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Samant S, Oberle S, Marcek T, Poulos C, Chintakayala P, Langevin E, Petigara T, Boeri M. Preferences of healthcare providers in Switzerland for attributes of pediatric hexavalent vaccines: a discrete-choice experiment. Curr Med Res Opin 2024:1-12. [PMID: 38501272 DOI: 10.1080/03007995.2024.2325550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To understand the preferences of healthcare providers (HCPs) in Switzerland for pediatric hexavalent vaccine attributes. METHODS A discrete-choice experiment included a series of choices between 2 hypothetical pediatric hexavalent vaccines with varying attributes: device type (including preparation time and risk of dosage errors), proportion of infants seroprotected against Haemophilus influenzae type b (Hib) at 11-12 months (pre-booster), packaging size, years on the market, and the thermostability at room temperature. Odds ratios (ORs) and conditional relative attribute importance (CRAI) were calculated using random-parameters logit. RESULTS HCPs (150 pediatricians and 40 nursing staff) in Switzerland were unlikely to choose a vaccine conferring 50% (OR 0.00; 95% CI 0.00-0.00) or 70% (OR 0.01; 95% CI 0.00-0.01) of infants with Hib seroprotection at 11-12 months (pre-booster) compared with a vaccine conferring 90% seroprotection. The odds of choosing a vaccine available on the market for more than 3 years were nearly 5 times the odds of choosing a vaccine available on the market for less than 1 year (OR 4.76; 95% CI 1.87-7.65). The odds of choosing a vaccine in a prefilled syringe were nearly 3 times the odds of choosing a reconstituted vaccine (OR 2.77; 95% CI 1.39-4.15), and the odds of choosing a vaccine with a smaller package size were nearly 2 times the odds of choosing a vaccine with larger package size (OR 1.89; 95% CI 1.23-2.55). HCPs were equally likely to choose vaccines that can stay at room temperature for 6 versus 3 days (OR 1.07; 95% CI 0.73-1.42). According to CRAI, the most important attribute was Hib seroprotection, followed by years on the market, device type, and packaging size. CONCLUSION Hib seroprotection at 11-12 months was the most important hexavalent vaccine attribute to HCPs in this study.
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Myers K, Silverberg JI, Parasuraman S, Pierce A, Eichenfield LF, Poulos C. Treatment preferences among patients with mild-to-moderate atopic dermatitis. J DERMATOL TREAT 2023; 34:2215356. [PMID: 37259544 DOI: 10.1080/09546634.2023.2215356] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Study purpose: New treatments for atopic dermatitis (AD) are emerging; however, little is known about the treatment preferences of patients with mild-to-moderate AD. To measure patients' preferences, a cross-sectional, web-based discrete choice experiment (DCE) survey was developed and administered to 300 adults in the United States with a self-reported physician diagnosis of mild-to-moderate AD.Materials and methods: In the DCE, respondents evaluated pairs of hypothetical AD treatment profiles defined by efficacy, risk, and mode and frequency of administration attributes. The DCE data were analyzed using a random parameters logit model. Subgroup analysis was used to investigate preference heterogeneity.Results: The results revealed achieving clear or almost clear skin within 3-4 months of treatment was the most important attribute relative to all other study attributes. The results indicated that a topical cream applied twice daily was preferred to systemic treatments. Subgroup analysis revealed that respondents with lower self-assessed disease burden were more likely to choose topical over systemic treatments and less averse to the risk of pain, burning, and/or stinging from the medicine (all other treatment features remaining equal) than respondents with higher self-assessed disease burden.Conclusion: The results of this study can help inform shared decision-making to manage mild-to-moderate AD.
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Affiliation(s)
- Kelley Myers
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Jonathan I Silverberg
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | | | - Anna Pierce
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California San Diego, San Diego, CA, USA
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Stothers Rosenberg S, Ng X, Mansfield C, Poulos C, Peay H, Lee TH, Irony T, Ho M. Adaptation of the WOMAC for Use in a Patient Preference Study. Ther Innov Regul Sci 2023; 57:702-711. [PMID: 37061632 PMCID: PMC10105612 DOI: 10.1007/s43441-023-00510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/07/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVES To adapt a patient-reported outcome (PRO) measure, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), into efficacy attributes for a discrete choice experiment (DCE) survey designed to quantify the relative importance of endpoints commonly used in knee osteoarthritis (KOA) trials. METHODS The adaptation comprised four steps: (1) selecting domains of interest; (2) determining presentation and framing of selected attributes; (3) determining attribute levels; and (4) developing choice tasks. This process involved input from multiple stakeholders, including regulators, health preference researchers, and patients. Pretesting was conducted to evaluate if patients comprehended the adapted survey attributes and could make trade-offs among them. RESULTS The WOMAC pain and function domains were selected for adaption to two efficacy attributes. Two versions of the discrete choice experiment (DCE) instrument were created to compare efficacy using (1) total domain scores and (2) item scores for "walking on a flat surface." Both attributes were presented as improvement from baseline scores by levels of 0%, 30%, 50%, and 100%. Twenty-six participants were interviewed in a pretest of the instrument (average age 60 years; 58% female; 62% had KOA for ≥ 5 years). The participants found both versions of attributes meaningful and relevant for treatment decision-making. They demonstrated willingness and ability to tradeoff improvements in pain and function separately, though many perceived them as inter-related. CONCLUSIONS This study adds to the growing literature regarding adapting PRO measures for patient preference studies. Such adaptation is important for designing a preference study that can incorporate a clinical trial's outcomes with PRO endpoints.
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Affiliation(s)
- Sarah Stothers Rosenberg
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Xinyi Ng
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
| | | | | | - Holly Peay
- RTI International, Research Triangle Park, NC, USA
| | - Ting-Hsuan Lee
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Telba Irony
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Martin Ho
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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Tzivelekis S, Orange J, Poulos C, Meckley LM, Peay H, Sutphin J, Hernandez-Trujillo VP, Wasserman RL. Development of a novel shared decision making aid for primary immunodeficiency diseases. Immunotherapy 2023; 15:647-656. [PMID: 37158075 DOI: 10.2217/imt-2022-0193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Aim: To describe development of a shared decision making (SDM) aid in treating primary immunodeficiency diseases (PID) with immunoglobulin replacement therapy (IGRT). Materials & methods: Expert engagement and qualitative formative research informed development. IGRT administration features were prioritized using object-case best-worst scaling (BWS) methodology. The aid was assessed by US adults self-reporting PID and revised following interviews/mock treatment-choice discussions with immunologists. Results: Patients participating in interviews (n = 19) and mock treatment-choice discussions (n = 5) deemed the aid useful/accessible and supported the utility of BWS, with content and BWS exercises refined following participant feedback. Conclusion: Formative research led to an improved SDM aid/BWS exercise, and illustrated how the aid may improve treatment decision making. The aid may help less-experienced patients and facilitate efficient SDM.
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Affiliation(s)
| | - Jordan Orange
- Columbia University Irving Medical Center, 632 W168th Street, New York, NY 10032, USA
| | - Christine Poulos
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, Durham, NC 27709, USA
| | - Lisa M Meckley
- Takeda, 650 East Kendall Street, Cambridge, MA 02142, USA
| | - Holly Peay
- RTI International, 3040 Cornwallis Road, Research Triangle Park, Durham, NC 27709, USA
| | - Jessie Sutphin
- Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham NC 27705-3976, USA
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, Durham, NC 27709, USA
| | | | - Richard L Wasserman
- Allergy Partners of North Texas, Suite B-332, 7777 Forest Lane, Dallas, TX 75230, USA
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Vass C, Pinto CA, Myers K, Imai K, Bussberg C, Bhattacharya R, Calhoun SR, Poulos C. Heterogeneity in physician and patient preferences for the treatment of renal cell carcinoma: Evidence from latent class analysis. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
661 Background: To inform shared decision-making, it is important to learn how patients or physicians trade off the features of adjuvant treatments and whether there is heterogeneity within preferences. Methods: An online discrete-choice experiment survey was administered to patients with physician-confirmed renal cell carcinoma (RCC) and physician-defined intermediate high/high risk of recurrence and physicians who treat such patients. Hypothetical treatment choices were defined by median disease-free survival (DFS); 5-year overall survival (OS) rate; mode and frequency of administration; need for concomitant daily pill; treatment duration; and the risks of severe diarrhea, fatigue, and dizziness. After making an adjuvant treatment choice, respondents were presented with the opportunity to opt out of treatment. Patient and physician choice data were analyzed separately using latent class (LC) models, which identify clusters within patients and physicians making similar choices. Each class’ preference weights were used to calculate the conditional relative attribute importance. Results: LC analysis identified three classes among the 250 patients (% respondents) that placed greater relative importance on: 1) 5-year OS and opting into treatment (37.5%), 2) median DFS and opting into treatment (26.9%), and 3) treatment duration and opting out of treatment (35.5%) (Table). Among the 250 physicians, the LC analysis identified three classes that placed greater relative importance on: 1) 5-year OS and recommending treatment (37.5%), 2) median DFS and recommending treatment (37.8%), and 3) not recommending treatment (24.7%). Additionally, each LC analysis showed that the other treatment attributes evaluated were less important, but the importance varied by LC (Table). Conclusions: Heterogeneity in physician and patient preferences for RCC adjuvant therapy was found, highlighting a need for shared decision-making. Discordance within patients and physicians in the propensity to opt out of adjuvant treatment suggests patient-physician dialogue is important. [Table: see text]
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Affiliation(s)
| | | | - Kelley Myers
- RTI Health Solutions, Research Triangle Park, NC
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Calhoun SR, Vass C, Myers K, Imai K, Bussberg C, Bhattacharya R, Pinto CA, Poulos C. Patient and physician preferences for adjuvant treatment of renal cell carcinoma: A discrete-choice experiment. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
635 Background: Although a handful of studies have elicited treatment preferences in renal cell carcinoma (RCC), most focused on advanced disease. This study elicited United States patients’ and physicians’ preferences for adjuvant treatment characteristics. Methods: Patients with physician-confirmed RCC and (physician-defined) intermediate high or high risk of recurrence and physicians who treat such patients completed online surveys in Q1-Q2 2022 with a discrete-choice experiment. Hypothetical treatments were described by median disease-free survival (DFS); 5-year overall survival (OS) rate; mode and frequency of administration; need for concomitant daily pill; treatment duration; and the risks of severe diarrhea, fatigue, and dizziness. Preference weight estimates from random parameter logit analysis were used to calculate the conditional relative importance of attributes and risk tolerance measures. Results: 250 patients (50% post-nephrectomy) and 250 physicians (64% oncologists; 36% urologists) completed the survey. OS was the most important attribute to both patients and physicians, but DFS was also important (Table). OS had a greater influence on physicians’ choices than on patients’ choices. On average, OS was 3.2 and 2.5 times as important as DFS and 5.8-9.1 and 2.4-3 times more important than the evaluated risks for physicians and patients, respectively. Further, DFS was 1.8-2.9 times more important to physicians than the evaluated risks, while the importance of DFS and risks were nearly equivalent for patients. The need for concomitant oral medication was the least important attribute to patients and physicians. Both groups were willing to accept more than a 25-percentage-point increase in the risks of severe diarrhea, fatigue, and dizziness for improvements (from 45% to 60% or 85%) in OS. Conclusions: While both patients and physicians weighted OS improvements more than the other treatment attributes, including risks, physicians tended to place lower importance on changes in risk and administration than patients. Physicians and patients should discuss potential benefits and harms when considering adjuvant RCC therapies. [Table: see text]
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Affiliation(s)
| | | | - Kelley Myers
- RTI Health Solutions, Research Triangle Park, NC
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Kandzari DE, Weber MA, Poulos C, Coulter J, Cohen SA, DeBruin V, Jones D, Pathak A. Patient Preferences for Pharmaceutical and Device-Based Treatments for Uncontrolled Hypertension: Discrete Choice Experiment. Circ Cardiovasc Qual Outcomes 2023; 16:e008997. [PMID: 36484251 PMCID: PMC9848220 DOI: 10.1161/circoutcomes.122.008997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Discrete choice experiment is a survey method used to understand how individuals make decisions and to quantify the relative importance of features. Using discrete choice experiment methods, we quantified patient benefit-risk preferences for hypertension treatments, including pharmaceutical and interventional treatments, like renal denervation. METHODS Respondents from the United States with physician-confirmed uncontrolled hypertension selected between treatments involving a procedure or pills, using a structured survey. Treatment features included interventional, noninterventional, or no hypertension treatment; number of daily blood pressure (BP) pills; expected reduction in office systolic BP; duration of effect; and risks of drug side effects, access site pain, or vascular injury. The results of a random-parameters logit model were used to estimate the importance of each treatment attribute. RESULTS Among 400 patients completing the survey between 2020 and 2021, demographics included: 52% women, mean age 59.2±13.0 years, systolic BP 155.1±12.3 mm Hg, and 1.8±0.9 prescribed antihypertensive medications. Reduction in office systolic BP was the most important treatment attribute. The remaining attributes, in decreasing order, were duration of effect, whether treatment was interventional, number of daily pills, risk of vascular injury, and risk of drug side effects. Risk of access site pain did not influence choice. In general, respondents preferred noninterventional over interventional treatments, yet only a 2.3 mm Hg reduction in office systolic BP was required to offset this preference. Small reductions in office systolic BP would offset risks of vascular injury or drug side effects. At least a 20% risk of vascular injury or drug side effects would be tolerated in exchange for improved BP. CONCLUSIONS Reduction in systolic BP was identified as the most important driver of patient treatment preference, while treatment-related risks had less influence. The results indicate that respondents would accept interventional treatments in exchange for modest reductions in systolic BP compared with those observed in renal denervation trials.
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Affiliation(s)
| | | | | | - Joshua Coulter
- RTI Health Solutions, Research Triangle Park, NC, (J.C.)
| | | | | | - Denise Jones
- Medtronic, Santa Rosa, CA (S.A.C., V.D.B., D.J.)
| | - Atul Pathak
- Department of Cardiovascular Medicine, Centre Hospitalier Princese Grace, Monaco (A.P.).,UMR UT CNRS 88 Hypertension and Heart Failure: molecular and clinical investigations. Toulouse, France, INI-CRCT F-CRIN, GREAT Networks (A.P.)
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Poulos C, Xu Y, Botha W, Leach C, Wrobleski KK, Gordon K, Missmer SA, Estes SJ. A discrete-choice experiment study of physicians' prioritization of attributes of medical treatments for endometriosis-associated pain. Expert Rev Pharmacoecon Outcomes Res 2023; 23:111-121. [PMID: 36625547 DOI: 10.1080/14737167.2023.2152006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Physicians' preferences for attributes of medical treatments for endometriosis-associated pain have not previously been quantified. METHODS US obstetrician-gynecologists completed an online discrete-choice experiment survey. In a series of questions, physicians chose a medical treatment for a hypothetical patient with endometriosis experiencing severe, persistent dysmenorrhea, nonmenstrual pelvic pain, and/or dyspareunia. Each question presented two hypothetical medical treatments for endometriosis-associated pain, defined by seven attributes with varying levels. Preferences weights and conditional relative importance (CRI) were calculated using a random-parameters logit model. RESULTS Respondents (N = 250) had an average age of 53 years; 36% were female. The most important attribute, conditional on the attributes and levels evaluated, was risk of moderate-to-severe hot flashes (CRI, 3.34). In descending order of importance, the CRIs of the other attributes were 2.13 for improvement in nonmenstrual pelvic pain, 2.04 for improvement in dyspareunia, 1.88 for improvement in dysmenorrhea, 1.16 for risk of pregnancy-related complications if pregnancy occurs during treatment, 0.62 for increased risk of bone fracture later in life, and 0.48 for mode of administration. CONCLUSIONS In addition to valuing pain reduction, respondents prioritized avoiding moderate-to-severe hot flashes, followed by less common and less immediate risks of pregnancy-related complications and bone fracture.
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Affiliation(s)
- Christine Poulos
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, NC, United States
| | - Yanqing Xu
- Health Economics and Outcomes Research, AbbVie Inc, North Chicago, IL, United States
| | - Willings Botha
- Health Preference Assessment, RTI Health Solutions, Manchester, UK
| | - Colton Leach
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, NC, United States
| | | | - Keith Gordon
- Health Economics and Outcomes Research, AbbVie Inc, North Chicago, IL, United States
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, MI, United States
| | - Stephanie J Estes
- Department of Obstetrics and Gynecology, Penn State Health, Hershey, PA, United States
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Poulos C, Boeri M, Coulter J, Huang L, Schley K, Pugh SJ. Travelers' preferences for tick-borne encephalitis vaccination. Expert Rev Vaccines 2022; 21:1495-1504. [PMID: 36154795 DOI: 10.1080/14760584.2022.2108798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aimed to quantify preferences and risk tolerance for a tick-borne encephalitis (TBE) vaccination. RESEARCH DESIGN AND METHODS A stated-preference survey instrument was administered to international travelers living in the United States to elicit preferences for a no-cost TBE vaccine when planning an international trip, conditional upon four different qualitative levels of endemic TBE risk. RESULTS The likelihood of choosing the vaccine increased with a destination's level of endemic risk. Most respondents (94%) would choose to receive the vaccine at the highest risk level presented in the survey (i.e. when multiple TBE cases among humans are reported year after year); 6% of the sample would choose not to receive the vaccine at any risk level. Respondents who engage in outdoor activities were twice as likely as the average respondent to choose vaccination rather than opting out of vaccination, and were one-third more likely than the average respondent to choose to receive the vaccine at the lowest risk level. CONCLUSIONS Respondents were highly interested in a TBE vaccine, assuming no cost, and most were willing to be vaccinated at all qualitative TBE risk levels. Respondents who participated in outdoor activities were more likely than the average respondent to choose the vaccine.
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Affiliation(s)
| | - Marco Boeri
- RTI Health Solutions, Belfast, Northern Ireland
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Kandzari DE, Weber MA, Poulos C, Coulter J, Cohen SA, DeBruin V, Jones D, Pathak A. U.S. Patient Preferences for Interventional and Pharmaceutical Hypertension Treatments: Initial Subgroup Analyses. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vietri J, Meyers K, Poulos C, Chilson E, Sweeney C, Davis K, Snow V. 06. United States Healthcare Provider Preferences for Adult Pneumococcal Vaccine Recommendations. Open Forum Infect Dis 2021. [PMCID: PMC8645019 DOI: 10.1093/ofid/ofab466.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Pneumococcal vaccine recommendations for US adults are complex, varying by age and underlying conditions, and include both 23-valent polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine. The Advisory Committee on Immunization Practices (ACIP) will vote on new recommendations in October after the 15- (PCV15) and 20-valent (PCV20) conjugate vaccines are approved. Stakeholder acceptability is part of ACIP’s evidence to recommendation framework, but few data are available on health care providers’ (HCPs) preferences for potential recommendations. Methods 752 HCPs (300 physicians, 150 nurse practitioners, 150 physician assistants, & 152 pharmacists) were surveyed. Object case best-worst scaling (BWS) was used to elicit preferences for hypothetical recommendations for 1) adults 19-64 years with chronic conditions and 2) immunocompetent adults ≥65 years. Presented recommendations included combinations of PCV15/PCV20 either as routine or after shared clinical decision making (SCDM), and PPSV23 as routine, SCDM, or no recommendation. Following BWS, HCPs were asked to assume ACIP was considering implementing both of their preferred recommendations for the age/risk groups. HCPs were then given the opportunity to change their selections and propose recommendations not included in the BWS exercise. Additional information was collected using conventional survey items. Results Routine use of higher-valent PCVs in sequence with PPSV23 was most often preferred for both adults 19-64 with chronic conditions (40%) and immunocompetent adults ≥65 (49%) when elicited separately for each age/risk group. Most respondents (63%) revised their recommendations after considering implementation, which resulted in most (59%) favoring recommendations harmonized across the age/risk groups, and 75% favoring routine use of PCV15 or PCV20 among immunocompetent adults ≥65. When asked directly, HCPs generally approved of the idea of simplifying adult pneumococcal vaccine recommendations, harmonizing the interval between vaccines, and lowering the cutoff for age-based recommendations below 65 years. Conclusion US HCPs generally prefer simplification of the adult pneumococcal recommendation, favoring broad routine use of both higher-valent PCVs and PPSV23. Disclosures Jeffrey Vietri, PhD, Pfizer Inc (Employee, Shareholder) Kelley Meyers, PhD, RTI Health Solutions (Independent Contractor) Christine Poulos, PhD, Pfizer Inc (Other Financial or Material Support, Employee of RTI-HS, which received funds from Pfizer to conduct the study) Erica Chilson, PharmD, Pfizer, Inc (Employee, Shareholder) Vincenza Snow, MD, Pfizer Vaccines (Employee)
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Alkashash AM, Saxena R, Poulos C, Phillips CL, Nassiri M, Hains D. Rare presentation of primary hepatic marginal zone B-cell lymphoma and membranous glomerulopathy in a 3-year-old boy. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Primary hepatic marginal zone B-cell lymphoma (MZL) is a rare entity that has been described with chronic inflammatory disorders such as chronic viral hepatitides B and C and primary biliary cholangitis. We report MZL in a 3-year-old African-American boy that was discovered incidentally at autopsy.
Methods/Case Report
The patient first came to medical attention at 9-months of age with bilateral periorbital edema that progressed to generalized edema of the[PL1] face, extremities, and abdomen. Laboratory testing showed nephrotic syndrome with massive proteinuria (50-60 g/day). A percutaneous renal biopsy specimen showed membranous glomerulopathy with PLA2R detected by immunofluorescence, and granular IgG deposition along tubular basement membranes. Serum was negative for anti-PLA2R antibodies. The patient suffered recurrent upper respiratory tract infections requiring several intensive care hospitalizations. At 3 years of age, he was transported unresponsive and pulseless to the emergency department where he was pronounced dead. A brother with the infantile nephrotic syndrome had died from sepsis at 2 years of age. Suspicion of abuse led to an autopsy by the medical examiner, who discovered nodular masses in the right and left liver lobes, which histologically showed a serpiginous infiltrate of small B-lymphocytes positive for CD20, CD43 admixed with plasmacytoid cells with kappa light chain restriction. There were no extrahepatic tumors. Transmission electron microscopy of glomeruli showed membranous glomerulopathy. Kidneys showed dense reactive interstitial lymphocytic infiltrate with germinal centers
Results (if a Case Study enter NA)
NA
Conclusion
To our knowledge, this is the first reported case of MZL presenting in a pediatric patient with membranous glomerulopathy. Both diagnoses are associated with autoimmune diseases and persistent, chronic inflammation. Recurrent infections in this patient suggest an immunoregulatory disorder, setting the stage for chronic inflammation, as seen in the kidney, with progression to MZL in the liver.
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Affiliation(s)
- A M Alkashash
- Pathology, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - R Saxena
- Pathology, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - C Poulos
- Pathology, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - C L Phillips
- Pathology, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - M Nassiri
- Pathology, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - D Hains
- Ped-Nephrology, Indiana University, Indianapolis, Indiana, UNITED STATES
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Estes SJ, Poulos C, Xu Y, Botha W, Leach C, Wrobleski KK, Gordon K, Missmer SA. A DISCRETE CHOICE EXPERIMENT STUDY OF PHYSICIANS’ PReferences FOR TREATMENTS FOR ENDOMETRIOSIS-ASSOCIATED PAIN. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Patterson BJ, Myers K, Stewart A, Mange B, Hillson EM, Poulos C. Preferences for herpes zoster vaccination among adults aged 50 years and older in the United States: results from a discrete choice experiment. Expert Rev Vaccines 2021; 20:729-741. [PMID: 33902368 DOI: 10.1080/14760584.2021.1910502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Most adults, and disproportionately fewer African-Americans, have not received herpes zoster (HZ) vaccination despite current recommendations. This study (GSK study identifiers: 208677/HO-17-18066) assessed HZ vaccination preferences among adults aged ≥ 50 years. RESEARCH DESIGN AND METHODS In this discrete choice experiment, respondents chose among a 'no vaccine' option and two HZ vaccine profiles, characterized by seven attributes, in a series of choice questions. Random-parameters logit results were used to predict likely vaccine uptake. Subgroup and latent class analysis of African-American's preferences were performed. RESULTS The preference weight for choosing HZ vaccines over no vaccine was statistically significant among the 1,454 respondents (71.9% whites; 25.2% African-Americans). Out-of-pocket (OOP) cost and vaccine effectiveness (VE) were the most important attributes. The African-American and the non-African-American subgroups had statistically significant differences in preferences (χ2 = 59.91, p < 0.001), mainly driven by OOP cost and VE. Latent class analysis identified three groups of African-American respondents with systematically different preferences; two comprised likely-vaccinators, with one being more cost sensitive at lower price thresholds, and one likely non-vaccinators. CONCLUSIONS For all respondents, HZ vaccine choices were most sensitive to total OOP cost, followed by VE.
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Affiliation(s)
| | - Kelley Myers
- Health Preference Assessment Group, RTI Health Solutions, Research Triangle Park, NC, United States
| | | | - Brennan Mange
- Health Preference Assessment Group, RTI Health Solutions, Research Triangle Park, NC, United States
| | - Eric M Hillson
- US Health Outcomes & Epidemiology, GSK, Philadelphia, PA, United States
| | - Christine Poulos
- Health Preference Assessment Group, RTI Health Solutions, Research Triangle Park, NC, United States
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Feldman SR, Poulos C, Gilloteau I, Mange B, Boehm K, Boeri M, Naatz M, Augustin M. Exploring determinants of psoriasis patients' treatment choices: a discrete-choice experiment study in the United States and Germany. J DERMATOL TREAT 2021; 33:1511-1520. [PMID: 33535847 DOI: 10.1080/09546634.2020.1839007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Biologic psoriasis treatments are differentiated by efficacy, side effects, and other attributes. OBJECTIVE Determine attributes of biologic psoriasis treatments that drive patients' treatment choices. METHODS Respondents (USA: n = 300; Germany: n = 300) with moderate-to-severe psoriasis completed a discrete-choice-experiment survey, choosing between hypothetical treatments characterized by attributes with varying levels: chance of clear skin after 1 year, number of first-year treatments, first-year risks of mild-to-moderate injection site reaction (ISR) and serious infection, and years of proven efficacy/safety. RESULTS U.S. respondents most valued clear skin (conditional relative importance, 1.88; p < .05). While other attributes were of generally equivalent importance, ISR risk outweighed serious-infection risk (1.06 vs. 0.70; p < .05). German respondents placed greatest importance on ISR risk (1.61; p < .05) and clear skin (1.49; p < .05). LIMITATIONS Respondents evaluated hypothetical treatments and were recruited from web panels. CONCLUSIONS Clear skin and ISR risk are stronger drivers of treatment choice than injection frequency and infection risk.
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Affiliation(s)
- Steven R Feldman
- Departmemt of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Brennan Mange
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | - Mandy Naatz
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Poulos C, Soliman AM, Tekin S, Agarwal SK. Patient preferences for elagolix and leuprolide for treating endometriosis-related pain in the United States. Expert Rev Pharmacoecon Outcomes Res 2020; 21:1091-1099. [PMID: 33140977 DOI: 10.1080/14737167.2021.1832468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We evaluated elagolix and leuprolide from the patient's perspective for the treatment of endometriosis-related pain. AREA COVERED Preference weights from a published discrete choice experiment were used to evaluate preferences for treatment profiles simulating elagolix (150 mg/day and 200 mg/twice-daily dosages) and leuprolide for the treatment of moderate to severe endometriosis-related pain. Sensitivity analyses were conducted by varying the range of risk for pregnancy-related problems, moderate to severe hot flashes, and bone fracture across scenarios. EXPERT OPINION The 200 mg twice daily dosage of elagolix is more likely to be preferred over leuprolide by patients with moderate to severe endometriosis-related pain in all scenarios explored in the evaluation and sensitivity analyses. The probability that an average respondent would select a treatment was sensitive to increases in risk of moderate to severe hot flashes for leuprolide and possible variations in the risk of pregnancy-related problems for both treatments but was not influenced by an increased risk of bone fracture. CONCLUSIONS Patients' preferences for treatment of endometriosis-related pain should be evaluated using the benefits and risks of each pharmacological option. Respondents were more likely to prefer the treatment profile similar to 200 mg twice daily elagolix over that of leuprolide in all scenarios.
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Affiliation(s)
- Christine Poulos
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Ahmed M Soliman
- Health Economics and Outcomes Research (HEOR), AbbVie Inc, North Chicago, IL, USA
| | - Sibel Tekin
- Health Economics and Outcomes Research (HEOR), AbbVie Inc, North Chicago, IL, USA
| | - Sanjay K Agarwal
- Center for Endometriosis Research and Treatment, University of California San Diego, La Jolla, CA, USA
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Poulos C, Wakeford C, Kinter E, Mange B, Schenk T, Jhaveri M. Patient and physician preferences for multiple sclerosis treatments in Germany: A discrete-choice experiment study. Mult Scler J Exp Transl Clin 2020; 6:2055217320910778. [PMID: 32215218 PMCID: PMC7065293 DOI: 10.1177/2055217320910778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/21/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To assess heterogeneity in patient and physician preferences for multiple sclerosis treatment features and outcomes via a discrete-choice experiment. Method Patients with self-reported multiple sclerosis and treating physicians participated in an online discrete-choice experiment. Patients, each considering a better or worse reference condition, and physicians, each considering two patient profiles, chose between hypothetical treatment profiles defined by seven attributes with varying levels: years until disability progression, number of relapses in the decade, mode of administration, dosing frequency, and risks of mild, moderate, and severe side effects. Latent class analysis was used to measure respondent preferences and identify potential subgroups with distinct preferences. Results Distinct treatment preferences emerged among subgroups of patients (n = 301) and physicians (n = 308). Patients in class 1 (43% of sample) were most concerned about side effects; chief concerns of class 2 patients (57%) were delaying disability progression and avoiding severe side-effect risks. The most important attributes for physicians (by class) were delaying disability (class 1, 45%), avoiding severe side-effect risks and (class 2, 33%), and avoiding all side-effect risks (class 3, 22%). Conclusion Patients and physicians have diverse preferences for multiple sclerosis treatments, reflecting heterogeneity in the disease course and available therapies and the need for shared decision making.
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Bianco C, Nunez A, Sanchez-Cordon P, Hansen R, Reid S, Jeckel S, Brown I, Thomas S, Poulos C, Brooks S. Pathology of Natural Highly Pathogenic Avian Influenza Viruses (HPAIV) H5N8 (2017) and HPAIV H5N6 (2018) Infection in Wild Birds in the UK. J Comp Pathol 2020. [DOI: 10.1016/j.jcpa.2019.10.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Poulos C, Wakeford C, Kinter E, Mange B, Schenk T. PND16 PREFERENCES OF PATIENTS FOR FEATURES OF INJECTABLE, ORAL, AND INFUSED DISEASE-MODIFYING TREATMENTS FOR RELAPSE-REMITTING MULTIPLE SCLEROSIS. Value Health Reg Issues 2019. [DOI: 10.1016/j.vhri.2019.08.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Poulos C, Soliman AM, Renz CL, Posner J, Agarwal SK. Patient Preferences for Endometriosis Pain Treatments in the United States. Value Health 2019; 22:728-738. [PMID: 31198191 DOI: 10.1016/j.jval.2018.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To quantify patient preferences for endometriosis-associated pain treatments and risk tolerance in exchange for pain reduction and to explore whether preferences vary on the basis of patient characteristics. METHODS US women with a self-reported physician diagnosis of endometriosis and moderate to severe dysmenorrhea and nonmenstrual pelvic pain (NMPP) completed an online discrete choice experiment survey. Each choice question had a pair of hypothetical treatments characterized by attributes with varying levels: improvements in severe dysmenorrhea, severe NMPP, and severe dyspareunia; mode of administration; and treatment-related risks of pregnancy-related problems, bone fracture later in life, and moderate to severe hot flashes. A random-parameters logit model was used to quantify preferences and the attributes' conditional relative importance. RESULTS A total of 250 women (mean age 34 years) completed the survey. The conditional relative importance of attributes was 3.66 for risk of moderate to severe hot flashes among respondents with and 3.58 among respondents without experience with moderate to severe hot flashes; 1.70, 1.49, and 1.48 for improvements in dyspareunia, NMPP, and dysmenorrhea, respectively; 0.60 for risk of pregnancy-related problems; 0.53 for mode of administration; and 0.49 for bone fracture risk. Preference weights for bone fracture risk levels were not statistically significantly different. In exchange for a greater improvement in dysmenorrhea from severe to mild (vs moderate), respondents without a history of hot flashes accepted a greater increase in the risk of moderate to severe hot flashes (38%) than did respondents with this history (16%). CONCLUSIONS Respondents placed the greatest weight on risk of hot flashes, followed by improvements in dyspareunia, NMPP, dysmenorrhea. Bone fracture risk did not drive preferences.
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Affiliation(s)
| | | | | | - Joshua Posner
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Sanjay K Agarwal
- Center for Endometriosis Research and Treatment, University of California San Diego, La Jolla, CA, USA
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Poulos C, Standaert B, Sloesen B, Stryjewska I, Janitsary A, Hauber B. Preferences for vaccines against children’s diarrheal illness among mothers in Poland and Hungary. Vaccine 2018; 36:6022-6029. [DOI: 10.1016/j.vaccine.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 12/26/2022]
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Cole A, Poulos C, Poulos R, Walmsley B, Reynolds N. We asked our patients – ‘What do you need in a cancer rehabilitation program?’. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Poulos C, Curran D, Anastassopoulou A, De Moerlooze L. Corrigendum to “German travelers’ preferences for travel vaccines assessed by a discrete choice experiment” [Vaccine 36 (2018) 969–978]. Vaccine 2018; 36:3387. [DOI: 10.1016/j.vaccine.2018.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Poulos C. DRIVING RESEARCH FOCUSED ON REAL CHANGE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C. Poulos
- HammondCare, Sydney, New South Wales, Australia,
- Universtiy of New South Wales, Hornsby, New South Wales, Australia
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Poulos R, Harkin D, Beattie E, Cunningham C, Poulos C. PARTICIPATORY ARTS IN THE HOME TO SUPPORT WELLNESS IN DEMENTIA CAREGIVER AND CARE RECIPIENT DYADS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R. Poulos
- University of New South Wales, Sydney, New South Wales, Australia,
| | - D. Harkin
- HammondCare, Sydney, New South Wales, Australia,
| | - E.R. Beattie
- Queensland University of Technology, Brisbane, Queensland, Australia,
| | - C. Cunningham
- HammondCare, Sydney, New South Wales, Australia,
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - C. Poulos
- HammondCare, Sydney, New South Wales, Australia,
- University of New South Wales, Sydney, New South Wales, Australia,
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Kurrle S, Poulos C. A COLLABORATIVE RESEARCH MODEL TO IMPROVE THE LIVES OF PEOPLE LIVING WITH DEMENTIA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S. Kurrle
- University of Sydney, Hornsby, New South Wales, Australia
| | - C. Poulos
- HammondCare, Sydney, New South Wales, Australia
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Poulos C, Kinter E, Yang JC, Bridges JFP, Posner J, Reder AT. Patient Preferences for Injectable Treatments for Multiple Sclerosis in the United States: A Discrete-Choice Experiment. Patient 2017; 9:171-80. [PMID: 26259849 PMCID: PMC4796329 DOI: 10.1007/s40271-015-0136-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Objective Patients’ perceptions and experiences of medication efficacy, medication adverse events, dosing frequency, and dosing complexity have been found to influence adherence to injectable disease-modifying treatments (DMTs) in patients with multiple sclerosis (MS). The aim of this study was to quantify patient preferences for features of injectable DMTs for MS. Methods Adult patients in the United States (US) with a self-reported diagnosis of MS completed an online discrete-choice experiment survey to assess preference for a number of features of a hypothetical injectable DMT. Patients chose hypothetical treatments in paired comparisons, where each treatment was described by features or attributes, including the number of years until disability progression, the number of relapses in the next 4 years, injection time, the frequency of injections, the occurrence of flu-like symptoms (FLS), and severity of injection-site reactions. Random-parameters logit regression parameters were used to calculate preference weights of attribute levels and the relative importance of changes in treatment features. Results Of the 205 patients who completed the survey, 192 provided sufficient data for analysis. The results indicated a broad range of tradeoffs that patients would be willing to make. With regard to this, the relative importance of an improvement in the number of years until disability progression from 1 to 2 (i.e., vertical distance between preference weights for these attribute levels) was 0.9 [95 % confidence interval (CI) 0.5–1.2], the relative importance of this change was approximately equivalent to that of an improvement from 12 injections per month to two (mean 0.8, 95 % CI 0.4–1.2), or approximately equivalent to a decrease from four to one relapses in the next 4 years (mean 0.8, 95 % CI 0.5–1.2), or FLS 3 days after every injection to 3 days after some injections (mean 1.0, 95 % CI 0.6–1.4). Conclusions These results suggest that an improvement in treatment efficacy may be as important as a reduction in injection frequency or a reduction in some adverse events for patients who self-administer injectable DMTs for MS. Understanding the preferences of patients who use injectable treatments will inform the development of such treatments, which may in turn improve patient medication adherence and well-being. Electronic supplementary material The online version of this article (doi:10.1007/s40271-015-0136-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christine Poulos
- RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, PO Box 12194, Durham, NC, 27709, USA.
| | | | | | | | - Joshua Posner
- RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, PO Box 12194, Durham, NC, 27709, USA
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Mamounas E, Poulos C, Goertz HP, González JM, Pugh A, Antao V. Neoadjuvant Systemic Therapy for Breast Cancer: Factors Influencing Surgeons' Referrals. Ann Surg Oncol 2016; 23:3510-3517. [PMID: 27283292 PMCID: PMC5009159 DOI: 10.1245/s10434-016-5296-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Indexed: 11/18/2022]
Abstract
Background This study aimed to assess the influence of disease- and patient-related factors on surgeons’ decisions to refer patients with early-stage breast cancer (EBC) for neoadjuvant systemic therapy (NST). Methods An online survey of United States surgeons evaluated the influence of selected disease- and patient-related factors on surgeons’ decisions, rated their influence (individually and in combination), and provided a relative ranking of jointly considered factors using best–worst scaling. Results The participants in this study were 100 licensed surgeons. The surgeons referred approximately 25 % of EBC patients for NST to improve surgical management. Approximately 75 % of the surgeons agreed that NST is important for EBC, if only to improve surgical management. More than half were “very likely” to refer EBC patients for NST based on anatomicopathologic factors. Less than 50 % were “very likely” to do so when considering tumor phenotype factors. Tumor size and lymph node status were ranked highest in hypothetical patient scenarios. Regarding combinations of factors, the importance of any single factor varied according to the combinations presented. Less than half of the respondents were “very familiar,” and half were “somewhat familiar” with NST guidelines for breast cancer. More than half of the respondents were unaware that findings have shown achievement of pathologic complete response (pCR) after NST to be associated with improved survival. Conclusions Surgeons’ decision to refer for NST is strongly driven by surgical management goals. Anatomicopathologic factors are more influential than tumor phenotype. However, no single disease or patient factor consistently drives the decision to refer for NST. Surgeons’ awareness of the association between pCR achievement and longer survival could be improved. Electronic supplementary material The online version of this article (doi:10.1245/s10434-016-5296-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | - Amy Pugh
- RTI Health Solutions, Research Triangle Park, NC, USA
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Poulos C, Kinter E, Yang JC, Bridges JFP, Posner J, Gleißner E, Mühlbacher A, Kieseier B. A discrete-choice experiment to determine patient preferences for injectable multiple sclerosis treatments in Germany. Ther Adv Neurol Disord 2016; 9:95-104. [PMID: 27006697 DOI: 10.1177/1756285615622736] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the relative importance of features of a hypothetical injectable disease-modifying treatment for patients with multiple sclerosis using a discrete-choice experiment. METHODS German residents at least 18 years of age with a self-reported physician diagnosis of multiple sclerosis completed a 25-30 minute online discrete-choice experiment. Patients were asked to choose one of two hypothetical injectable treatments for multiple sclerosis, defined by different levels of six attributes (disability progression, the number of relapses in the next 4 years, injection time, frequency of injections, presence of flu-like symptoms, and presence of injection-site reactions). The data were analyzed using a random-parameters logit model. RESULTS Of 202 adults who completed the survey, results from 189 were used in the analysis. Approximately 50% of all patients reported a diagnosis of relapsing-remitting multiple sclerosis, and 31% reported secondary progressive multiple sclerosis. Approximately 71% of patients had current or prior experience with injectable multiple sclerosis medication. Approximately 53% had experienced flu-like symptoms caused by their medication, and 47% had experienced mild injection-site reactions. At least one significant difference was seen between levels in all attributes, except injection time. The greatest change in relative importance between levels of an attribute was years until symptoms get worse from 1 to 4 years. The magnitude of this difference was about twice that of relapses in the next 4 years, frequency of injections, and flu-like symptoms. CONCLUSIONS Most attributes examined in this experiment had an influence on patient preference. Patients placed a significant value on improvements in the frequency of dosing and disability progression. Results suggest that changes in injection frequency can be as important as changes in efficacy and safety attributes. Understanding which attributes of injectable therapies influence patient preference could potentially improve outcomes and adherence in patients with multiple sclerosis.
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Affiliation(s)
- Christine Poulos
- RTI Health Solutions, 200 Park Offices Drive, PO Box 12194, Research Triangle Park, NC 27709, USA
| | | | - Jui-Chen Yang
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | - Joshua Posner
- RTI Health Solutions, Research Triangle Park, NC, USA
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Hauber B, Raimundo K, Zlotnick S, Poulos C, Borie D, Turpcu A. AB1110 Patient Preference for a Shorter Infusion Time of Rituximab in RA. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Poulos C, Reed Johnson F, Krishnarajah G, Anonychuk A, Misurski D. Pediatricians' preferences for infant meningococcal vaccination. Value Health 2015; 18:67-77. [PMID: 25595236 DOI: 10.1016/j.jval.2014.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/14/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Meningococcal disease is rare but can cause death or disabilities. Although the Advisory Committee on Immunization Practices has recommended meningococcal vaccination for at-risk children aged 9 through 23 months, it has not endorsed universal vaccination. Health insurance payments for the vaccination of children who are not at risk are likely to be limited. Use of infant meningococcal vaccines by these families will thus depend on the preferences of physicians who might recommend vaccination to parents, as well as parents' preferences. OBJECTIVE To quantify pediatricians' preferences for specific features of hypothetical infant meningococcal vaccines. METHODS A sample of pediatricians (n = 216) completed a Web-enabled, discrete choice experiment survey in which respondents chose between pairs of hypothetical vaccines in a series of trade-off questions. The questions described vaccines with six attributes. A random-parameters logit regression model was used to estimate the relative importance weights physicians place on vaccine features. These weights were used to calculate the predicted probability that a physician chooses hypothetical vaccines with given characteristics. RESULTS Pediatricians' choices indicated that increases in vaccine effectiveness were among the most important factors in their vaccine recommendations, followed by increases in the number of injections. The age at which protection begins and the number of additional office visits were less important. Whether a booster was required after 5 years was the least important factor in vaccine recommendations. The results suggest that virtually all (99.9%) physicians in the sample would recommend a vaccine even with the least-preferred features rather than no infant meningococcal vaccine. CONCLUSIONS Physicians' responses indicate a strong preference for infant meningococcal vaccination.
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Affiliation(s)
- J M González
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - C Poulos
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - P Mollon
- Novaris Pharma AG, Basel, Switzerland
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Hauber AB, Standaert B, Poulos C. Development of a Survey to Quantify Parents' Priorities for Vaccinating Children Against Rotavirus. Value Health 2014; 17:A681. [PMID: 27202517 DOI: 10.1016/j.jval.2014.08.2541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A B Hauber
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | - C Poulos
- RTI Health Solutions, Research Triangle Park, NC, USA
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Poulos C, Hauber AB, González JM, Turpcu A. Patients' willingness to trade off between the duration and frequency of rheumatoid arthritis treatments. Arthritis Care Res (Hoboken) 2014; 66:1008-15. [PMID: 24339373 DOI: 10.1002/acr.22265] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 12/03/2013] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Biologic treatments for rheumatoid arthritis (RA) vary widely in both the time required to administer treatment and treatment frequency. This study aimed to quantify the rate at which RA patients are willing to trade off between the time required to administer treatment (duration) and treatment frequency. METHODS Respondents with a self-reported physician diagnosis of moderate to severe RA completed an online discrete choice experiment survey (also known as conjoint analysis). Respondents were presented with a series of treatment-choice questions. Each hypothetical treatment included 6 attributes: response rate, mode of administration, treatment duration, treatment frequency, and the risks of immediate mild and serious treatment reactions. Preference weights, also called marginal utilities or relative importances, were estimated using mixed-logit methods and then used to calculate the marginal rates of substitution between attributes, including treatment duration and treatment frequency. RESULTS Among the 901 respondents, 505 were in the RA Information, Service, and Education group (www.risesupport.com) and 396 were members of an online panel. The marginal utility of changes in treatment features was largest for a 1-hour change in treatment duration, while a 1-unit change in the annual frequency of treatment was the second least important change. The marginal utility of changes in annual treatment frequency depends on the treatment duration and vice versa. CONCLUSION Respondents would accept treatments with lower efficacy and greater risk to achieve lower duration and frequency. Previous studies have linked patient preferences to treatment adherence, suggesting that reductions in duration or frequency could improve adherence and health outcomes.
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Yuan Z, Levitan B, Burton P, Poulos C, Brett Hauber A, Berlin JA. Relative importance of benefits and risks associated with antithrombotic therapies for acute coronary syndrome: patient and physician perspectives. Curr Med Res Opin 2014; 30:1733-41. [PMID: 24827068 DOI: 10.1185/03007995.2014.921611] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In acute coronary syndrome (ACS), antithrombotic therapies prevent thrombotic events, but also increase bleeding risk. Knowledge is limited about how patients and physicians balance these benefits and risks. OBJECTIVE To quantify US patient and physician preferences for outcomes associated with antithrombotic therapies in ACS. METHODS Two independent web-based surveys were conducted using best-worst scaling in board-certified cardiologists and adult patients hospitalized within the last 5 years due to heart attack and who used aspirin or prescription antithrombotic therapies. Participants selected best and worst of three possible outcomes across a series of questions. Outcomes included death, various levels of stroke, myocardial infarction (MI), and bleeding. Data were analyzed using a maximum difference model employing random-parameters logit. Relative importance of each outcome was estimated relative to death. FINDINGS Patients (n = 206) and physicians (n = 273) who met face validity requirements, viewed death and nonfatal major disabling stroke as nearly equivalent and most important outcomes to avoid. Relative to death and disabling stroke, physicians considered nondisabling stroke, all nonfatal bleeding, and mild MI all as least important to avoid, while patients considered all bleeds, except major bleeding requiring transfusion, as least important to avoid. Physicians considered severe MI equivalent to 0.92 (0.02 SE) deaths. Patients (∼0.35 [0.04] deaths) and physicians (∼0.64 [0.05] deaths) had different views for nonfatal moderate stroke. Patients viewed nonfatal major bleeding requiring transfusion ∼0.13 (0.02) deaths, and nonfatal heart attack ∼0.09 (0.02) deaths. CONCLUSION US patients and physicians agree on the relative importance of avoiding death, disabling stroke and bleeding without transfusions. Differing perspectives on bleeding requiring transfusions, MI, and moderately disabling stroke suggest that patients and physicians may have different benefit-risk preferences. Transparent discussion between physicians and patients in ACS treatment shared decision-making seems warranted, although limitations of survey methodology and cultural differences compared with US participants should be considered.
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Affiliation(s)
- Zhong Yuan
- Department of Epidemiology, Janssen Research & Development , Titusville, NJ , USA
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Brown DS, Poulos C, Johnson FR, Chamiec-Case L, Messonnier ML. Adolescent Girls’ Preferences for HPV Vaccines: A Discrete Choice Experiment. Preference Measurement in Health 2014. [DOI: 10.1108/s0731-219920140000024002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Brown DS, Poulos C, Johnson FR, Chamiec-Case L, Messonnier ML. Adolescent girls' preferences for HPV vaccines: a discrete choice experiment. Adv Health Econ Health Serv Res 2014; 24:93-121. [PMID: 25244906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To measure adolescent girls' preferences over features of human papillomavirus (HPV) vaccines in order to provide quantitative estimates of the perceived benefits of vaccination and potential vaccine uptake. DESIGN/METHODOLOGY/APPROACH A discrete choice experiment (DCE) survey was developed to measure adolescent girls' preferences over features of HPV vaccines. The survey was fielded to a U.S. sample of 307 girls aged 13-17 years who had not yet received an HPV vaccine in June 2008. FINDINGS In a latent class logit model, two distinct groups were identified--one with strong preferences against vaccination which largely did not differentiate between vaccine features, and another that was receptive to vaccination and had well-defined preferences over vaccine features. Based on the mean estimates over the entire sample, we estimate that girls' valuation of bivalent and quadrivalent HPV vaccines ranged between $400 and $460 in 2008, measured as willingness-to-pay (WTP). The additional value of genital warts protection was $145, although cervical cancer efficacy was the most preferred feature. We estimate maximum uptake of 54-65%, close to the 53% reported for one dose in 2011 surveillance data, but higher than the 35% for three doses in surveillance data. RESEARCH LIMITATIONS/IMPLICATIONS We conclude that adolescent girls do form clear opinions and some place significant value on HPV vaccination, making research on their preferences vital to understanding the determinants of HPV vaccine demand. ORIGINALITY/VALUE DCE studies may be used to design more effective vaccine-promotion programs and for reassessing public health recommendations and guidelines as new vaccines are made available.
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Poulos C, González JM, Lee LJ, Boye KS, Johnson FR, Bae JP, Deeg MA. Physician preferences for extra-glycemic effects of type 2 diabetes treatments. Diabetes Ther 2013; 4:443-59. [PMID: 24254337 PMCID: PMC3889326 DOI: 10.1007/s13300-013-0046-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The purpose of this study was to quantify United States (US) and United Kingdom (UK) physicians' preferences for attributes of type 2 diabetes treatments. METHODS Samples of general practitioners (GPs) and endocrinologists in the US (n = 204) and the UK (n = 200) completed a discrete-choice experiment in which respondents chose between pairs of hypothetical type 2 diabetes treatments in a series of trade-off questions. The questions described hypothetical injectable treatments with differing levels of attributes, such as glucose control and treatment side effects. Relative importance of attributes was estimated by a multivariate regression model for limited dependent variables. These results were used to calculate how the predicted probability of choosing hypothetical type 2 diabetes treatments varies with changes in given attributes. RESULTS The most important attributes to physicians were glucose control, risk of a fatal myocardial infarction (MI), and weight change. For US physicians, glucose control was about twice as important as gastrointestinal side effects, 5 times more important than changes in depression symptoms, and 20 times more important than liver monitoring. For UK physicians, reduction in MI risk was about 1.5 times more important than glucose control, 2.5 times more important than gastrointestinal side effects, and 10 times more important than liver-monitoring requirements. Preferences were similar among physicians in the US and the UK and among GPs and endocrinologists. CONCLUSIONS Physicians valued type 2 diabetes treatments that go beyond glycemic control, although mitigating different complications and comorbidities was not equally as important.
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Affiliation(s)
- Christine Poulos
- RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC, 27709, USA,
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Kim D, Lauria DT, Poulos C, Dong B, Whittington D. Effect of travel distance on household demand for typhoid vaccines: implications for planning. Int J Health Plann Manage 2013; 29:e261-76. [DOI: 10.1002/hpm.2172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/23/2013] [Accepted: 01/27/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dohyeong Kim
- School of Economic, Political and Policy Sciences; University of Texas at Dallas, Richardson; Texas USA
| | - Donald T. Lauria
- Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill North Carolina USA
| | - Christine Poulos
- Research Triangle Institute; Research Triangle Park North Carolina USA
| | - Baiqing Dong
- Guangxi Center for Disease Control and Prevention; Nanning China
| | - Dale Whittington
- Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill North Carolina USA
- Manchester Business School; University of Manchester; Manchester UK
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Poulos C, Yang JC, Patil SR, Pattanayak S, Wood S, Goodyear L, Gonzalez JM. Consumer preferences for household water treatment products in Andhra Pradesh, India. Soc Sci Med 2012; 75:738-46. [DOI: 10.1016/j.socscimed.2012.02.059] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 02/07/2012] [Accepted: 02/09/2012] [Indexed: 11/25/2022]
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Poulos C, Riewpaiboon A, Stewart JF, Clemens J, Guh S, Agtini M, Sur D, Islam Z, Lucas M, Whittington D. Costs of illness due to endemic cholera. Epidemiol Infect 2012; 140:500-9. [PMID: 21554781 PMCID: PMC3824392 DOI: 10.1017/s0950268811000513] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Economic analyses of cholera immunization programmes require estimates of the costs of cholera. The Diseases of the Most Impoverished programme measured the public, provider, and patient costs of culture-confirmed cholera in four study sites with endemic cholera using a combination of hospital- and community-based studies. Families with culture-proven cases were surveyed at home 7 and 14 days after confirmation of illness. Public costs were measured at local health facilities using a micro-costing methodology. Hospital-based studies found that the costs of severe cholera were US$32 and US$47 in Matlab and Beira. Community-based studies in North Jakarta and Kolkata found that cholera cases cost between US$28 and US$206, depending on hospitalization. Patients' cost of illness as a percentage of average monthly income were 21% and 65% for hospitalized cases in Kolkata and North Jakarta, respectively. This burden on families is not captured by studies that adopt a provider perspective.
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Affiliation(s)
- C Poulos
- Research Triangle Institute, Durham, NC 27709, USA.
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Poulos C, Yang JC, Levin C, Van Minh H, Giang KB, Nguyen D. Mothers' preferences and willingness to pay for HPV vaccines in Vinh Long Province, Vietnam. Soc Sci Med 2011; 73:226-34. [PMID: 21733609 DOI: 10.1016/j.socscimed.2011.05.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 04/23/2011] [Accepted: 05/17/2011] [Indexed: 10/18/2022]
Abstract
About 530,000 women develop cervical cancer worldwide and 275,000 die from the disease each year. Eighty percent of these deaths occur in developing countries. In Vietnam, cervical cancer has recently emerged as the most common type of cancer in women, and there are no national screening programs for cervical cancer. Since 2009, two different human papillomavirus (HPV) vaccines have been licensed for use in Vietnam, but access to these vaccines is generally limited to people who live in urban areas. Studies have shown that HPV vaccination may be cost-effective in cervical cancer prevention in Vietnam, depending on vaccination costs. Given that current HPV vaccines are expensive and public health funding for supporting a rapid introduction of the vaccine is limited, expanding and sustaining access to the HPV vaccine may require alternative financing mechanisms, such as fees-based immunization services. A conjoint analysis study was conducted with mothers of girls 9-17 years of age in Vinh Long Province in Vietnam to estimate the mothers' demand for HPV vaccines for their daughters and to measure the tradeoffs between vaccine fees and vaccine uptake. The results suggest that the demand for HPV vaccines was high, increased with vaccine effectiveness and duration of effectiveness, and decreased with vaccine cost. Vaccine effectiveness was the most important vaccine attribute to these mothers, followed by duration of effectiveness. The predicted probability of respondents buying an HPV vaccine that was 70% effective for 10 years varied by the price, ranging from 30% when the vaccine price was $353 per course, to 68% when the vaccine cost $6 per course. As expected, demand and predicted purchase probability were higher among groups with higher socioeconomic status.
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Poulos C, Riewpaiboon A, Stewart JF, Clemens J, Guh S, Agtini M, Anh DD, Baiqing D, Bhutta Z, Sur D, Whittington D. Cost of illness due to typhoid fever in five Asian countries. Trop Med Int Health 2011; 16:314-23. [PMID: 21223462 DOI: 10.1111/j.1365-3156.2010.02711.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To generate community-based estimates of the public (paid by the government) and private (paid by households) costs of blood culture-confirmed typhoid fever in Hechi, China; North Jakarta, Indonesia; Kolkata, India; Karachi, Pakistan and Hue, Vietnam. METHODS To measure out-of-pocket costs of illness and lost earnings, families with culture-proven cases were surveyed 7, 14 and 90 days after onset of illness. Public costs of treatment were measured at local health facilities using a micro costing (bottom-up) method. RESULTS The costs of hospitalized cases ranged from USD 129 in Kolkata to USD 432 in North Jakarta (hospitalization rates varied from 2% in Kolkata to 40% in Hechi) and the costs of non-hospitalized cases ranged from USD 13 in Kolkata to USD 67 in Hechi. Where costs were highest (Hechi, North Jakarta and Karachi), the bulk of the costs of hospitalized cases was borne by families, comprising up to 15% of annual household income. CONCLUSION Although these estimates may understate true costs due to the fact that higher quality treatment may have been provided earlier-than-usual, this multi-country community-based study contributes to evidence on the public and private costs of typhoid fever in developing countries. These cost estimates were used in a cost-effectiveness analysis of typhoid vaccines and will help policymakers respond to World Health Organization's updated typhoid fever immunization recommendations.
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Pattanayak SK, Poulos C, Yang JC, Patil S. How valuable are environmental health interventions? Evaluation of water and sanitation programmes in India. Bull World Health Organ 2010; 88:535-42. [PMID: 20616973 PMCID: PMC2897982 DOI: 10.2471/blt.09.066050] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Revised: 11/07/2009] [Accepted: 11/16/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate and quantify the economic benefits attributable to improvements in water supply and sanitation in rural India. METHODS We combined propensity-score "pre-matching" and rich pre-post panel data on 9500 households in 242 villages located in four geographically different districts to estimate the economic benefits of a large-scale community demand-driven water supply programme in Maharashtra, India. We calculated coping costs and cost of illness by adding across several elements of coping and illness and then estimated causal impacts using a difference-in-difference strategy on the pre-matched sample. The pre-post design allowed us to use a difference-in-difference estimator to measure "treatment effect" by comparing treatment and control villages during both periods. We compared average household costs with respect to out-of-pocket medical expenses, patients' lost income, caregiving costs, time spent on collecting water, time spent on sanitation, and water treatment costs due to filtration, boiling, chemical use and storage. FINDINGS Three years after programme initiation, the number of households using piped water and private pit latrines had increased by 10% on average, but no changes in hygiene-related behaviour had occurred. The behavioural changes observed suggest that the average household in a programme community could save as much as 7 United States dollars per month (or 5% of monthly household cash expenditures) in coping costs, but would not reduce illness costs. Poorer, socially marginalized households benefited more, in alignment with programme objectives. CONCLUSION Given the renewed interest in water, sanitation and hygiene outcomes, evaluating the economic benefits of environmental interventions by means of causal research is important for understanding the true value of such interventions.
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Affiliation(s)
- Subhrendu K Pattanayak
- Duke University, 126 Rubinstein Hall, 302 Towerview Drive, Durham, NC, 27708-0312, United States of America.
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Mohiuddin M, Zacharisen M, Poulos C, Levy M. Non-Hospital Asthma Deaths in Milwaukee County, Wisconsin from 2004-2008. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brown DS, Johnson FR, Poulos C, Messonnier ML. Mothers' preferences and willingness to pay for vaccinating daughters against human papillomavirus. Vaccine 2009; 28:1702-8. [PMID: 20044060 DOI: 10.1016/j.vaccine.2009.12.024] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 12/12/2009] [Accepted: 12/14/2009] [Indexed: 11/30/2022]
Abstract
A choice-format, conjoint-analysis survey was developed and fielded to estimate how features of human papillomavirus (HPV) vaccines affect mothers' perceived benefit and stated vaccine uptake for daughters. Data were collected from a national sample of 307 U.S. mothers of girls aged 13-17 years who had not yet received an HPV vaccine. Preferences for four features of HPV vaccines were evaluated: protection against cervical cancer, protection against genital warts, duration of protection, and cost. We estimate that mean maximum willingness-to-pay (WTP)-an economic measure of the total benefits to consumers-for current HPV vaccine technology ranges between $560 and $660. All vaccine features were statistically significant determinants of WTP and uptake. Mothers were willing to pay $238 more for a vaccine that provides 90% protection for genital warts relative to a vaccine that provides no protection against warts. WTP for lifetime protection vs. 10 years protection was $245. Mothers strongly valued greater cervical cancer efficacy, with 100% protection against cervical cancers the most desired feature overall. Adding a second HPV vaccine choice to U.S. consumers' alternatives is predicted to increase stated uptake by 16%. Several features were significantly associated with stated choices and uptake: age of mother, race/ethnicity, household income, and concern about HPV risks. These findings provide new data on how HPV vaccines are viewed and valued by mothers, and how uptake may change in the context of evolving vaccine technology and as new data are reported on duration and efficacy.
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Affiliation(s)
- Derek S Brown
- RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States.
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Pattanayak SK, Yang JC, Dickinson KL, Poulos C, Patil SR, Mallick RK, Blitstein JL, Praharaj P. Shame or subsidy revisited: social mobilization for sanitation in Orissa, India. Bull World Health Organ 2009; 87:580-7. [PMID: 19705007 DOI: 10.2471/blt.08.057422] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 01/15/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of a sanitation campaign that combines 'shaming' (i.e. emotional motivators) with subsidies for poor households in rural Orissa, an Indian state with a disproportionately high share of India's child mortality. METHODS Using a cluster-randomized design, we selected 20 treatment and 20 control villages in the coastal district of Bhadrak, rural Orissa, for a total sample of 1050 households. We collected sanitation and health data before and after a community-led sanitation project, and we used a difference-in-difference estimator to determine the extent to which the campaign influenced the number of households building and using a latrine. FINDINGS Latrine ownership did not increase in control villages, but in treatment villages it rose from 6% to 32% in the overall sample, from 5% to 36% in households below the poverty line (eligible for a government subsidy) and from 7% to 26% in households above the poverty line (not eligible for a government subsidy). CONCLUSION Subsidies can overcome serious budget constraints but are not necessary to spur action, for shaming can be very effective by harnessing the power of social pressure and peer monitoring. Through a combination of shaming and subsidies, social marketing can improve sanitation worldwide.
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Affiliation(s)
- Subhrendu K Pattanayak
- Sanford Institute of Public Policy and Nicholas School of the Environment, Duke University, Durham, NC, United States of America.
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Abstract
OBJECTIVES We evaluated the cost-effectiveness of a low-cost cholera vaccine licensed and used in Vietnam, using recently collected data from four developing countries where cholera is endemic. Our analysis incorporated new findings on vaccine herd protective effects. METHODS Using data from Matlab, Bangladesh, Kolkata, India, North Jakarta, Indonesia, and Beira, Mozambique, we calculated the net public cost per disability-adjusted life year avoided for three immunization strategies: 1) school-based vaccination of children 5 to 14 years of age; 2) school-based vaccination of school children plus use of the schools to vaccinate children aged 1 to 4 years; and 3) community-based vaccination of persons aged 1 year and older. RESULTS We determined cost-effectiveness when vaccine herd protection was or was not considered, and compared this with commonly accepted cutoffs of gross domestic product (GDP) per person to classify interventions as cost-effective or very-cost effective. Without including herd protective effects, deployment of this vaccine would be cost-effective only in school-based programs in Kolkata and Beira. In contrast, after considering vaccine herd protection, all three programs were judged very cost-effective in Kolkata and Beira. Because these cost-effectiveness calculations include herd protection, the results are dependent on assumed vaccination coverage rates. CONCLUSIONS Ignoring the indirect effects of cholera vaccination has led to underestimation of the cost-effectiveness of vaccination programs with oral cholera vaccines. Once these effects are included, use of the oral killed whole cell vaccine in programs to control endemic cholera meets the per capita GDP criterion in several developing country settings.
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Affiliation(s)
- Marc Jeuland
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Pattanayak SK, Poulos C, Yang JC, Patil SR, Wendland KJ. Of taps and toilets: quasi-experimental protocol for evaluating community-demand-driven projects. J Water Health 2009; 7:434-51. [PMID: 19491494 DOI: 10.2166/wh.2009.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Sustainable and equitable access to safe water and adequate sanitation are widely acknowledged as vital, yet neglected, development goals. Water supply and sanitation (WSS) policies are justified because of the usual efficiency criteria, but also major equity concerns. Yet, to date there are few scientific impact evaluations showing that WSS policies are effective in delivering social welfare outcomes. This lack of an evaluation culture is partly because WSS policies are characterized by diverse mechanisms, broad goals and the increasing importance of decentralized delivery, and partly because programme administrators are unaware of appropriate methods. We describe a protocol for a quasi-experimental evaluation of a community-demand-driven programme for water and sanitation in rural India, which addresses several evaluation challenges. After briefly reviewing policy and implementation issues in the sector, we describe key features of our protocol, including control group identification, pre-post measurement, programme theory, sample sufficiency and robust indicators. At its core, our protocol proposes to combine propensity score matching and difference-in-difference estimation. We conclude by briefly summarizing how quasi-experimental impact evaluations can address key issues in WSS policy design and when such evaluations are needed.
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Affiliation(s)
- Subhrendu K Pattanayak
- Duke University, Sanford Institute of Public Policy, Nicholas Schools of the Environment, and Global Health Institute, Durham, NC 27708-0312, USA.
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Cook J, Jeuland M, Whittington D, Poulos C, Clemens J, Sur D, Anh DD, Agtini M, Bhutta Z. The cost-effectiveness of typhoid Vi vaccination programs: Calculations for four urban sites in four Asian countries. Vaccine 2008; 26:6305-16. [DOI: 10.1016/j.vaccine.2008.09.040] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 09/09/2008] [Accepted: 09/15/2008] [Indexed: 11/24/2022]
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