Patients' preferences and economic considerations play an important role in treatment decisions: a discrete choice experiment among rheumatologists

Monika Hifinger*, Mickael Hiligsmann, Sofia Ramiro, Johan L. Severens, Bruno Fautrel, Verity Watson, Annelies Boonen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

15 Citations (Web of Science)

Abstract

Objective. To evaluate to what extent rheumatologists consider economic aspects and patients' preferences when choosing drug treatments in patients with active RA.

Methods. In a discrete choice experiment, rheumatologists were asked to choose between two unlabelled drug treatment options for a hypothetical RA patient with moderate disease activity who failed two synthetic DMARDs. Attributes and levels of drug treatments were selected based on existing literature, rheumatologists' opinion and expert consensus. This resulted in five attributes each described by three levels: efficacy (level of improvement and achieved state on DAS28), safety (probability of a serious adverse event), patients' preference (level of agreement), annual medication costs and cost-effectiveness (incremental cost-effectiveness ratio). An efficient experimental design generated 14 treatment choices and a random parameter logit model estimated the relative importance of attributes.

Results. Sixty-three rheumatologists from the Netherlands contributed to the analysis; 44% were female and mean (S.D.) age was 49 (8) years. Drug efficacy had the strongest relative contribution to the drug choice (44%) followed by medication costs (24%), patients' preference (17%) and cost-effectiveness (14%). Patients' preferences were most relevant when patients disliked a proposed treatment. The risk of serious but uncommon or rare side effects only played a minor role in the treatment choice (1%).

Conclusion. In addition to drug efficacy, rheumatologists account for economic aspects and for patients' preferences when deciding on drugs. Decisions are more influenced by absolute costs than relative cost-effectiveness and by patients' disliking as opposed to favouring the treatment.

Original languageEnglish
Pages (from-to)68-76
Number of pages9
JournalRheumatology
Volume56
Issue number1
DOIs
Publication statusPublished - Jan 2017

Keywords

  • clinicians
  • costs
  • cost-effectiveness
  • discrete choice experiment
  • patient preference
  • rheumatoid arthritis
  • MODIFYING ANTIRHEUMATIC DRUGS
  • RHEUMATOID-ARTHRITIS
  • EULAR RECOMMENDATIONS
  • COST-EFFECTIVENESS
  • HEALTH-CARE
  • ETANERCEPT
  • INFLIXIMAB
  • ADALIMUMAB
  • MANAGEMENT
  • THERAPY

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