Given the increasing number of genetic tests available, decisions have to be made on how to allocate limited health-care resources to them. Different criteria have been proposed to guide priority ...setting. However, their relative importance is unclear. Discrete-choice experiments (DCEs) and best-worst scaling experiments (BWSs) are methods used to identify and weight various criteria that influence orders of priority. This study tests whether these preference eliciting techniques can be used for prioritising genetic tests and compares the empirical findings resulting from these two approaches. Pilot DCE and BWS questionnaires were developed for the same criteria: prevalence, severity, clinical utility, alternatives to genetic testing available, infrastructure for testing and care established, and urgency of care. Interview-style experiments were carried out among different genetics professionals (mainly clinical geneticists, researchers and biologists). A total of 31 respondents completed the DCE and 26 completed the BWS experiment. Weights for the levels of the six attributes were estimated by conditional logit models. Although the results derived from the DCE and BWS experiments differed in detail, we found similar valuation patterns in the DCE and BWS experiments. The respondents attached greatest value to tests with high clinical utility (defined by the availability of treatments that reduce mortality and morbidity) and to testing for highly prevalent conditions. The findings from this study exemplify how decision makers can use quantitative preference eliciting methods to measure aggregated preferences in order to prioritise alternative clinical interventions. Further research is necessary to confirm the survey results.
Background
Severe hypercholesterolemia is a major risk factor of death in patients with coronary heart disease. New adjunctive drug therapies (proprotein convertase subtilisin/kexin type 9 PCSK9 ...inhibitors) have gained approval in Europe and the USA.
Objective
In this empirical study, we documented preferences regarding adjuvant drug therapy in apheresis-treated patients with severe familial hypercholesterolemia.
Methods
We conducted a systematic literature search to identify patient-relevant outcomes in patients with severe hypercholesterolemia currently undergoing apheresis. Data were used to generate a semi-structured qualitative interview that enabled seven patient-relevant characteristics with three levels each to be identified. For the discrete choice experiment, an experimental design (7 × 3) was generated using NGene Software that consisted of 96 choices divided into eight blocks. The survey was conducted between November 2015 and April 2016 using computer-assisted personal interviews.
Results
The survey was completed by 348 patients (64.9% male). The random parameter logit estimation showed predominance for the attribute ‘reduction of LDL-C (low-density lipoprotein cholesterol) level’. ‘Risk of myopathy’ and ‘frequency of apheresis’ dominated next. Within the random parameter logit estimation, all coefficients were significant (
P
≤ 0.01). The latent class analysis identified three patient groups. The first group (126 patients) found ‘reduction of LDL-C level in blood’ to be most important. This group focused solely on this treatment outcome independently of apheresis frequency or additional injections. The second group (106 patients) focused on three attributes: ‘frequency of apheresis’, ‘risk of myopathy’, and ‘reduction of LDL-C level in blood’. Respondents clearly considered a high frequency of apheresis to have a negative impact. The third group (116 patients) demonstrated the highest preference for apheresis. These patients have adjusted to apheresis for > 10 years.
Conclusion
Regarding patient preference, clinical efficacy seems to dominate. Hence, ‘reduction of LDC-C in blood’ was ranked highest above patient-relevant modes of administration and adverse effects. In the patient groups identified, reduction of apheresis was important for only a subsegment (30%) of patients. Another 30% wanted effective LDL-C reduction by whatever means necessary. Most strikingly, another 30% preferred higher frequencies of apheresis.
Efforts to eliminate the HIV epidemic will require increased HIV testing rates among high-risk populations. To inform the design of HIV testing interventions, a discrete choice experiment (DCE) with ...six policy-relevant attributes of HIV testing options elicited the testing preferences of 300 female barworkers and 440 male Kilimanjaro mountain porters in northern Tanzania. Surveys were administered between September 2017 and July 2018. Participants were asked to complete 12 choice tasks, each involving first- and second-best choices from 3 testing options. DCE responses were analyzed using a random effects latent class logit (RELCL) model, in which the latent classes summarize common participant preference profiles, and the random effects capture additional individual-level preference heterogeneity with respect to three attribute domains: (a) privacy and confidentiality (testing venue, pre-test counseling, partner notification); (b) invasiveness and perceived accuracy (method for obtaining the sample for the HIV test); and (c) accessibility and value (testing availability, additional services provided). The Bayesian Information Criterion indicated the best model fit for a model with 8 preference classes, with class sizes ranging from 6% to 19% of participants. Substantial preference heterogeneity was observed, both between and within latent classes, with 12 of 16 attribute levels having positive and negative coefficients across classes, and all three random effects contributing significantly to participants’ choices. The findings may help identify combinations of testing options that match the distribution of HIV testing preferences among high-risk populations; the methods may be used to systematically design heterogeneity-focused interventions using stated preference methods.
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•A discrete choice experiment (DCE) was used to quantify preferences for HIV testing.•Substantial preference heterogeneity was observed among high risk populations.•A random-effects latent class logit (RELCL) model identified 8 preference classes.•RELCL models outperformed latent class models without random effects.•Preference profiles and random variation across individuals both impacted choices.
Background and Objective
Cardiovascular disease is the main cause of death in Germany and other industrialized countries. However, until now, little has been known about how people with acute ...coronary syndrome (ACS) value aspects of their medical treatment. The objective of this study was to evaluate patients’ preferences regarding different antiplatelet medication options following an ACS.
Method
After identification of patient-relevant treatment attributes (a literature review and qualitative interviews), a discrete-choice experiment (DCE) including five patient-relevant attributes was conducted. The DCE used a forced-choice approach in which no “opt out” was present, as no treatment is not an option after ACS. The attribute and level combinations were created using a fractional–factorial NGene design with priors. Data analysis was performed using a random-effects logit model. An additional generalized linear latent and mixed models (GLLAMM) analysis was performed to evaluate subgroup differences.
Results
ACS patients (
N
= 683) participated in computer-assisted personal interviews. Preference analysis showed a clear dominance of the attribute “mortality risk” (coefficient: 0.803). Ranked second was “side effect: dyspnea” (coefficient: 0.550) followed by “risk of a new myocardial infarction” (coefficient: 0.464) and “side effect: bleeding” (coefficient: 0.400). “Frequency of intake” was less important (coefficient: 0.025). Within the 3-class GLLAMM, the variables “marital status” (
p
= 0.008), “highest level of education” (
p
= 0.003), and “body-mass index” (according to World Health Organization cluster;
p
= 0.014) showed a significant impact on the estimated class probabilities.
Conclusion
Our study found “mortality risk” to be of the highest value for patients. Patient-centered care and decision making requires consideration of patient preferences; moreover, the information on preferences can be used to develop effective therapies after an ACS. The data generated will enable healthcare decision makers and stakeholders to understand patient preferences to promote patients’ benefit.
While there is an increasing emphasis on patient empowerment and shared decision-making, subjective values for attributes associated with their treatment still need to be measured and considered. ...This contribution seeks to define properties of an ideal drug treatment of individuals concerned with Attention-Deficit/Hyperactivity Disorder (ADHD). Because of the lack of information on patient needs in the decision-makers assessment of health services, the individuals' preferences often play a subordinate role at present. Discrete Choice Experiments offer strategies for eliciting subjective values and making them accessible for physicians and other health care professionals.
The evidence comes from a Discrete Choice Experiments (DCE) performed in 2007. After reviewing the literature about preferences of ADHS we conducted a qualitative study with four focus groups consisting of five to eleven ADHS-patients each. In order to achieve content validity, we aimed at collecting all relevant factors for an ideal ADHS treatment. In a subsequent quantitative study phase (n = 219), data was collected in an online or paper-pencil self-completed questionnaire. It included sociodemographic data, health status and patients' preferences of therapy characteristics using direct measurement (23 items on a five-point Likert-scale) as well as a Discrete-Choice-Experiment (DCE, six factors in a fold-over design).
Those concerned were capable of clearly defining success criteria and expectations. In the direct assessment and the DCE, respondents attached special significance to the improvement of their social situation and emotional state (relative importance 40%). Another essential factor was the desire for drugs with a long-lasting effect over the day (relative importance 18%). Other criteria, such as flexibility and discretion, were less important to the respondents (6% and 9%, respectively).
Results point out that ADHD patients and their family members have clear ideas of their needs. This is especially important against the backdrop of present discussions in the healthcare sector on the relevance of patient reported outcomes (PROs) and shared decision-making. The combination of the methods used in this study offer promising strategies to elicit subjective values and making them accessible for health care professionals in a manner that drives health choices.
Cardiovascular disease is one of the most common causes of death worldwide, with many individuals having experienced acute coronary syndrome (ACS). How patients with a history of ACS value aspects of ...their medical treatment have been evaluated rarely. The aim of this study was to determine patient priorities for long-term drug therapy after experiencing ACS.
To identify patient-relevant treatment characteristics, a systematic literature review and qualitative patient interviews were conducted. A questionnaire was developed to elicit patient's priorities for different characteristics of ACS treatment using Analytic Hierarchy Process (AHP). To evaluate the patient-relevant outcomes, the eigenvector method was applied.
Six-hundred twenty-three patients participated in the computer-assisted personal interviews and were included in the final analysis. Patients showed a clear priority for the attribute "reduction of mortality risk" (weight: 0.402). The second most preferred attribute was the "prevention of a new myocardial infarction" (weight: 0.272), followed by "side effect: dyspnea" (weight: 0.165) and "side effect: bleeding" (weight: 0.117). The "frequency of intake" was the least important attribute (weight: 0.044).
In conclusion, this study shows that patients strongly value a reduction of the mortality risk in post-ACS treatment. Formal consideration of patient preferences and priorities can help to inform a patient-centered approach, clinical practice, development of future effective therapies, and health policy for decision makers that best represents the needs and goals of the patient.
Zusammenfassung
Diabetes mellitus ist eine Volkskrankheit mit hohen Ausgaben für das Gesundheitssystem. Bis heute gibt es in der Diabetesversorgung ungelöste verfahrenstechnische und medizinische ...Probleme. Dazu gehören die unzureichende glykämische Anpassung, Versorgungslücken und mangelnde Motivation. Aufgrund der gewaltigen sozioökonomischen Bedeutung von Innovationen ist es wichtig, die Erwartungen und Bedürfnisse zu berücksichtigen bzw. den Patientennutzen zu maximieren. Der Einsatz von Methoden zur Präferenzmessung verfolgt das Ziel, die Präferenzen für Therapieeigenschaften aus der Patientenperspektive abzubilden. Die Erfassung von Patientenpräferenzen in der Indikation Diabetes zielt auf die Identifikation und Gewichtung von Eigenschaften von Medikamenten, Therapien und/oder Versorgungsprogrammen ab, die für die Wahl von Therapieschemata für Patienten mit Diabetes mellitus relevant sind. Bislang ist unklar, in welcher Form diese Evidenz bei der Nutzenbewertung medizinischer Interventionen dokumentiert wird und wie die Erkenntnisse Entscheidungsträgern zur Verfügung gestellt werden.
Health Preference Research: An Overview Craig, Benjamin M; Lancsar, Emily; Mühlbacher, Axel C ...
The patient : patient-centered outcomes research,
08/2017, Letnik:
10, Številka:
4
Journal Article
Zusammenfassung
Ziel
Diabetes ist eine der teuersten Volkskrankheiten in Deutschland. Aufgrund der großen sozioökonomischen Bedeutung ist es wichtig, die Erwartungen und Bedürfnisse der Betroffenen ...in Hinblick auf die Therapie zu berücksichtigen. Ziel der Untersuchung ist es, die verfügbare Evidenz über die Patientenpräferenzen bei der medikamentösen Therapie des Diabetes Mellitus Typ 2 zu analysieren und zu vergleichen. Die Analyse soll einen Überblick über den aktuellen Forschungstand in Hinblick auf die Ermittlung von Patientenpräferenzen in der Indikation Diabetes liefern.
Methode
Es wurde ein Literaturreview durchgeführt um Stated-Preference Studien im Indikationsgebiet Diabetes zu identifizieren. Mittels der Berechnung der Level-Difference aus den Koeffizienten oder Odds Ratios der identifizierten Präferenzstudien und einer Normalisierung der Werte wurde versucht, einheitliche Gewichte für die Attribute der Studien zu ermitteln. Im Ergebnis wurde eine Rangreihung über die patientenrelevanten Kriterien dokumentiert. Es wurde studienübergreifend belegt, an Hand welcher Eigenschaften Patienten Therapien beurteilen und welche Zielkriterien bei der Bewertung am wichtigsten sind.
Ergebnisse
N
= 13 DCE-Studien wurden in die Analyse einbezogen. Infolge der Neuberechnung und Normalisierung von N=7 Studien konnten alle Attribute einheitlich abgebildet werden. Die Präferenzstudien zeigen, dass die Kontrolle des Blutzuckers, Nebenwirkungen (wie Hypoglykämien, Magenbeschwerden oder Gewichtsveränderungen), Langzeitkomplikationen, die Art der Verabreichung sowie die zusätzlichen Kosten die patientenrelevanten Zielkriterien in der Therapie sind. Die Blutzuckerkontrolle war in 5 der 13 Studien die wichtigste Eigenschaft der Behandlung. In je 2 Studien belegten Hypoglykämien und Gewichtsänderungen den 1. Rang. Die Nebenwirkungen Übelkeit/Magenbeschwerden konnten ebenfalls in 2 Studien als primäre Endpunkte bestimmt werden.
Fazit
Der Einsatz von Stated-Preference Methoden in der Gesundheitsökonomie verfolgt das Ziel, die Präferenzen einzelner Therapieeigenschaften aus Patienten- oder Expertenperspektive abzubilden. Bislang ist unklar, in welcher Form diese Evidenz bei der Nutzenbewertung medizinischer Interventionen dokumentiert wird und wie die Erkenntnisse Entscheidungsträgern zur Verfügung gestellt werden. Der in der Analyse erstmalig angewandte Ansatz der systematischen Klassifizierung ermöglicht studienübergreifende Aussagen zur Bedeutung der Eigenschaften einer Diabetestherapie aus Patientensicht.
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