M Hifinger1,2, M Hiligsmann1,3, S Ramiro4, V Watson5, J L Severens6, B Fautrel7, T Uhlig8, R van Vollenhoven9, P Jacques10, J Detert11, J Canas da Silva12, C A Scirè13, F Berghea14, L Carmona15, M Péntek16,17, A Keat18, A Boonen1,2. 1. CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands. 2. Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands. 3. Department of Health Services Research, Maastricht University, Maastricht, The Netherlands. 4. Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. 5. Health Economics Research Unit, University of Aberdeen, Aberdeen, UK. 6. Institute for Health Policy and Management, Erasmus Rotterdam University, Rotterdam, The Netherlands. 7. Department of Rheumatology, University Paris 6, GRC-UPMC08, Pierre Louis Institute of Epidemiology and Public Health-AP-HP, Pitie Salpetriere University Hospital, Paris, France. 8. National Advisory Unit for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo, Oslo, Norway. 9. Unit for Clinical Therapy Research Inflammatory Diseases, Karolinska Institute, Stockholm, Sweden. 10. Department of Rheumatology, University Hospital Ghent, Ghent, Belgium. 11. Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany. 12. Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal. 13. Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy. 14. Department of Rheumatology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania. 15. Department of Rheumatology, Instituto de Salud Musculoesqueletica, Madrid, Spain. 16. Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary. 17. Department of Rheumatology, Flór Ferenc Hospital, Kistarcsa, Hungary. 18. Arthritis Centre, Northwick Park Hospital, Harrow, UK.
Abstract
OBJECTIVE: To compare the value that rheumatologists across Europe attach to patients' preferences and economic aspects when choosing treatments for patients with rheumatoid arthritis. METHODS: In a discrete choice experiment, European rheumatologists chose between two hypothetical drug treatments for a patient with moderate disease activity. Treatments differed in five attributes: efficacy (improvement and achieved state on disease activity), safety (probability of serious adverse events), patient's preference (level of agreement), medication costs and cost-effectiveness (incremental cost-effectiveness ratio (ICER)). A Bayesian efficient design defined 14 choice sets, and a random parameter logit model was used to estimate relative preferences for rheumatologists across countries. Cluster analyses and latent class models were applied to understand preference patterns across countries and among individual rheumatologists. RESULTS: Responses of 559 rheumatologists from 12 European countries were included in the analysis (49% females, mean age 48 years). In all countries, efficacy dominated treatment decisions followed by economic considerations and patients' preferences. Across countries, rheumatologists avoided selecting a treatment that patients disliked. Latent class models revealed four respondent profiles: one traded off all attributes except safety, and the remaining three classes disregarded ICER. Among individual rheumatologists, 57% disregarded ICER and these were more likely from Italy, Romania, Portugal or France, whereas 43% disregarded uncommon/rare side effects and were more likely from Belgium, Germany, Hungary, the Netherlands, Norway, Spain, Sweden or UK. CONCLUSIONS: Overall, European rheumatologists are willing to trade between treatment efficacy, patients' treatment preferences and economic considerations. However, the degree of trade-off differs between countries and among individuals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: To compare the value that rheumatologists across Europe attach to patients' preferences and economic aspects when choosing treatments for patients with rheumatoid arthritis. METHODS: In a discrete choice experiment, European rheumatologists chose between two hypothetical drug treatments for a patient with moderate disease activity. Treatments differed in five attributes: efficacy (improvement and achieved state on disease activity), safety (probability of serious adverse events), patient's preference (level of agreement), medication costs and cost-effectiveness (incremental cost-effectiveness ratio (ICER)). A Bayesian efficient design defined 14 choice sets, and a random parameter logit model was used to estimate relative preferences for rheumatologists across countries. Cluster analyses and latent class models were applied to understand preference patterns across countries and among individual rheumatologists. RESULTS: Responses of 559 rheumatologists from 12 European countries were included in the analysis (49% females, mean age 48 years). In all countries, efficacy dominated treatment decisions followed by economic considerations and patients' preferences. Across countries, rheumatologists avoided selecting a treatment that patients disliked. Latent class models revealed four respondent profiles: one traded off all attributes except safety, and the remaining three classes disregarded ICER. Among individual rheumatologists, 57% disregarded ICER and these were more likely from Italy, Romania, Portugal or France, whereas 43% disregarded uncommon/rare side effects and were more likely from Belgium, Germany, Hungary, the Netherlands, Norway, Spain, Sweden or UK. CONCLUSIONS: Overall, European rheumatologists are willing to trade between treatment efficacy, patients' treatment preferences and economic considerations. However, the degree of trade-off differs between countries and among individuals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Monika Hifinger; Mickael Hiligsmann; Sofia Ramiro; Verity Watson; Florian Berghea; Márta Péntek; Andrew Keat; Johan L Severens; Bruno Fautrel; Annelies Boonen Journal: RMD Open Date: 2017-09-04
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