1
|
Preferences for Risks and Benefits of Islet Cell Transplantation for Persons With Type 1 Diabetes With History of Episodes of Severe Hypoglycemia: A Discrete-Choice Experiment to Inform Regulatory Decisions. Transplantation 2022; 106:e368-e379. [PMID: 35655355 DOI: 10.1097/tp.0000000000004189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The advisory panel for US Food and Drug Administration (FDA) recently endorsed pancreatic islet cell transplantation (ICT) therapy for suboptimally controlled type 1 diabetes (T1D), and FDA approval is under consideration. An important part of regulatory approval includes the patient perspective, through discrete choice. We developed a discrete-choice instrument and used it to determine how 90 people with T1D weigh the risks and benefits of ICT to inform regulatory decisions. METHODS Sawtooth software created a random, full-profile, balanced-overlap experimental design for a measure with 8 attributes of ICT risks/benefits, each with 3 to 5 levels. We asked 18 random task pairs, sociodemographics, diabetes management, and hypoglycemia questions. Analysis was performed using random parameters logistic regression technique. RESULTS The strongest preference was for avoiding the highest chance (15%) of serious procedure-related complications (β = -2.03, P < 0.001). The strongest positive preference was for gaining 5-y insulin independence (β = 1.75, P < 0.001). The desire for 5-y HbA1C-defined clinical treatment success was also strong (β = 1.39, P < 0.001). Subgroup analysis suggested strong gender differences with women showing much higher preferences for all benefits (68% higher for 5-y insulin independence), and men were generally more risk averse than women. Those with high versus low diabetes distress showed 3 times stronger preference for 5-y insulin independence but also twice preference to avoid risks of serious complications. CONCLUSION Despite showing the most preference for avoiding serious ICT complications, people with T1D had a strong preference for achieving ICT benefits, especially insulin independence. We identified important attributes of ICT and demonstrated that patients are willing to make these trade-offs, showing support for the introduction of ICT.
Collapse
|
2
|
Dowling A, Lane H, Haines T. Community preferences for the allocation of scarce healthcare resources during the Covid-19 pandemic: a review of the literature. Public Health 2022; 209:75-81. [PMID: 35849934 PMCID: PMC9212404 DOI: 10.1016/j.puhe.2022.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
Objective The purpose of this thematic review is to examine the literature on the publics’ preferences of scarce medical resource allocation during COVID-19. Study design Literature review. Methods A review of Ovid MEDLINE, Embase, CINAHL and Scopus was performed between December 2019 and June 2022 for eligible articles. Results Fifteen studies using three methodologies and spanning five continents were included. Five key themes were identified: (1) prioritise the youngest; (2) save the most lives; (3) egalitarian allocation approaches; (4) prioritise healthcare workers; and (5) bias against particular groups. The public gave high priority to allocation that saved the most lives, particularly to patients who are younger and healthcare workers. Themes present but not supported as broadly were giving priority to individuals with disabilities, high frailty or those with behaviours that may have contributed to their ill-health (e.g. smokers). Allocation involving egalitarian approaches received the least support among community members. Conclusion The general public prefer rationing scarce medical resources in the COVID-19 pandemic based on saving the most lives and giving priority to the youngest and frontline healthcare workers rather than giving preference to patients with disabilities, frailty or perceived behaviours that may have contributed to their own ill-health. There is also little public support for allocation based on egalitarian strategies.
Collapse
|
3
|
McLeod C, Wood J, Mulrennan S, Morey S, Schultz A, Messer M, Spaapen K, Wu Y, Mascaro S, Smyth AR, Blyth CC, Webb S, Snelling TL, Norman R. Preferred health outcome states following treatment for pulmonary exacerbations of cystic fibrosis. J Cyst Fibros 2022; 21:581-587. [PMID: 35033463 DOI: 10.1016/j.jcf.2021.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment for pulmonary exacerbations of cystic fibrosis (CF) can produce a range of positive and negative outcomes. Understanding which of these outcomes are achievable and desirable to people affected by disease is critical to agreeing to goals of therapy and determining endpoints for trials. The relative importance of outcomes resulting from treatment of these episodes are not reported. We aimed to (i) quantify the relative importance of outcomes resulting from treatment for pulmonary exacerbations and (ii) develop patient and proxy carer-reported weighted outcome measures for use in adults and children, respectively. METHODS A discrete choice experiment (DCE) survey was conducted. Participants were asked to make a series of hypothetical decisions about treatment for pulmonary exacerbations to assess how they make trade-offs between different attributes of health. Data were analysed using a conditional logistic regression model. The correlation coefficients from these data were rescaled to enable generation of a composite health outcome score between 0 and 100 (worst to best health state). RESULTS 362 individuals participated (167 people with CF and 195 carers); of these, 206 completed the survey (56.9%). Most participants were female and resided in Australia. Difficult/painful breathing had the greatest impact on the preferred health state amongst people with CF and carers alike. Avoidance of gastrointestinal problems also heavily influenced decision-making. CONCLUSIONS These data should be considered when making treatment decisions and determining endpoints for trials. Further research is recommended to quantify the preferences of children and to determine whether these align with those of their carer(s).
Collapse
Affiliation(s)
- Charlie McLeod
- Infectious Diseases Implementation Research Division, Telethon Kids Institute, Nedlands 6009, Australia; Infectious Diseases Department, Perth Children's Hospital, Nedlands 6009, Australia.
| | - Jamie Wood
- Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Respiratory Department, Sir Charles Gairdner Hospital, Nedlands 6009, Australia
| | - Siobhain Mulrennan
- Respiratory Department, Sir Charles Gairdner Hospital, Nedlands 6009, Australia; Faculty of Health and Medical Sciences, University of Western Australia, Crawley 6009, Australia
| | - Sue Morey
- Respiratory Department, Sir Charles Gairdner Hospital, Nedlands 6009, Australia
| | - André Schultz
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Crawley 6009, Australia; Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands 6009, Australia; Department of Respiratory Medicine, Perth Children's Hospital, Nedlands 6009, Australia
| | - Mitch Messer
- Infectious Diseases Implementation Research Division, Telethon Kids Institute, Nedlands 6009, Australia
| | - Kate Spaapen
- Infectious Diseases Implementation Research Division, Telethon Kids Institute, Nedlands 6009, Australia
| | - Yue Wu
- Sydney School of Public Health, The University of Sydney, Sydney 2052, Australia
| | | | - Alan R Smyth
- Evidence Based Child Health Group, School of Medicine, University of Nottingham, NottinghamNG7 2RD, United Kingdom
| | - Christopher C Blyth
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Crawley 6009, Australia; Infectious Diseases Department, Perth Children's Hospital, Nedlands 6009, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands 6009, Australia; Pathwest Laboratory Medicine WA, QEII Medical Centre, Nedlands 6009, Australia
| | - Steve Webb
- Department of Intensive Care, St John of God Hospital, Subiaco 6008, Australia; School of Population Health and Preventive Medicine, Monash University, St Kilda 3004, Australia
| | - Thomas L Snelling
- Sydney School of Public Health, The University of Sydney, Sydney 2052, Australia; Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi 0810, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Bentley 6102, Australia
| |
Collapse
|
4
|
Application of discrete choice experiments to estimate value of life: a national study protocol in Iran. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:6. [PMID: 33516226 PMCID: PMC7846904 DOI: 10.1186/s12962-021-00259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Global concerns regarding the significant burden of non-communicable diseases and injuries (NCDIs) exist from both public health and economic perspectives. Our research focuses on the reduction of fatal risks due to NCDIs and the citizens’ preferences about health programs and intervention to reduce premature death due to NCDIs. Governments and health authorities need reliable evidence and information to prioritize the interests of their citizens. One crucial piece of evidence to justify the resources spent on NCDIs is the value derived from the interventions on prevention and NCDIs control. This concept is usually called “Value of Statistical Life” (VSL), meaning the monetary value that individuals place on changes in the risk levels of life- threatening events. To the best of our knowledge, for the first time, our study will estimate the statistical value of life for selected interventions for the prevention and control of NCDIs at both national and sub-national levels in the context of Iran. This paper reports the development of a national protocol through Discrete Choice Experiments (DCEs) method. Methods and designs Our study comprises several stages: (a) a literature review to identify the attributes and levels of the prevention programs and Willingness to Pay (WTP) for reducing the NCDI’s fatal risks; (b) experimental design to assessing, prioritizing, and finalizing the identified attributes and levels; (c) instrumental design to conduct face-to-face structured survey interviews of 3180 respondents aged 18–69 across the entire country; (d) statistical analysis to estimate the results through the Mixed Multinomial logit (MMNL) model. Discussion We anticipate that our findings will help build a stronger empirical basis for monetizing the value of small changes in selected fatality risks. It paves the way for other national or vast VSL estimates for NCDIs, as well as other major causes of morbidity and mortality in the context of Iran, and perhaps other low and middle-income countries (LMICs).
Collapse
|