The discretechoiceexperiment (DCE) is a quantitative survey-based method, which has been extensively used to assess patientpreferences, and marginal rates of substitu- tion (e.g. marginal willingness to pay) in health care. 21–24 In a DCE, respondents are presented with a sequence of hypothetical scenarios (choice sets) composed by de ﬁ ned attributes (ef ﬁ cacy, safety, mode of administration, costs, etc.) that are assigned with different levels. For each choice set, respondents are asked to choose their preferred scenario. Thus, relative preferences of given attributes can be determined and the trade-offs that respondents make can be quanti ﬁ ed. There are several checklists available during the design of DCE study. 23,25–28
In most of the treatment characteristics the assessments of physicians seen in this study and patients found in the previous study  are congruent. In some characteristics, however, there are obvious differences: thus, compared to patient assessments, physicians tend to underestimate the relevance of the characteristics “Drug allows further ther- apy options in the future”, “Drug does not generate resist- ance”, “Drug can be used also in case of comorbidities” and “Dosing of drug may vary to current state”. Effects of socio-demographic baseline characteristics of the physi- cians showed that professionally more experienced physi- cians assessed “High efficacy”, “Not generating resistance” and “Unlikely long term side-effects” as being more im- portant, while physicians with large numbers of patients for example assessed “Unlikely long term side-effects”, “Improvement of physical state” and of “Emotional and mental state” as more important. Whereas these assess- ments of more experienced physicians seem to be closer to the patientpreferences, the assessments of less experi- enced physicians might truly reflect a different patient population. However, these findings can also be a misinter- pretation of patientpreferences due to less patient contacts. In a second step, preferences were measured using a DiscreteChoiceExperiment in which the physicians had to choose eight times between two treatment options, which were described by combinations of 6 quality as- pects. The influence of each treatment characteristic on the treatment decision was evaluated.
Purpose: The purpose of this study was to assess patientpreferences regarding pharmacological treatment attributes for bipolar depression using a discretechoiceexperiment (DCE). Methods: Adult members of an Internet survey panel with a self-reported diagnosis of bipolar depression were invited via e-mail to participate in a web-based DCE survey. Participants were asked to choose between hypothetical medication alternatives defined by attributes and levels that were varied systematically. The six treatment attributes included in the DCE were time to improvement, risk of becoming manic, weight gain, risk of sedation, increased blood sugar, and increased cholesterol. Attributes were supported by literature review, expert input, and results of focus groups with patients. Sawtooth CBC System for Choice-Based Conjoint Analysis was used to estimate the part-worth utilities for the DCE analyses.
were identified, selected, and refined. Then, choice tasks were created and were tested with people with type 2 diabetes to determine whether they understood the attribute descriptions and could successfully complete the choice tasks. The final treatment profiles contained six attributes: A1c decrease (0%, 0.5%, and 1%), stable blood glucose (2 days per week, 4 days per week, 6 days per week), low blood glucose/hypoglycemia (none, during the day, during the day and/or at night), nausea (none, 30 minutes per day, 90 minutes per day), treatment burden (one pill per day, two pills per day, one pill and one injection per day), and out-of-pocket costs ($10 per month, $30 per month, $50 per month). The survey instrument included an explanation and example on how to complete a choice task. It also included detailed descriptions on all attributes and levels that had been pretested with people with type 2 diabetes to test their understanding of the concepts. It discussed the benefits of lowering A1c and the potential health consequences of high A1c levels.
Cancer staging pathways are complex, typically comprising a variety of imaging modalities including ultrasound, computed tomography (CT), and positron emission tomography (PET) CT. Multi-modality pathways are inconvenient for patients and prolong time to treatment. Conversely, whole-body mag- netic resonance imaging (WB-MRI) may facilitate staging with a single investigation, while simultaneously achieving greater accuracy for metastatic disease, without imparting i- onising radiation [1, 2]. However, patients perceive WB-MRI as more challenging than conventional staging scans , par- ticularly among those with coexisting physical conditions and/or high anxiety levels . MRI scan acquisition is noisy and whole-body imaging can take up to 1 h, much longer than standard CT or PET-CT. In addition, WB-MRI elicits claustrophobia in a substantial proportion of patients, which can terminate the scan prematurely . Furthermore, WB- MRI may itself generate future tests such as PET-CT for equivocal findings.
for oral DMTs changes when the frequency of the oral treat- ment is substantially higher than the frequency of injectable treatment. Even though the classification of side effects used in the study is not necessarily suited to categorize side effects in daily practice, semistructured interviews with patients and MS physicians revealed that, since severity of side effects is perceived differently for each patient, it will be more easy for them to evaluate each level of this attribute using the descrip- tion of mild, moderate, and severe instead of describing side effects such as headache or flu-like symptoms. Due to the small sample size of some study subgroups, any extrapolation of results should be done with caution. Further research regarding preferences of patients in these subgroups is warranted. The comparison between patients’ subjective thoughts and physi- cians’ data may increase the strength of our results, however, since patients were contacted through patient’s associations, physicians’ data were not available, and this comparison was not possible to be performed. Finally, these results should be interpreted within the context of the study.
Different estimation methods of DCE data can be found in the literature . In most cases, probit or logit esti- mations are used. For the current study, the conditional logit model has been evaluated as the best methodo- logical approach. By the use of the DCE method, study participants were implicitly forced to weight different product attributes simultaneously. Hereby, the weak- nesses of single-attributive approaches (e.g. Likert scales) with ceiling effects and “all-is-important” results, when asking individuals single disconnected questions, were avoided . Accordingly, the discrete-choice method is explicitly recommended by regulatory institutions evalu- ating health technologies for the measurement of patientpreferences for purposes of weighing and ranking of single preferences .
The data collected in the DCE were based on re- sponses to hypothetical choice profiles. These choices were intended to simulate possible clinical decisions, but obviously do not have the same clinical, financial or emotional consequences of actual decisions. Although we identified the key clinical features that differ across PC treatment options, there are a multitude of other fac- tors (e.g., presentation of treatment options by the phys- ician, Internet research, family/friend opinion, etc.) that would be present in a real-world choice selection that could not reasonably be accounted for in our controlled experiment. As a result, when confronted with a real choice, preferences may differ from our DCE results. Thus, differences can arise between stated and actual choices. Finally, duration of treatment and patient bur- den may also have affected patientpreferences, although subgroup analysis using patient clinical background did not show any significant differences in preference.
The highest relevance for the treatment choice of the patients was found for emotional quality of life being mainly characterized by the characteristic that the dis- ease was not obvious for other persons. The next rele- vant patient-relevant outcome from the patient point of view were the avoidance of physical impairments such as diarrhoea and vomiting and the facilitation to participate in social life. Being still statistically significant, the characteristic “maximum increase of life expectancy” followed at some distance. The reduction of the risk of Table 4 Results of random effects logit model (discretechoiceexperiment; negative pole as reference group)
The administration of (biologically-derived) drugs for various disease conditions involves consumption of resources that constitutes a direct monetary cost to healthcare payers and providers. An often ignored cost relates to a mismatch between patients ’ preferences and the mode of drug administration. The “ intangible ” benefits of giving patients what they want in terms of the mode of drug delivery is seldom considered. This study aims to evaluate, in monetary terms, end-user preferences for the non-monetary attributes of different modes of drug administration using a discrete-choiceexperiment. It provides empirical support to the notion that there are significant benefits from developing patient-friendly approaches to drug delivery. The gross benefits per patient per unit administration is in the same order of magnitude as the savings in resource costs of administering drugs. The study argues that, as long as the underlying manufacturing science is capable, a patient-centred approach to producing drug delivery systems should be encouraged and pursued.
or not). Our ﬁ ndings additionally re ﬂ ect other patient prefer- ence work in myeloma. 24,37,38 In a recent German study exam- ining patientpreferences for relapsed refractory multiple myeloma treatments, they found that mode of administration and progression-free survival were the most important features. 37 Our results match these ﬁ ndings with remission period and mode/treatment frequency being equally important, second only to overall survival which was not included in the German study. Postmus et al ’ s (2017) recent study examined trade-offs between possible bene ﬁ ts and risks of treatments in myeloma. 38 These researchers found that participants who ranked severe or life-threatening toxicity above mild or mod- erate toxicity were more frequently younger, working, and looking after dependent family members. Findings echo this current preference study, where a divide existed between patients who placed more importance on survival and mild- to-moderate side effects and patients who placed more impor- tance on the mode and frequency of treatment. Both studies demonstrate that there is variance around what characteristics of treatment patients with myeloma value in the UK.
Breastcancer is the most common cancer in women worldwide, and breastcancer screening (BCS) programs via mammography are frequently established in an effort to decrease mortal- ity. Reaching high screening uptake is challenging to achieve. Only half of the BCS programs in European Union reached the benchmark of acceptable participation ( > 70%) . Besides, informed by the ongoing debates on the benefits/harms ratio of BCS , women invited to the new screening programs may be negatively affected by the risk of false-positive result of the test and overdiagnosis . This fear of screening-related harms may avert their preferences from BCS in general or shift them towards programs with lower risk of harms from a popula- tion perspective (e.g. more qualified doctors, specialized or private hospitals, etc.).Therefore, implementation of any BCS requires a deep insight into population preferences for screening strategies and their characteristics before nation-wide program implementation.
Materials and methods: Patients aged 18 years or older with a self-reported diagnosis of mCRC and board-certified (or equivalent) oncologists who had treated patients with mCRC were recruited by two survey research companies from existing online patient panels in the USA. Additional oncologists were recruited from a list of US physicians. Patients and oncolo- gists completed a discrete-choiceexperiment (DCE) survey. DCEs offer a systematic method of eliciting preferences and quantifying both the relative importance of treatment attributes and the tradeoffs respondents are willing to make among benefits and risks. Treatment attributes in the DCE were progression-free survival (PFS) and risks of severe papulopustular rash, serious hemorrhage, cardiopulmonary arrest, and gastrointestinal perforation. Patients’ and physicians’ maximum levels of acceptable treatment-related risks for two prespecified increases in efficacy were estimated.
Main outcome measures Men’s preferences for, and trade-offs between, the attributes of diarrhoea, hot flushes, ability to maintain an erection, breast swelling or tenderness, physical energy, sex drive, life expectancy, and out of pocket expenses. Results The men’s responses to changes in attributes were all statistically significant. When asked to assume a starting life expectancy of five years, the men were willing to make trade-offs between life expectancy and side effects. On average, they were most willing to give up life expectancy to avoid limitations in physical energy (mean three months) and least willing to trade life expectancy to avoid hot flushes (mean 0.6 months to move from a moderate to mild level or from mild to none).
Recent national guidelines state that patients with operable breastcancer should be treated with surgery, and not PET, “irrespective of age” unless this is precluded by comorbidities ; whilst the International Society of Geriatric Oncology (SIOG) and European Society of BreastCancer Specialists (EUSOMA) recommend that PET should only be offered to patients with “short estimated life expectancy (<2-3 years), who are considered unfit for surgery… or who refuse surgery” . However, life expectancy is impossible to accurately assess with any certainty, and although considered important by HCPs in determining treatment for older patients with operable breastcancer , a recent study has shown that surgeons are poor at gauging life-expectancy of older patients, with a tendency to under-estimate it . Additionally, these current guidelines do not specify which comorbidities may preclude surgery or what constitutes being “unfit” and as such it is left to the treating HCP to determine which patients are considered unsuitable for surgery based on the clinical information available.
study determined that a specific combination of attribute levels cannot be used in this study. The attribute levels nine months and one year cannot be combined. In this scenario the patient has a follow-up of one year and every nine months a follow-up consult. This would result in three months of follow-up that will be unused. Since presenting all 256 scenarios would be too burdensome for the respondent, a fraction of these scenarios must be used. Research has showed that for a DCE the maximum amount of attributes is six and the maximum amount of levels is three or four per attribute and that a maximum of twenty choice set of scenarios is accepted (35). To determine the number of scenarios needed to ensure a balanced choice set of attributes and levels, the program Sawtooth 6.4.6. is used to determine all possible designs. This program produced the most orthogonal design, which results that not the same attribute level occur twice in a DCE choice set. With this program 24 scenarios are determined resulting in twelve DCE choice set questions. The statistical efficiency and respondent burden must be balanced to minimize the overall error in the questionnaire responses. A higher amount of attributes and levels can cause overlap between attributes. This overlap takes place when an attribute in a choice question (between two or more scenarios) has the same level for a given attribute. This overlap can have positive effect for the response efficiency, because it simplifies the choice questions by reducing the attribute differences between scenarios. However, overlap may reduce the design efficiency because it potentially limits the amount of trade-off information obtained by the design (51).
These findings concur with motivations that underlie the ongoing dissemination of differ- entiated service delivery models . The strong preference for dispensation of more drugs, and therefore longer intervals between visits, underscores the fact that that even though the medications are free, opportunity costs of travel to clinics for medication refills and scheduled patient review are formidable [25,26]. Many patients engaged in hourly wage labor must give up a day of income to travel to facilities for HIV care. Caregivers for children often must travel with dependents, creating additional expenses and difficulties. Finally, many patients experi- ence unexpected social obligations (such as weddings or burials) that conflict with frequent clinic visits. Studies showing an association between longer visit intervals and a higher proba- bility of making the visit and reduced risk of loss to follow-up complement the findings in this analysis as well as demonstrate concordance between patient report (or stated preferences) with evidence of behaviors (or revealed preference) .
Tumour factors were also shown to have an independent influence over the HCPs treatment preference. Larger tumours were associated with lower rates of preference for surgery. This may reflect the fact that larger tumours are more likely to require mastectomy rather than breast conservation surgery and HCPs may wish to avoid more major surgery, although exact tumour size was not specified in the scenarios. Interestingly, preference for surgery significantly increased with increasing ER status but preference for PET did not. This is contrary to what might be expected as response rates for PET are generally higher for patients with greater ER positivity . Additionally, preference for surgery increased for HER2 negative tumours but there was no difference in
The authors would like to thank all of the patients who participated in the survey. They would also like to thank the physicians and (study) nurses for recruiting the patients, especially: PD Dr med. Heiko Golpon, Annette Nocon (Hannover Medical School: Department of Pneumology), Prof Dr med. Arndt Vogel and team (Hannover Medical School: Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany), Dr med. Parvis Sadjadian (Johannes Wesling Medical Center, Department of Hematology, Oncology, Hemostaseology, and Palliative Care UKRUB, University of Bochum, Minden), Dr med. Monika Heilmann and Mrs J Brandes (Lung Cancer Center at the Hospital Region Hannover), Dr rer. nat. Silvia Wagner and Dr med. Silke Templin (Clinic for Visceral, General and Transplant Surgery Surgical Study Center, University Hospital Tuebingen), Dr med. Michael Gärtner and his team (Ambulatory Oncological Center Hannover), Dr med. Raack and Gabriele Germann (Group Practice for Internal Medicine and Pulmonology, Celle), PD Dr med. Annalen Bleckmann (Interdisciplinary Short-term Oncology, Department of