and statistical analysis We evaluated preferences and preference heterogeneity related to survival benefits and treatment-related adverse effects using mixed multinomial logit models and estimated the maximum survival time participants were willing to trade to avert specific adverse effects. We further assessed characteristics associated with different preference patterns via subgroup and latent class analyses. Results and limitations Patients with mPC showed an overall stronger preference for survival benefits in comparison to men from the general population (p = 0.004), with substantial preference heterogeneity between individuals within the two samples (both p < 0.001). There was no evidence of differences in preferences for men aged 45-65 yr versus ≥65 yr, patients with mPC in different disease stages or with different adverse effect experiences, or general population participants with and without experiences with cancer. Latent class analyses suggested the presence of two groups strongly preferring either survival or the absence of adverse effects, with no specific characteristic clearly associated with belonging to either group. Potential biases due to participant selection, cognitive burden, and hypothetical choice scenarios may limit the study results. Conclusions Given the relevant heterogeneity in participant preferences regarding the benefits and harms of treatment for mHSPC, patient preferences should be explicitly discussed during decision-making in clinical practice and reflected in clinical practice guidelines and regulatory assessment regarding treatment for mHSPC. Patient summary We examined the preferences (values and perceptions) of patients and men from the general population regarding the benefits and harms of treatment for metastatic prostate cancer. There were large differences between men in how they balanced the expected survival benefits and potential adverse effects. While some men strongly valued survival, others more strongly valued the absence of adverse effects. Therefore, it is important to discuss patient preferences in clinical practice.
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Affiliation(s)
- Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Corresponding author. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. Tel. +41 44 6344615.
| | - Michela C. Piatti
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Aurelius Omlin
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Onkozentrum Zürich, Zurich, Switzerland
| | - Richard Cathomas
- Division of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - Stefanie Fischer
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christophe Iselin
- Department of Urology, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - Marc Küng
- Department of Oncology, Hôpital Cantonal Fribourg, Fribourg, Switzerland
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Prause
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Rothermundt
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Alix O'Meara Stern
- Department of Oncology, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
| | - Deborah Zihler
- Department of Oncology, Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Max Lippuner
- Europa Uomo Switzerland, Ehrendingen, Switzerland
| | - Julia Braun
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Thomas Cerny
- Foundation Board, Cancer Research Switzerland, Bern, Switzerland
- Human Medicines Expert Committee, Swissmedic, Bern, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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14
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Zhu M, Dong D, Lo HHM, Wong SYS, Mo PKH, Sit RWS. Patient preferences in the treatment of chronic musculoskeletal pain: a systematic review of discrete choice experiments. Pain 2023; 164:675-689. [PMID: 36149784 PMCID: PMC10026832 DOI: 10.1097/j.pain.0000000000002775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic musculoskeletal pain (CMP) is a preference-sensitive condition for which numerous treatment options are available, each with benefits and risks. Thus, patient preferences play a critical role in decision making. This study summarized evidence from discrete choice experiments (DCEs) to quantify patient preferences for CMP treatment and identified important treatment attributes. A systematic review of DCEs on patient preferences for CMP treatment was conducted. Studies were included if they used DCE to determine patient preferences for CMP. A previously described methodological assessment tool was used to assess the risk of bias. The treatment attributes were summarized and sorted according to the frequency of citation and relative weight. Subgroup analyses were conducted to explore the intervention-specific attributes. A total of 15 eligible studies with 4065 participants were included. We identified "capacity to realize daily life activities," "risk of adverse events," "effectiveness in pain reduction," and "out-of-pocket cost" as important attributes. Although "treatment frequency" and "onset of treatment efficacy" were less frequently mentioned, they were also important attributes. The attribute of "risk of adverse events" was especially important for drug treatment. The "out-of-pocket cost" and "treatment location and mode" were important attributes of exercise therapy. The attributes identified in this review will inform the design of future DCE studies, facilitate the translation of measurement-based care to value-based care, and provide the rationale to promote shared decision making and patient-centered care.
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Affiliation(s)
- Mengting Zhu
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Dong Dong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Hermione Hin-Man Lo
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Phoenix Kit-Han Mo
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Regina Wing-Shan Sit
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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15
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Veldwijk J, de Bekker-Grob E, Juhaeri J, van Overbeeke E, Tcherny-Lessenot S, Pinto CA, DiSantostefano RL, Groothuis-Oudshoorn CGM. Suitability of Preference Methods Across the Medical Product Lifecycle: A Multicriteria Decision Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:579-588. [PMID: 36509368 DOI: 10.1016/j.jval.2022.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES This study aimed to understand the importance of criteria describing methods (eg, duration, costs, validity, and outcomes) according to decision makers for each decision point in the medical product lifecycle (MPLC) and to determine the suitability of a discrete choice experiment, swing weighting, probabilistic threshold technique, and best-worst scale cases 1 and 2 at each decision point in the MPLC. METHODS Applying multicriteria decision analysis, an online survey was sent to MPLC decision makers (ie, industry, regulatory, and health technology assessment representatives). They ranked and weighted 19 methods criteria from an existing performance matrix about their respective decisions across the MPLC. All criteria were given a relative weight based on the ranking and rating in the survey after which an overall suitability score was calculated for each preference elicitation method per decision point. Sensitivity analyses were conducted to reflect uncertainty in the performance matrix. RESULTS Fifty-nine industry, 29 regulatory, and 5 health technology assessment representatives completed the surveys. Overall, "estimating trade-offs between treatment characteristics" and "estimating weights for treatment characteristics" were highly important criteria throughout all MPLC decision points, whereas other criteria were most important only for specific MPLC stages. Swing weighting and probabilistic threshold technique received significantly higher suitability scores across decision points than other methods. Sensitivity analyses showed substantial impact of uncertainty in the performance matrix. CONCLUSION Although discrete choice experiment is the most applied preference elicitation method, other methods should also be considered to address the needs of decision makers. Development of evidence-based guidance documents for designing, conducting, and analyzing such methods could enhance their use.
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Affiliation(s)
- Jorien Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | | | | | | | - Catharina G M Groothuis-Oudshoorn
- Health Technology and Services Research, Faculty of Behavioural and Management Science, University of Twente, Enschede, The Netherlands
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16
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Bridges JFP, de Bekker-Grob EW, Hauber B, Heidenreich S, Janssen E, Bast A, Hanmer J, Danyliv A, Low E, Bouvy JC, Marshall DA. A Roadmap for Increasing the Usefulness and Impact of Patient-Preference Studies in Decision Making in Health: A Good Practices Report of an ISPOR Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:153-162. [PMID: 36754539 DOI: 10.1016/j.jval.2022.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 06/18/2023]
Abstract
Many qualitative and quantitative methods are readily available to study patient preferences in health. These methods are now being used to inform a wide variety of decisions, and there is a growing body of evidence showing studies of patient preferences can be used for decision making in a wide variety of contexts. This ISPOR Task Force report synthesizes current good practices for increasing the usefulness and impact of patient-preference studies in decision making. We provide the ISPOR Roadmap for Patient Preferences in Decision Making that invites patient-preference researchers to work with decision makers, patients and patient groups, and other stakeholders to ensure that studies are useful and impactful. The ISPOR Roadmap consists of 5 key elements: (1) context, (2) purpose, (3) population, (4) method, and (5) impact. In this report, we define these 5 elements and provide good practices on how patient-preference researchers and others can actively contribute to increasing the usefulness and impact of patient-preference studies in decision making. We also present a set of key questions that can support researchers and other stakeholders (eg, funders, reviewers, readers) to assess efforts that promote the ongoing impact (both intended and unintended) of a particular preference study and additional studies in the future.
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Affiliation(s)
- John F P Bridges
- The Ohio State University College of Medicine, Columbus, OH, USA.
| | | | | | | | - Ellen Janssen
- Janssen Research & Development, LLC, New Brunswick, NJ, USA
| | | | | | | | - Eric Low
- Eric Low Consulting, Haddington, Scotland, UK
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17
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Yan N, Liu T, Xu Y, Fang X, Ma X, Yang M, Du J, Tan Z, Fan EW, Huang J, Akinwunmi B, Zhang CJP, Ming WK, Luo L. Healthcare preferences of the general Chinese population in the hierarchical medical system: A discrete choice experiment. Front Public Health 2022; 10:1044550. [PMID: 36466449 PMCID: PMC9713319 DOI: 10.3389/fpubh.2022.1044550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Chinese health insurance system faces resource distribution challenges. A patient-centric approach allows decision-makers to be keenly aware of optimized medical resource allocation. Objective This study aims to use the discrete choice model to determine the main factors affecting the healthcare preferences of the general Chinese population and their weights in the three scenarios (chronic non-communicable diseases, acute infectious diseases, and major diseases). Methods This study firstly identified the key factors affecting people's healthcare preferences through literature review and qualitative interviews, and then designed the DCE questionnaire. An online questionnaire produced by Lighthouse Studio (version 9.9.1) software was distributed to voluntary respondents recruited from mainland China's entire population from January 2021 to June 2021. Participants were required to answer a total of 21 questions of three scenarios in the questionnaire. The multinomial logit model and latent class model were used to analyze the collected data. Results A total of 4,156 participants from mainland China were included in this study. The multinomial logit and latent class model analyses showed that medical insurance reimbursement is the most important attribute in all three disease scenarios. In the scenario of "non-communicable diseases," the attributes that participants valued were, from the most to the least, medical insurance reimbursement (45.0%), hospital-level (21.6%), distance (14.4%), cost (9.7%), waiting time (8.3%), and care provider (1.0%). As for willingness to pay (WTP), participants were willing to pay 204.5 yuan, or 1,743.8 yuan, to change from private hospitals or community hospitals to tertiary hospitals, respectively. Conclusions This study explores the healthcare preferences of Chinese residents from a new perspective, which can provide theoretical reference for the refinement of many disease medical reimbursement policies, such as developing different reimbursement ratios for various common diseases and realizing rational configuration of medical resources.
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Affiliation(s)
- Ni Yan
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Taoran Liu
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yuan Xu
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xuanbi Fang
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xinyang Ma
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Meng Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jianhao Du
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zijian Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Er-wen Fan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jian Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Babatunde Akinwunmi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital Boston, Boston, MA, United States,Center for Genomic Medicine (CGM), Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, MA, United States
| | - Casper J. P. Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China,*Correspondence: Wai-Kit Ming
| | - Liangping Luo
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China,Liangping Luo
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Thomas C, Raibouaa A, Wollenberg A, Capron JP, Krucien N, Karn H, Tervonen T. Patient preferences for atopic dermatitis medications in the UK, France and Spain: a discrete choice experiment. BMJ Open 2022; 12:e058799. [PMID: 35918108 PMCID: PMC9351316 DOI: 10.1136/bmjopen-2021-058799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES We aimed to quantify patient preferences for efficacy, safety and convenience features of atopic dermatitis (AD) treatments. DESIGN AND SETTING Online discrete choice experiment survey. PARTICIPANTS Adults in the UK, France and Spain who had used AD treatments during the past 2 years. PRIMARY AND SECONDARY OUTCOME MEASURES Preferences for attributes were analysed using a multinomial logit model. Willingness to make trade-offs was expressed as the maximum acceptable decrease (MAD) in the probability of achieving clear/almost clear skin at week 16. RESULTS The survey was completed by 404 patients (44.1±12.0 years; 65% women; 64% moderate/severe eczema). Most patients (68%) had no prior experience of using self-injectable treatments for AD or any other illness. Participants most valued increasing the chance of achieving a meaningful reduction in itch at week 16 from 20% to 50%, followed by reducing the risks of serious infections from 6% to 0% and of eye inflammation from 20% to 0%. Participants were willing to accept a decrease in the possibility of achieving clear/almost clear skin to obtain a treatment that can be paused (MAD=24.1%), requires occasional check-ups (MAD=16.1%) or no check-ups (MAD=20.9%) over frequent check-ups, is administered as a one time per day or two times per day oral pill versus a subcutaneous injection every 2 weeks (MAD=16.6%), has a 2-day over 2-week onset of action (MAD=11.3%), and can be used for flare management (MAD=5.8%). CONCLUSIONS Although patients with AD most valued treatment benefits and risks, they were willing to tolerate reduced efficacy to obtain a rapid onset, oral administration, less frequent monitoring and a treatment that can be paused. Understanding patients' preferences for AD therapies, including new targeted therapies, can aid shared decision-making between clinicians and patients and support health technology assessments.
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Affiliation(s)
| | | | - Andreas Wollenberg
- Department of Dermatology and Allergy, University Hospital of Ludwig-Maximilian University of Munich, Munich, Germany
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Building Infrastructure to Exploit Evidence from Patient Preference Information (PPI) Studies: A Conceptual Blueprint. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Patients are the most important actors in clinical research. Therefore, patient preference information (PPI) could support the decision-making process, being indisputable for research value, quality, and integrity. However, there is a lack of clear guidance or consensus on the search for preference studies. In this blueprint, an openly available and regularly updated patient preference management system for an integrated database (PPMSDB) that contains the minimal set of data sufficient to provide detailed information for each study (the so-called evidence tables in systematic reviews) and a high-level overview of the findings of a review (summary tables) is described. These tables could help determine which studies, if any, are eligible for quantitative synthesis. Finally, a web platform would provide a graphical and user-friendly interface. On the other hand, a set of APIs (application programming interfaces) would also be developed and provided. The PPMSDB, aims to collect preference measures, characteristics, and meta-data, and allow researchers to obtain a quick overview of a research field, use the latest evidence, and identify research gaps. In conjunction with proper statistical analysis of quantitative preference measures, these aspects can facilitate formal evidence-based decisions and adequate consideration when conducting a structured decision-making process. Our objective is to outline the conceptual infrastructure necessary to build and maintain a successful network that can monitor the currentness and validity of evidence.
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20
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Building a culture of responsible neurotech: Neuroethics as socio-technical challenges. Neuron 2022; 110:2057-2062. [PMID: 35671759 DOI: 10.1016/j.neuron.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/28/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
Scientists around the globe are joining the race to achieve engineering feats to read, write, modulate, and interface with the human brain in a broadening continuum of invasive to non-invasive ways. The expansive implications of neurotechnology for our conception of health, mind, decision-making, and behavior has raised social and ethical considerations that are inextricable from neurotechnological progress. We propose "socio-technical" challenges as a framing to integrate neuroethics into the engineering process. Intentionally aligning societal and engineering goals within this framework offers a way to maximize the positive impact of next-generation neurotechnologies on society.
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Bywall KS, Johansson JV, Erlandsson I, Heidenvall M, Lason M, Appel Esbensen B. Making space for patients' preferences in precision medicine: a qualitative study exploring perspectives of patients with rheumatoid arthritis. BMJ Open 2022; 12:e058303. [PMID: 35649604 PMCID: PMC9161063 DOI: 10.1136/bmjopen-2021-058303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Precision medicine in rheumatoid arthritis (RA) creates new opportunities to involve patients in early identification of accurate indicators of health trajectories. The aim of this study was to explore patient perspectives on patient-centredness in precision medicine for RA treatment. DESIGN Semistructured interviews were conducted to explore patients' perspectives on a new personalised approach to RA treatment. The interview guide was developed together with patient research partners and health care professionals. SETTING An invitation to the interviews was sent through a mobile application. The interviews were one-on-one, using an interview guide with open-ended questions. Interviews were conducted digitally (October 2020-February 2021) via Zoom or telephone, depending on each participant's preferences. PARTICIPANTS Patients with RA (N=12) were purposively recruited. Patients were eligible if they had an RA diagnosis, were aged 18-80 years, and understood and expressed themselves in Swedish. Participants and researchers did not know each other prior to the interviews. RESULTS Participants expressed desires and needs for patients to have an active role in precision medicine by making shared treatment decisions together with a healthcare professional. In order for that to work, patients need information on potential treatment options, an ability to express their preferences, an individual treatment plan and identification of personal treatment goals. Patients also identified two requirements of healthcare professional in precision medicine: a safe environment to express personal matters and two-way communication with healthcare professionals. CONCLUSION Communication between patients and healthcare professionals needs to be more focused on patients' individual treatment preferences and expressed needs, in order to increase patient-centredness in treatment decisions, so shared decision-making can become a reality. More research is needed to design multifaceted implementation strategies to support patients and healthcare professionals to increase patient-centredness throughout treatment personalisation.
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Affiliation(s)
| | - Jennifer Viberg Johansson
- Centre for Research Ethics & Bioethics, Uppsala Universitet, Uppsala, Sweden
- Institute for Futures Studies, Stockholm, Sweden
| | | | | | | | - Bente Appel Esbensen
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Kobenhavn, Denmark
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22
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Ferraro S, Biganzoli EM, Castaldi S, Plebani M. Health Technology Assessment to assess value of biomarkers in the decision-making process. Clin Chem Lab Med 2022; 60:647-654. [PMID: 35245972 DOI: 10.1515/cclm-2021-1291] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/08/2022] [Indexed: 12/20/2022]
Abstract
Clinical practice guidelines (CPGs) on screening, surveillance, and treatment of several diseases recommend the selective use of biomarkers with central role in clinical decision-making and move towards including patients in this process. To this aim we will clarify the multidisciplinary interactions required to properly measure the cost-effectiveness of biomarkers with regard to the risk-benefit of the patients and how Health Technology Assessment (HTA) approach may assess value of biomarkers integrated within the decision-making process. HTA through the interaction of different skills provides high-quality research information on the effectiveness, costs, and impact of health technologies, including biomarkers. The biostatistical methodology is relevant to HTA but only meta-analysis is covered in depth, whereas proper approaches are needed to estimate the benefit-risk balance ratio. Several biomarkers underwent HTA evaluation and the final reports have pragmatically addressed: 1) a redesign of the screening based on biomarker; 2) a de-implementation/replacement of the test in clinical practice; 3) a selection of biomarkers with potential predictive ability and prognostic value; and 4) a stronger monitoring of the appropriateness of test request. The COVID-19 pandemic has disclosed the need to create a robust and sustainable system to urgently deal with global health concerns and the HTA methodology enables rapid cost-effective implementation of diagnostic tests allowing healthcare providers to make critical patient-management decisions.
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Affiliation(s)
- Simona Ferraro
- Endocrinology Laboratory Unit, "Luigi Sacco" University Hospital, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Silvana Castaldi
- Fondazione Ca' Granda Ospedale Maggiore Policlinico Research Institute of Milano, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padua, Italy
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23
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Masri HE, McGuire TM, Dalais C, van Driel M, Benham H, Hollingworth SA. Patient-based benefit-risk assessment of medicines: development, refinement, and validation of a content search strategy to retrieve relevant studies. J Med Libr Assoc 2022; 110:185-204. [PMID: 35440905 PMCID: PMC9014953 DOI: 10.5195/jmla.2022.1306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Introduction: Poor indexing and inconsistent use of terms and keywords may prevent efficient retrieval of studies on the patient-based benefit-risk assessment (BRA) of medicines. We aimed to develop and validate an objectively derived content search strategy containing generic search terms that can be adapted for any search for evidence on patient-based BRA of medicines for any therapeutic area. Methods: We used a robust multistep process to develop and validate the content search strategy: (1) we developed a bank of search terms derived from screening studies on patient-based BRA of medicines in various therapeutic areas, (2) we refined the proposed content search strategy through an iterative process of testing sensitivity and precision of search terms, and (3) we validated the final search strategy in PubMed by firstly using multiple sclerosis as a case condition and secondly computing its relative performance versus a published systematic review on patient-based BRA of medicines in rheumatoid arthritis. Results: We conceptualized a final search strategy to retrieve studies on patient-based BRA containing generic search terms grouped into two domains, namely the patient and the BRA of medicines (sensitivity 84%, specificity 99.4%, precision 20.7%). The relative performance of the content search strategy was 85.7% compared with a search from a published systematic review of patient preferences in the treatment of rheumatoid arthritis. We also developed a more extended filter, with a relative performance of 93.3% when compared with a search from a published systematic review of patient preferences in lung cancer.
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Affiliation(s)
- Hiba El Masri
- , PhD Candidate, School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| | - Treasure M McGuire
- , Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia, Mater Pharmacy, Mater Health, Raymond Tce, South Brisbane, QLD, Australia
| | - Christine Dalais
- , University Library, The University of Queensland, Brisbane, QLD, Australia
| | - Mieke van Driel
- , Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Helen Benham
- , Department of Rheumatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Comparing Patient Preferences for Antithrombotic Treatment During the Acute and Chronic Phases of Myocardial Infarction: A Discrete-Choice Experiment. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:255-266. [PMID: 34569030 PMCID: PMC8866301 DOI: 10.1007/s40271-021-00548-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/27/2022]
Abstract
Background Antithrombotic drugs are used as preventive treatment in patients with a prior myocardial infarction (MI) in both the acute and chronic phases of the disease. To support patient-centered benefit–risk assessment, it is important to understand the influence of disease stage on patient preferences. Objective The aim of this study was to examine patient preferences for antithrombotic treatments and whether they differ by MI disease phase. Methods A discrete-choice experiment was used to elicit preferences of adults in the acute (≤ 365 days before enrolment) or chronic phase (> 365 days before enrolment) of MI for key ischemic events (risk of cardiovascular [CV] death, non-fatal MI, and non-fatal ischemic stroke) and bleeding events (risk of non-fatal intracranial hemorrhage and non-fatal other severe bleeding). Preference data were analyzed using the multinomial logit model. Trade-offs between attributes were calculated as the maximum acceptable increase in the risk of CV death for a decrease in the risk of the other outcomes. To assess the potential effect of sociodemographic and clinical characteristics on patient preferences, subgroups were introduced as interaction terms in logit models. Results The evaluable population included 155 patients with MI in the acute phase of disease and 180 in the chronic phase. The overall population was 82% male, mean age was 64.2 ± 9.6 years, and 93% had not experienced bleeding events or key ischemic events other than MI. Patients valued reduction in the risk of non-fatal intracranial hemorrhage more than CV death (p < 0.01) and CV death more than non-fatal ischemic events (p < 0.01). Preferences were similar in the acute and chronic populations (p = 0.17). However, older patients valued reduction in risk of MI more than younger patients (p = 0.04), and patients with bleeding risk factors valued reduction in the risk of CV death (p = 0.01) and MI (p = 0.01) less than patients without bleeding risk factors. Also, patients who were at high risk of future ischemic events valued reduction of the risk of CV death less than those at low risk (p = 0.01). Conclusion Patient preferences for antithrombotic treatments were unaffected by disease stage but varied by bleeding risk and other factors. This heterogeneity in preferences is an important consideration because it can affect the benefit–risk balance and the acceptability of antithrombotic treatments to patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00548-6.
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Ashaye A, Thomas C, Dalal M, Kota V, Krucien N, Sae-Hau M, Weiss E, Campbell S, Marsh K. Patient preferences for frontline therapies for Philadelphia chromosome-positive acute lymphoblastic leukemia: a discrete choice experiment. Future Oncol 2022; 18:2075-2085. [PMID: 35209721 DOI: 10.2217/fon-2022-0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Aim: We examined the preferences of adults with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) for benefits and risks of tyrosine kinase inhibitors combined with chemotherapy for first-line treatment. Methods: In a discrete choice experiment, 201 patients chose between hypothetical treatment alternatives with varied levels of remission duration and overall survival (OS), and risks of major cardiovascular (CV) events and myelosuppression. Results: Although OS was the most important attribute to patients with Ph+ ALL, they were willing to tolerate a 2.9% increase in CV risk for 1 additional month of OS. Older patients (>59 years) and patients not in remission were less likely to tolerate increased CV risk. Conclusion: Preferences and risk tolerance varied between patients, highlighting the importance of shared decision making when selecting treatments for Ph+ ALL.
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Affiliation(s)
- Ajibade Ashaye
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
| | | | - Mehul Dalal
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
| | - Vamsi Kota
- Section of Hematology & Oncology, Georgia Cancer Center at Augusta University, Augusta, GA 30912, USA
| | | | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | - Scott Campbell
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
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26
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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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Stamuli E, Corry S, Ross D, Konstantopoulou T. Patient preferences for breast cancer treatments: a discrete choice experiment in France, Ireland, Poland, Spain. Future Oncol 2022; 18:1115-1132. [PMID: 35043660 DOI: 10.2217/fon-2021-0635] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: To understand breast cancer patients' trade-offs when choosing treatments and to identify the most important treatment attributes which drive decisions. Materials & methods: A discrete choice experiment was conducted in France, Ireland, Poland and Spain. Progression-free survival, febrile neutropenia, pain, functional well-being and out-of-pocket payment were the treatment attributes. Results: 371 patients were willing to pay €6896 per year for 1 additional year of progression-free survival, €17,288 per year for perfect functional well-being and €15,138 for one pain-free year. Patients are willing to trade off progression-free survival months for better functional abilities and less pain. Conclusion: Patient preferences should be considered by regulatory agencies, reimbursement bodies, payors and clinicians for best treatment choices for the individuals.
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Affiliation(s)
- Eugena Stamuli
- Pharmecons Easy Access Ltd, Health Economics and Outcomes Research (HEOR), York YO31 0AA, UK
| | - Sorcha Corry
- Novartis Ireland Limited, Vista Building, Elm Park Business Campus, Merrion Road, IE- Dublin 4,Ireland
| | - Derek Ross
- Centre for Innovative Human Systems, School of Psychology Trinity College Dublin, The University of Dublin, College Green, Dublin 2 D02 PN40, Ireland
| | - Thomais Konstantopoulou
- Novartis Oncology Region Europe, Novartis Farma S.p.A., Largo Umberto Boccioni 1I-21040, Origgio / VA Italy
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28
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EL Masri H, McGuire TM, van Driel ML, Benham H, Hollingworth SA. Dynamics of Patient-Based Benefit-Risk Assessment of Medicines in Chronic Diseases: A Systematic Review. Patient Prefer Adherence 2022; 16:2609-2637. [PMID: 36164323 PMCID: PMC9508999 DOI: 10.2147/ppa.s375062] [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: 05/24/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A critical gap exits in understanding the dynamics of patient-based benefit-risk assessment (BRA) of medicines in chronic diseases during the disease journey. PURPOSE To systematically review and synthesize current evidence on the changes of patients' preferences about the benefits and risks of medicines during their disease journey including the influence of disease duration and severity, and previous treatment experience. METHODS A systematic review of studies identified in PubMed and Embase, from inception to November 2020, was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Articles were eligible if they analyzed adult patient-based BRA of medicines with a chronic disease, based on at least one of the pre-specified dimensions: disease severity, disease duration, or previous treatment experience. RESULTS A total of 26,228 articles were identified and 105 were eligible for inclusion. Of these, 85 detected a variation in patient-based BRA of medicines with at least one of the pre-specified criteria. Patients with higher disease severity and more treatment experience have increased risk tolerance. It remains inconclusive whether disease duration directly affects the relative importance of a patient's preference. CONCLUSION Factors important for patients' BRA of their medicines during a chronic disease journey vary more with their clinical situation and previous treatment experience than with time since diagnosis. Due to the importance of these factors on patients' perspectives and potential impact on their decision-making and eventually their clinical outcomes, there is a need for more studies to assess the dynamics of patients' BRA in every disease.
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Affiliation(s)
- Hiba EL Masri
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
- Correspondence: Hiba EL Masri, School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Brisbane, Queensland, 4102, Australia, Tel +61 478512234, Email
| | - Treasure M McGuire
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- Mater Pharmacy, Mater Health, Brisbane, Queensland, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Helen Benham
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Rheumatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Lang Y, Wu B, Sun Z, Ye E, Dou G, Guan X. Patient Preference for Biologic Treatments of Psoriasis in the Chinese Setting. Patient Prefer Adherence 2022; 16:1071-1084. [PMID: 35479654 PMCID: PMC9038155 DOI: 10.2147/ppa.s357795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Assessments of patients' preferences can support in clinical decision-making regarding biologic therapies for psoriasis. Our objective was to investigate patient preference for biologic treatments in patients with psoriasis in China. METHODS From October 2020 to January 2021, psoriasis patients were recruited for a survey that included demographic and disease-related questions, as well as a discrete choice experiment to measure their preferences for biologic therapy. A discrete-choice experiment was used in which respondents selected psoriasis treatments based on benefits (ie, early onset of efficacy, long-term efficacy, sustained efficacy) and treatment costs. We analyzed choice data using conditional logit model. RESULTS This study included 236 patients with moderate-to-severe psoriasis. The relative importance of the cost of biologic treatments, probability of keeping PASI100 at 5 years, probability of achieving PASI100 at 3 months and time to achieve PASI50 after initiation the biologic treatment were 0.593, 0.137, 0.185 and 0.085. Over 50% of patients regarded the cost of biologic treatments as the most important attribute. High-income and low-income subgroups had higher preference weight in probability of achieving PASI100 at 3-month and monthly cost. CONCLUSION The cost of biologic treatments was found as the most important attribute for Chinese patients with psoriasis. Among efficacy attributes, the probability of achieving PASI100 at 3 months showed most sensitive. These results may be helpful to understand patient preference for biologic treatments used for psoriasis in China.
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Affiliation(s)
- Yitian Lang
- Department of Pharmacy, Huangpu Branch, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People’s Republic of China
| | - Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 201100, People’s Republic of China
| | - Zhilin Sun
- Department of Dermatology, Peking University Third Hospital, Peking University, Haidian District, Beijing, People’s Republic of China
| | - Erjia Ye
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, People’s Republic of China
| | - Guanshen Dou
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, People’s Republic of China
| | - Xin Guan
- Department of Dermatology, Peking University Third Hospital, Peking University, Haidian District, Beijing, People’s Republic of China
- Correspondence: Xin Guan, Department of Dermatology, Peking University Third Hospital, Peking University, No. 49, Huayuan North Road, Haidian District, Beijing, People’s Republic of China, Email
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Menges D, Piatti MC, Cerny T, Puhan MA. Patient Preference Studies for Advanced Prostate Cancer Treatment Along the Medical Product Life Cycle: Systematic Literature Review. Patient Prefer Adherence 2022; 16:1539-1557. [PMID: 35789822 PMCID: PMC9250329 DOI: 10.2147/ppa.s362802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient preference studies can inform decision-making across all stages of the medical product life cycle (MPLC). The treatment landscape for advanced prostate cancer (APC) treatment has substantially changed in recent years. However, the most patient-relevant aspects of APC treatment remain unclear. This systematic review of patient preference studies in APC aimed to summarize the evidence on patient preferences and patient-relevant aspects of APC treatments, and to evaluate the potential contribution of existing studies to decision-making within the respective stages of the MPLC. METHODS We searched MEDLINE and EMBASE for studies evaluating patient preferences related to APC treatment up to October 2020. Two reviewers independently performed screening, data extraction and quality assessment in duplicate. We descriptively summarized the findings and analyzed the studies regarding their contribution within the MPLC using an analytical framework. RESULTS Seven quantitative preference studies were included. One study each was conducted in the marketing approval and the health technology assessment (HTA) and reimbursement stage, and five were conducted in the post-marketing stage of the MPLC. While almost all stated to inform clinical practice, the specific contributions to clinical decision-making remained unclear for almost all studies. Evaluated attributes related to benefits, harms, and other treatment-related aspects and their relative importance varied relevantly between studies. All studies were judged of high quality overall, but some methodological issues regarding sample selection and the definition of patient-relevant treatment attributes were identified. CONCLUSION The most patient-relevant aspects regarding the benefits and harms of APC treatment are not yet established, and it remains unclear which APC treatments are preferred by patients. Findings from this study highlight the importance of transparent reporting and discussion of study findings according to their aims and with respect to their stage within the MPLC. Future research may benefit from using the MPLC framework for analyzing or determining the aims and design of patient preference studies.
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Affiliation(s)
- Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
- Correspondence: Dominik Menges, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich, CH-8001, Switzerland, Tel +41 44 634 46 15, Email
| | - Michela C Piatti
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Thomas Cerny
- Foundation Board, Cancer Research Switzerland (Krebsforschung Schweiz KFS), Bern, Switzerland
- Human Medicines Expert Committee (HMEC), Swissmedic, Bern, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
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Hassanaly P, Dufour JC. Analysis of the Regulatory, Legal, and Medical Conditions for the Prescription of Mobile Health Applications in the United States, The European Union, and France. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:389-409. [PMID: 34853541 PMCID: PMC8628128 DOI: 10.2147/mder.s328996] [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: 07/24/2021] [Accepted: 10/14/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Mobile health (mHealth) is now considered an important approach to extend traditional health services and to meet the growing medical needs. The prescribability of mHealth applications is a complex problem because it depends on a large number of factors and concerns a wide range of disciplines and actors in the industrial, health, normative, and regulatory domains. OBJECTIVE Our study correlated data from the scientific literature with data on regulatory developments in the United States, the European Union, and France with the aim of identifying the conditions for the prescription of mHealth applications. METHODS The search method adopted was the systematic literature review process by Brereton et al. All empirical evidence from the relevant fields of study was gathered and then evaluated to answer our predefined research questions. The WoS and PubMed databases were queried for the period between 1 January 1975 and 30 November 2020. A total of 165 articles (15 with a direct focus and 150 with an indirect focus on mHealth prescribing) were analyzed/cross-referenced. The ScienceDirect database was consulted to complement the collected data when needed. Data published by international and national regulatory bodies were analyzed in light of the scientific data obtained from the WoS, PubMed, and ScienceDirect databases. RESULTS The International Medical Device Regulators Forum has ensured the international structuring of the regulatory field in collaboration with participating countries. The creation and updating of databases have allowed the tracking of medical device versions/upgrades and incidents. The regulatory organizations of the United States, the European Union, and France are currently consulting healthcare personnel, manufacturers, and patients to establish evaluation criteria for usability and quality of instructions for use that take into consideration patients' level of literacy. These organizations are also providing support to manufacturers who wish to file marketing applications. Marketing, privacy, and cybersecurity measures are evolving with developments in technology and state cooperation policies. The prescription of mHealth applications will gain social acceptance only if consistency and coordination are ensured at all stages of the process: from pre-design, through verification of medical effectiveness, to ethical consideration during data collection and use, and on to marketing. CONCLUSION The conditions for mHealth prescribability include the adaptation of international regulation by the different states, the state provision of marketing support, and the evaluation of mHealth applications. For mHealth to gain social acceptance, increased collaboration among physicians, manufacturers, and "information technology stakeholders" is needed. Once this is achieved, MHealth can become the cornerstone of successful health care reform.
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Affiliation(s)
- Parina Hassanaly
- Aix Marseille Université, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Jean Charles Dufour
- Aix Marseille Université, APHM, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Hop Timone, BioSTIC, Biostatistique et Technologies de l’Information et de la Communication, Marseille, France
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Functional capacity vs side effects: treatment attributes to consider when individualising treatment for patients with rheumatoid arthritis. Clin Rheumatol 2021; 41:695-704. [PMID: 34655004 PMCID: PMC8873051 DOI: 10.1007/s10067-021-05961-8] [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: 06/16/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/21/2022]
Abstract
Introduction Individualisation of rheumatoid arthritis (RA) treatment needs to take account of individual patients’ preferences to increase patient-centeredness in treatment decisions. The aim of this study was to identify patient-relevant treatment attributes to consider when individualising treatment for patients with RA. Method Patients with RA in Sweden were invited to rank the most important treatment attributes in an online survey (April to May 2020). Semi-structured interviews were conducted (October to November 2020) to further identify and frame potential attributes for shared decision-making. The interviews were audio-recorded, transcribed and analysed using thematic framework analysis. Patient research partners and rheumatologists supported the selection and framing of the treatment attributes across the assessment. Results The highest ranked attributes (N = 184) were improved functional capacity, reduced inflammation, reduced pain and fatigue and the risk of getting a severe side effect. The framework analysis revealed two overarching themes for further exploration: treatment goals and side effects. ‘Treatment goals’ emerged from functional capacity, revealing two dimensions: physical functional capacity and psychosocial functional capacity. ‘Side effects’ revealed that mild and severe side effects were the most important to discuss in shared decision-making. Conclusions Functional capacity (physical and psychosocial) and potential side effects (mild and severe) are important treatment attributes to consider when individualising RA treatment. Future research should assess how patients with RA weigh benefits and risks against each other, in order to increase patient-centeredness early on the treatment trajectory.
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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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Mühlbacher AC, Sadler A, Lamprecht B, Juhnke C. Patient preferences in the treatment of hemophilia A: A latent class analysis. PLoS One 2021; 16:e0256521. [PMID: 34424920 PMCID: PMC8382185 DOI: 10.1371/journal.pone.0256521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine subgroup-specific treatment preferences and characteristics of patients with hemophilia A. METHODS Best-Worst Scaling (BWS) Case 3 (four attributes: application type; bleeding frequencies/year; inhibitor development risk; thromboembolic events of hemophilia A treatment risk) conducted via online survey. Respondents chose the best and the worst option of three treatment alternatives. Data were analyzed via latent class model (LCM), allowing capture of heterogeneity in the sample. Respondents were grouped into a predefined number of classes with distinct preferences. RESULTS The final dataset contained 57 respondents. LCM analysis segmented the sample into two classes with heterogeneous preferences. Preferences within each were homogeneous. For class 1, the most decisive factor was bleeding frequency/year. Respondents seemed to focus mainly on this in their choice decisions. With some distance, inhibitor development was the second most important. The remaining attributes were of far less importance for respondents in this class. Respondents in class 2 based their choice decisions primarily on inhibitor development, also followed, by some distance, the second most important attribute bleeding frequency/year. There was statistical significance (P < 0.05) between the number of annual bleedings and the probability of class membership. CONCLUSIONS The LCM analysis addresses heterogeneity in respondents' choice decisions, which helps to tailor treatment alternatives to individual needs. Study results support clinical and allocative decision-making and improve the quality of interpretation of clinical data.
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Affiliation(s)
- Axel C. Mühlbacher
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany
- Gesellschaft für empirische Beratung GmbH, Freiburg, Germany
- Duke Department of Population Health Sciences and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Andrew Sadler
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany
| | | | - Christin Juhnke
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany
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Sugitani Y, Ito K, Ono S. Patient Preferences for Attributes of Chemotherapy for Lung Cancer: Discrete Choice Experiment Study in Japan. Front Pharmacol 2021; 12:697711. [PMID: 34354590 PMCID: PMC8329447 DOI: 10.3389/fphar.2021.697711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Our study objective was to determine lung cancer chemotherapy attributes that are important to patients in Japan. A discrete choice experiment survey in an anonymous web-based questionnaire format with a reward was completed by 200 lung cancer patients in Japan from November 25, 2019, to November 27, 2019. The relative importance of patient preferences for each attribute was estimated using a conditional logit model. A hierarchical Bayesian logit model was also used to estimate the impact of each demographic characteristic on the relative importance of each attribute. Of the 200 respondents, 191 with consistent responses were included in the analysis. In their preference, overall survival was the most important, followed by diarrhea, nausea, rash, bone marrow suppression (BMS), progression-free survival, fatigue, interstitial lung disease, frequency of administration, and duration of administration. The preferences were influenced by demographic characteristics (e.g., gender and age) and disease background (e.g., cancer type and stage). Interestingly, the experience of cancer drug therapies and adverse events had a substantial impact on the hypothetical drug preferences. For the Japanese lung cancer patients, improved survival was the most important attribute that influenced their preference for chemotherapy, followed by adverse events, including diarrhea, nausea, rash, and BMS. The preferences varied depending on the patient’s demographic and experience. As drug attributes can affect patient preferences, pharmaceutical companies should be aware of the patient preferences and develop drugs that respond to segmented market needs.
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Affiliation(s)
- Yasuo Sugitani
- Biometrics Department, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan.,Laboratory of Pharmaceutical Regulation and Sciences, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Kyoko Ito
- Sustainability Department, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Shunsuke Ono
- Laboratory of Pharmaceutical Regulation and Sciences, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
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Vass CM, Davison NJ, Vander Stichele G, Payne K. A Picture is Worth a Thousand Words: The Role of Survey Training Materials in Stated-Preference Studies. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:163-173. [PMID: 31565784 PMCID: PMC7075825 DOI: 10.1007/s40271-019-00391-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Online survey-based methods are increasingly used to elicit preferences for healthcare. This digitization creates an opportunity for interactive survey elements, potentially improving respondents’ understanding and/or engagement. Objective Our objective was to understand whether, and how, training materials in a survey influenced stated preferences. Methods An online discrete-choice experiment (DCE) was designed to elicit public preferences for a new targeted approach to prescribing biologics (“biologic calculator”) for rheumatoid arthritis (RA) compared with conventional prescribing. The DCE presented three alternatives, two biologic calculators and a conventional approach (opt out), described by five attributes: delay to treatment, positive predictive value, negative predictive value, infection risk, and cost saving to the national health service. Respondents were randomized to receive training materials as plain text or an animated storyline. Training materials contained information about RA and approaches to treatment and described the biologic calculator. Background questions included sociodemographics and self-reported measures of task difficulty and attribute non-attendance. DCE data were analyzed using conditional and heteroskedastic conditional logit (HCL) models. Results In total, 300 respondents completed the DCE, receiving either plain text (n = 158) or the animated storyline (n = 142). The HCL showed the estimated coefficients for all attributes aligned with a priori expectations and were statistically significant. The scale term was statistically significant, indicating that respondents who received plain-text materials had more random choices. Further tests suggested preference homogeneity after accounting for differences in scale. Conclusions Using animated training materials did not change the preferences of respondents, but they appeared to improve choice consistency, potentially allowing researchers to include more complex designs with increased numbers of attributes, levels, alternatives or choice sets. Electronic supplementary material The online version of this article (10.1007/s40271-019-00391-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caroline M Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK.,RTI Health Solutions, Manchester, UK
| | - Niall J Davison
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK.,BresMed, Manchester, UK
| | | | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK.
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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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Totton N, Julious S, Hughes D, Cook J, Biggs K, Coates L, Cook A, Hewitt C, Day S. Utilising benefit-risk assessments within clinical trials-a protocol for the BRAINS project. Trials 2021; 22:68. [PMID: 33468202 PMCID: PMC7814532 DOI: 10.1186/s13063-021-05022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depending on the treatment to be investigated, a clinical trial could be designed to assess objectives of superiority, equivalence or non-inferiority. The design of the study is affected by many different elements including the control treatment, the primary outcome and associated relationships. In some studies, there could be more than one outcome of interest. In these situations, benefit-risk methodologies could be used to assess the outcomes simultaneously and consider the trade-off between the benefits against the risks of a treatment. Benefit-risk is used within the regulatory industry but seldom included within publicly funded clinical trials within the UK. This project aims to gain an expert consensus on how to select the appropriate trial design (e.g. superiority) and when to consider including benefit-risk methods. METHODS The project will consist of four work packages: 1. A web-based survey to elicit current experiences and opinions, 2. A rapid literature review to assess any current recommendations, 3. A two-day consensus workshop to gain agreement on the recommendations, and 4. Production of a guidance document. DISCUSSION The aim of the project is to provide a guideline for clinical researchers, grant funding bodies and reviewers for grant bodies for how to select the most appropriate trial design and when it is appropriate to consider using benefit-risk methods. The focus of the guideline will be on publicly funded trials however, the vision is that the work will be applicable across research settings and we will connect with other organisations and committees as appropriate.
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Affiliation(s)
- Nikki Totton
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Steven Julious
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Jonathan Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katie Biggs
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lizzie Coates
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Andrew Cook
- Wessex Institute, University of Southampton, Southampton, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Simon Day
- Clinical Trials Consulting & Training Limited, Buckingham, UK
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Bywall KS, Kihlbom U, Hansson M, Falahee M, Raza K, Baecklund E, Veldwijk J. Patient preferences on rheumatoid arthritis second-line treatment: a discrete choice experiment of Swedish patients. Arthritis Res Ther 2020; 22:288. [PMID: 33341117 PMCID: PMC7749986 DOI: 10.1186/s13075-020-02391-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/09/2020] [Indexed: 01/26/2023] Open
Abstract
Background Preference assessments of patients with rheumatoid arthritis can support clinical therapeutic decisions for including biologic and targeted synthetic medicines to use. This study assesses patient preferences for attributes of second-line therapies and heterogeneity within these preferences to estimate the relative importance of treatment characteristics and to calculate the minimum benefit levels patients require to accept higher levels of side effects. Methods Between November 2018 to August 2019, patients with rheumatoid arthritis were recruited to a survey containing demographic and disease-related questions as well as a discrete choice experiment to measure their preferences for second-line therapies using biologics or Janus kinases inhibitors. Treatment characteristics included were route of administration, frequency of use, probability of mild short-term side effects, probability of side effects changing appearance, probability of psychological side effects, probability of severe side effects and effectiveness of treatment. Results A total of 358 patients were included in the analysis. A latent class analysis revealed three preference patterns: (1) treatment effectiveness as the single most important attribute, (2) route of administration as the most important attribute, closely followed by frequency of use and psychological side effects and (3) severe side effects as the most important attribute followed by psychological side effects. In addition, disease duration and mild side effects influenced the patients’ choices. Conclusion Respondents found either effectiveness, route of administration or severe side effects as the most important attribute. Patients noting effectiveness as most important were more willing than other patients to accept higher risks of side effects.
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Affiliation(s)
- Karin Schölin Bywall
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden.
| | - Ulrik Kihlbom
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden
| | - Mats Hansson
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden
| | - Marie Falahee
- Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Karim Raza
- Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH, UK
| | - Eva Baecklund
- Department of Medical Sciences, Rheumatology, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Jorien Veldwijk
- Erasmus School of Health Policy & Management, and Erasmus Choice Modelling Centre, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
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Saadati H, Baradaran HR, Danaei G, Ostovar A, Hadaegh F, Janani L, Steyerberg EW, Khalili D. Iranian general populations' and health care providers' preferences for benefits and harms of statin therapy for primary prevention of cardiovascular disease. BMC Med Inform Decis Mak 2020; 20:288. [PMID: 33148227 PMCID: PMC7640674 DOI: 10.1186/s12911-020-01304-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of statins for primary prevention of cardiovascular diseases is associated with different benefit and harm outcomes. The aime of this study is how important these outcomes are for people and what people's preferences are. METHODS We conducted a preference-eliciting survey incorporating a best-worst scaling (BWS) instrument in Iran from June to November 2019. The relative importance of 13 statins-related outcomes was assessed on a sample of 1085 participants, including 913 general population (486 women) and 172 healthcare providers from the population covered by urban and rural primary health care centers. The participants made trade-off decisions and selected the most and least worrisome outcomes concurrently from 13 choice sets; each contains four outcomes generated using the balanced incomplete block design. RESULTS According to the mean (SD) BWS scores, which can be (+ 4) in maximum and (- 4) in minimum, in the general population, the most worrisome outcomes were severe stroke (3.37 (0.8)), severe myocardial infarction (2.71(0.7)), and cancer (2.69 (1.33)). While myopathy (- 3. 03 (1.03)), nausea/headache (- 2.69 (0.94)), and treatment discontinuation due to side effects (- 2.24 (1.14)) were the least worrisome outcomes. Preferences were similar between rural and urban areas and among health care providers and the general population with overlapping uncertainty intervals. CONCLUSION The rank of health outcomes may be similar in various socio-cultural contexts. The preferences for benefits and harms of statin therapy are essential to assess benefit-harm balance when recommending statins for primary prevention of cardiovascular diseases.
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Affiliation(s)
- Hassan Saadati
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran. .,Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition University of Aberdeen, Aberdeen, UK. .,Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
| | - Goodarz Danaei
- Department of Global Health and Population and Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.,Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Chachoua L, Dabbous M, François C, Dussart C, Aballéa S, Toumi M. Use of Patient Preference Information in Benefit-Risk Assessment, Health Technology Assessment, and Pricing and Reimbursement Decisions: A Systematic Literature Review of Attempts and Initiatives. Front Med (Lausanne) 2020; 7:543046. [PMID: 33195294 PMCID: PMC7649266 DOI: 10.3389/fmed.2020.543046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives: Inclusion of patient preference (PP) data in decision making has been largely discussed in recent years. Healthcare decision makers—regulatory and health technology assessment (HTA)—are more and more conscious of the need for a patient-centered approach to decide on optimal allocation of scarce money, time, and technological resources. This literature review aims to examine the use of and recommendations for the integration of PP in decision making. Methods: A literature search was conducted through PubMed/Medline in May 2019 to identify publications on PP studies used to inform benefit–risk assessments (BRAs) and HTAs and patient-centered projects and guidelines related to the inclusion of PPs in health policy decision making. After title and abstract screening and full-text review, selected publications were analyzed to retrieve data related to the collection, use, and/or submission of PPs informing BRA or HTA as well as attempts and initiatives in recommendations for PPs integration in decision-making processes. Results: Forty-nine articles were included: 24 attempts and pilot project discussions and 25 PP elicitation studies. Quantitative approaches, particularly discrete choice experiments, were the most used (24 quantitative elicitation studies and 1 qualitative study). The objective of assessing PPs was to prioritize outcome-specific information, to value important treatment characteristics, to provide patient-focused benefit–risk trade-offs, and to appraise the patients' willingness to pay for new technologies. Moreover, attempts and pilot projects to integrate PPs in BRAs and HTAs were identified at the European level and across countries, but no clear recommendations have been issued yet. No less than seven public and/or private initiatives have been undertaken by governmental agencies and independent organizations to set guidance targeting improvement of patients' involvement in decision making. Conclusion: Despite the initiatives undertaken, the pace of progress remains slow. The use of PPs remains poorly implemented, and evidence of proper use of these data in decision making is lacking. Guidelines and recommendations formalizing the purpose of collecting PPs, what methodology should be adopted and how, and who should be responsible for generating these data throughout the decision-making processes are needed to improve and empower integration of PPs in BRA and HTA.
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Affiliation(s)
- Lylia Chachoua
- Laboratory EA 3279 - CEReSS, Aix-Marseille University, Life Sciences and Health Department of Clinical Research and Public Health, Marseille, France
| | - Monique Dabbous
- Laboratory EA 3279 - CEReSS, Aix-Marseille University, Life Sciences and Health Department of Clinical Research and Public Health, Marseille, France
| | - Clément François
- Laboratory EA 3279 - CEReSS, Aix-Marseille University, Life Sciences and Health Department of Clinical Research and Public Health, Marseille, France.,Creativ-Ceutical, Paris, France
| | | | - Samuel Aballéa
- Laboratory EA 3279 - CEReSS, Aix-Marseille University, Life Sciences and Health Department of Clinical Research and Public Health, Marseille, France.,Creativ-Ceutical, Paris, France
| | - Mondher Toumi
- Laboratory EA 3279 - CEReSS, Aix-Marseille University, Life Sciences and Health Department of Clinical Research and Public Health, Marseille, France.,Creativ-Ceutical, Paris, France
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Giubilato E, Cazzagon V, Amorim MJB, Blosi M, Bouillard J, Bouwmeester H, Costa AL, Fadeel B, Fernandes TF, Fito C, Hauser M, Marcomini A, Nowack B, Pizzol L, Powell L, Prina-Mello A, Sarimveis H, Scott-Fordsmand JJ, Semenzin E, Stahlmecke B, Stone V, Vignes A, Wilkins T, Zabeo A, Tran L, Hristozov D. Risk Management Framework for Nano-Biomaterials Used in Medical Devices and Advanced Therapy Medicinal Products. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E4532. [PMID: 33066064 PMCID: PMC7601697 DOI: 10.3390/ma13204532] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 12/25/2022]
Abstract
The convergence of nanotechnology and biotechnology has led to substantial advancements in nano-biomaterials (NBMs) used in medical devices (MD) and advanced therapy medicinal products (ATMP). However, there are concerns that applications of NBMs for medical diagnostics, therapeutics and regenerative medicine could also pose health and/or environmental risks since the current understanding of their safety is incomplete. A scientific strategy is therefore needed to assess all risks emerging along the life cycles of these products. To address this need, an overarching risk management framework (RMF) for NBMs used in MD and ATMP is presented in this paper, as a result of a collaborative effort of a team of experts within the EU Project BIORIMA and with relevant inputs from external stakeholders. The framework, in line with current regulatory requirements, is designed according to state-of-the-art approaches to risk assessment and management of both nanomaterials and biomaterials. The collection/generation of data for NBMs safety assessment is based on innovative integrated approaches to testing and assessment (IATA). The framework can support stakeholders (e.g., manufacturers, regulators, consultants) in systematically assessing not only patient safety but also occupational (including healthcare workers) and environmental risks along the life cycle of MD and ATMP. The outputs of the framework enable the user to identify suitable safe(r)-by-design alternatives and/or risk management measures and to compare the risks of NBMs to their (clinical) benefits, based on efficacy, quality and cost criteria, in order to inform robust risk management decision-making.
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Affiliation(s)
- Elisa Giubilato
- Department of Environmental Sciences, Informatics and Statistics, University Ca’ Foscari of Venice, Via Torino 155, 30172 Venice, Italy; (E.G.); (V.C.); (A.M.); (E.S.)
| | - Virginia Cazzagon
- Department of Environmental Sciences, Informatics and Statistics, University Ca’ Foscari of Venice, Via Torino 155, 30172 Venice, Italy; (E.G.); (V.C.); (A.M.); (E.S.)
| | - Mónica J. B. Amorim
- Department of Biology and CESAM, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Magda Blosi
- Institute of Science and Technology for Ceramics, National Research Council of Italy (CNR-ISTEC), Via Granarolo 64, 48018 Faenza, Italy; (M.B.); (A.L.C.)
| | - Jacques Bouillard
- Institut National de l’Environnement industriel et des Risques, Parc Technologique ALATA, 60550 Verneuil-en-Halatte, France; (J.B.); (A.V.)
| | - Hans Bouwmeester
- Division of Toxicology, Wageningen University, 6708 WE Wageningen, The Netherlands;
| | - Anna Luisa Costa
- Institute of Science and Technology for Ceramics, National Research Council of Italy (CNR-ISTEC), Via Granarolo 64, 48018 Faenza, Italy; (M.B.); (A.L.C.)
| | - Bengt Fadeel
- Division of Molecular Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Teresa F. Fernandes
- Institute of Life and Earth Sciences, School of Energy, Geoscience, Infrastructure and Society, Heriot-Watt University, Edinburgh EH14 4AS, UK;
| | - Carlos Fito
- Instituto Tecnologico del Embalaje, Transporte y Logistica, 46980 Paterna-Valencia, Spain;
| | - Marina Hauser
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland; (M.H.); (B.N.)
| | - Antonio Marcomini
- Department of Environmental Sciences, Informatics and Statistics, University Ca’ Foscari of Venice, Via Torino 155, 30172 Venice, Italy; (E.G.); (V.C.); (A.M.); (E.S.)
| | - Bernd Nowack
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland; (M.H.); (B.N.)
| | - Lisa Pizzol
- GreenDecision Srl, Via delle Industrie, 21/8, 30175 Venice, Italy; (L.P.); (A.Z.)
| | - Leagh Powell
- Institute of Biological Chemistry, Biophysics and Bioengineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK; (L.P.); (V.S.)
| | - Adriele Prina-Mello
- Trinity Translational Medicine Institute, Trinity College, The University of Dublin, Dublin 8, Ireland;
| | - Haralambos Sarimveis
- School of Chemical Engineering, National Technical University of Athens, 15780 Athens, Greece;
| | | | - Elena Semenzin
- Department of Environmental Sciences, Informatics and Statistics, University Ca’ Foscari of Venice, Via Torino 155, 30172 Venice, Italy; (E.G.); (V.C.); (A.M.); (E.S.)
| | | | - Vicki Stone
- Institute of Biological Chemistry, Biophysics and Bioengineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK; (L.P.); (V.S.)
| | - Alexis Vignes
- Institut National de l’Environnement industriel et des Risques, Parc Technologique ALATA, 60550 Verneuil-en-Halatte, France; (J.B.); (A.V.)
| | - Terry Wilkins
- Nanomanufacturing Institute, School of Chemical and Process Engineering, University of Leeds, Leeds LS2 9JT, UK;
| | - Alex Zabeo
- GreenDecision Srl, Via delle Industrie, 21/8, 30175 Venice, Italy; (L.P.); (A.Z.)
| | - Lang Tran
- Institute of Occupational Medicine, Research Avenue North, Riccarton, Edinburgh EH14 4AP, UK;
| | - Danail Hristozov
- Department of Environmental Sciences, Informatics and Statistics, University Ca’ Foscari of Venice, Via Torino 155, 30172 Venice, Italy; (E.G.); (V.C.); (A.M.); (E.S.)
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The Importance of Collaboration in Pursuit of Patient-Centered Value Assessment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:381-384. [PMID: 32856277 PMCID: PMC8205871 DOI: 10.1007/s40271-020-00446-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Sain N, Willems D, Charokopou M, Hiligsmann M. The importance of understanding patient and physician preferences for psoriasis treatment characteristics: a systematic review of discrete-choice experiments. Curr Med Res Opin 2020; 36:1257-1275. [PMID: 32468865 DOI: 10.1080/03007995.2020.1776233] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Treatment adherence continues to be a major challenge in psoriasis. Patient preference studies, especially discrete-choice experiments, are gaining popularity to gather insights into patient reported treatment outcomes. This systematic literature review aimed to critically assess all discrete choice experiments exploring patients' and physicians' preferences for psoriasis treatment characteristics.Methods: PubMed and EMBASE databases were searched using keywords "psoriasis" and "preferences" to identify relevant literature. Discrete-choice experiments conducted in French or English from the year 2000 onwards, that focused on evaluating psoriasis treatment preferences in patients and/or physicians, were included. The relative importance of treatment attributes was assessed and studies were critically appraised using validated checklists.Results: Out of 987 articles identified, 25 articles fulfilled the inclusion criteria. Overall, patients and physicians prioritize efficacy-specific outcomes. Patients are shown to place greater importance to process attributes when compared to physicians, especially route and location of administration. Physicians focus primarily of efficacy attributes, however when the top two attributes are considered, safety outcomes increasingly become considered important. Of the studies, 60% conducted subgroup analysis, of which many reported associations between specific patient characteristics and preferences. Factors such as age, disease severity, and duration of condition significantly affected preferences for treatment attributes.Conclusions: This review provides insight into the types of attributes that patients and physicians value most, and therefore can help improve shared decision-making. The findings of this study also encourage regulatory agencies to continue integrating patient preferences in their decision-making.
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Affiliation(s)
- Noem Sain
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Damon Willems
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- UCB Pharma, Brussels, Belgium
| | | | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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An overview of critical decision-points in the medical product lifecycle: Where to include patient preference information in the decision-making process? Health Policy 2020; 124:1325-1332. [PMID: 32839011 DOI: 10.1016/j.healthpol.2020.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 06/09/2020] [Accepted: 07/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patient preference (PP) information is not effectively integrated in decision-making throughout the medical product lifecycle (MPLC), despite having the potential to improve patients' healthcare options. A first step requires an understanding of existing processes and decision-points to know how to incorporate PP information in order to improve patient-centric decision-making. OBJECTIVES The aims were to: 1) identify the decision-making processes and decision-points throughout the MPLC for industry, regulatory authorities, and reimbursement/HTA, and 2) determine which decision-points can potentially include PP information. METHODS A scoping literature review was conducted using five scientific databases. Semi-structured interviews were conducted with representatives from seven European countries and the US, including industry (n = 24), regulatory authorities (n = 23), reimbursement/HTA (n = 23). Finally, validation meetings with key stakeholders (n = 11) were conducted. RESULTS Six critical decision-points were identified for industry decision-making, three for regulatory decision-making, and six for reimbursement/HTA decision-making. Stakeholder groups agreed that PP information is not systematically integrated, either as obligatory information or pre-set criteria, but would benefit all the listed decision-points in the future. CONCLUSION Currently, PP information is not considered as obligatory information to submit for any of the MPLC decision-points. However, PP information is considered an important component by most stakeholders to inform future decision-making across the MPLC. The integration of PP information into 15 identified decision-points needs continued discussion and collaboration between stakeholders.
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46
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dosReis S, Butler B, Caicedo J, Kennedy A, Hong YD, Zhang C, Slejko JF. Stakeholder-Engaged Derivation of Patient-Informed Value Elements. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 13:611-621. [PMID: 32676998 PMCID: PMC7479003 DOI: 10.1007/s40271-020-00433-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Our objective was to identify patient-informed value elements that can be used to make value assessment more patient centered. Methods Mixed methods were used iteratively to collect and integrate qualitative and quantitative data in a four-stage process: identification (stage 1), prioritization (stage 2), refinement (stage 3), and synthesis (stage 4). Qualitative methods involved one-on-one discussions with 14 patient stakeholders from diverse medical communities representing mental health, osteoporosis, blindness, lupus, eczema, oncology, chronic obstructive pulmonary disease, and hypercholesterolemia. Stakeholders completed guided activities to prioritize elements important to patient healthcare decision making. Responses were summarized descriptively as frequencies and proportions. Results Stakeholders identified 94 value elements in stage 1. Of these, 42 elements remained following the stage 2 prioritization and the stage 3 refinement. During the stage 4 synthesis, the 42 patient-informed value elements comprised the principal set of value elements that were organized by 11 categories: tolerability, disease burden, forecasting, accessibility of care/treatment, healthcare service delivery, cost incurred on the patient, cost incurred on the family, personal well-being, stigma, social well-being, and personal values. The categories fell under five domains: short- and long-term effects of treatment, treatment access, cost, life impact, and social impact. Conclusions In total, 75% of the value elements in the conceptual model were patient derived and distinct from the elements used in existing value frameworks. Recommendations for tailoring, quantifying, and applying the patient-informed value elements in distinct patient communities are provided. This provides a foundation from which future research may test patient-informed value elements in existing value frameworks and economic evaluations. Electronic supplementary material The online version of this article (10.1007/s40271-020-00433-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susan dosReis
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, 220 Arch Street, Baltimore, MD, 21201, USA.
| | | | | | - Annie Kennedy
- EveryLife Foundation for Rare Diseases, Washington, DC, USA
| | - Yoon Duk Hong
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, 220 Arch Street, Baltimore, MD, 21201, USA
| | - Chengchen Zhang
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, 220 Arch Street, Baltimore, MD, 21201, USA
| | - Julia F Slejko
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, 220 Arch Street, Baltimore, MD, 21201, USA
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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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48
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Sachs ML, Colding-Jørgensen M, Helboe P, Sporrong SK, Frøkjaer S, Jelic K, Kaae S. Danish Physicians' Views on the Appropriateness of the Involvement of Patients with Type 2 Diabetes in Regulatory Decision Making: A Qualitative Study. Pharmaceut Med 2020; 33:99-107. [PMID: 31933255 DOI: 10.1007/s40290-019-00275-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Regulators, the pharmaceutical industry, and patient organizations expect an increased inclusion of patients' risk preferences in medical regulatory decisions, for example, with regard to market approval. Merging of input from patients with, for example, multiple sclerosis, with expertise from health professionals in regulatory decisions has already occurred. The complex task of involving larger and more heterogeneous patient populations (e.g. with diabetes mellitus, asthma), however, remains. OBJECTIVE This study aimed to understand physicians' experiences with factors influencing patients with diabetes mellitus perceived risks of their medicines and to explore how physicians, based on these experiences, perceive patients with diabetes to be suited for involvement in regulatory decisions. This study will provide knowledge that can improve the inclusion of heterogeneous patient groups in regulatory decisions. METHODS We conducted five semi-structured interviews with physicians with different types of experiences with patients' risk perceptions (for example, being in contact with individual patients vs. being involved in developing guidelines at the population level) and one focus group interview with eight general practitioners in Sjælland, Denmark. We applied a thematic analysis to explore physicians' experiences of the risk perceptions of patients with type 2 diabetes and their perceptions of patients' fitness for involvement in regulatory decisions. RESULTS The risk perceptions and preferences of patients with diabetes were perceived to be rather diverse. Four drivers behind this diversity were described: past experiences, personality, prognosis ability, and knowledge. The legitimacy of patient preferences was not questioned, but the diversity of risk perceptions made the respondents question the existence of a uniform 'patient voice' useful for regulatory decision making. CONCLUSION The respondents acknowledged the relevance and legitimacy of the patient perspective, but it was a concern that patient risk perceptions, at present, are too diverse to be included in regulatory decisions. Whether patients make regulatory decisions as perceived by physicians needs to be confirmed by future studies.
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Affiliation(s)
| | | | - Per Helboe
- University of Copenhagen, Copenhagen, Denmark
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Ver Donck N, Vander Stichele G, Huys I. Improving Patient Preference Elicitation by Applying Concepts From the Consumer Research Field: Narrative Literature Review. Interact J Med Res 2020; 9:e13684. [PMID: 32229460 PMCID: PMC7157502 DOI: 10.2196/13684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 12/11/2019] [Accepted: 01/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although preference research finds its origins in consumer research, preference elicitation methods have increasingly attracted attention in different decision-making contexts in health care. Simulating real-life decision making is believed to be important during consumer preference elicitation. OBJECTIVE The aims of this study were to compare the process of decision making between patients and consumers and to identify methods from the consumer research field that could be applied in patient preference elicitation. METHODS A narrative literature review was performed to identify preference elicitation concepts from a consumer context that could offer improvements in health care. RESULTS The process of decision making between patients and consumers was highly comparable. The following five concepts from the consumer research field that could effectively simulate a real-life decision-making process for applications in health care were identified: simulating alternatives, self-reflection, feedback-driven exploration, separated (adaptive) dual response, and arranging profiles in blocks. CONCLUSIONS Owing to similarities in the decision-making process, patients could be considered as a subgroup of consumers, suggesting that preference elicitation concepts from the consumer field may be relevant in health care. Five concepts that help to simulate real-life decision making have the potential to improve patient preference elicitation. However, the extent to which real decision-making contexts can be mimicked in health care remains unknown.
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Affiliation(s)
- Niki Ver Donck
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium.,Health Economics Consultancy, ISMS, Turnhout, Belgium.,Digital Health Solution Development, MindBytes, Merksplas, Belgium
| | - Geert Vander Stichele
- Health Economics Consultancy, ISMS, Turnhout, Belgium.,Digital Health Solution Development, MindBytes, Merksplas, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
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50
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McGrady ME, Pai ALH, Prosser LA. Using discrete choice experiments to develop and deliver patient-centered psychological interventions: a systematic review. Health Psychol Rev 2020; 15:314-332. [PMID: 31937184 DOI: 10.1080/17437199.2020.1715813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Developing and/or tailoring psychological interventions to align with patient preferences is a critical component of patient-centered care and has the potential to improve patient engagement and treatment outcomes. Discrete choice experiments (DCEs) are a quantitative method of assessing patient preferences that offer numerous strengths (i.e., ability to account for trade-offs), but are not routinely incorporated into health psychology coursework, likely leaving many unaware of the potential benefits of this methodology. To highlight the potential applications of DCEs within health psychology, this systematic review synthesises previous efforts to utilise DCEs to inform the design of patient-centered psychological care, defined as interventions targeting psychological (e.g., depression, anxiety) or behavioural health (e.g., pain management, adherence) concerns. Literature searches were conducted in March 2017 and November 2019 for articles reporting on DCEs using the terms 'discrete choice', 'conjoint', or 'stated preference'. Thirty-nine articles met all inclusion criteria and used DCEs to understand patient preferences regarding psychosocial clinical services (n = 12), lifestyle behaviour change interventions (n = 11), HIV prevention and/or intervention services (n = 10), disease self-management programmes (n = 4), or other interventions (n = 2). Clinical implications as well as limitations and directions for future research are discussed.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Patient and Family Wellness Center, Cancer and Blood Diseases Institute; Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Patient and Family Wellness Center, Cancer and Blood Diseases Institute; Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lisa A Prosser
- Department of Pediatrics, Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
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