Monika Hifinger1,2, Mickael Hiligsmann3,4, Sofia Ramiro5, Johan L Severens6,7, Bruno Fautrel8, Verity Watson9, Annelies Boonen3,2. 1. CAPHRI Research Institute, Maastricht University monikahifinger@gmx.de. 2. Department of Internal Medicine, Maastricht University Medical Centre. 3. CAPHRI Research Institute, Maastricht University. 4. Department of Health Services Research, Maastricht University, Maastricht. 5. Department of Rheumatology, Leiden University Medical Center, Leiden. 6. Institute for Health Policy and Management, Erasmus Rotterdam University, Rotterdam. 7. iMTA-Institute of Medical Technology Assessment, Erasmus Rotterdam University, Rotterdam, The Netherlands. 8. GRC 08, Pierre Louis Institute of Epidemiology and Public Health, AP-HP, Department of Rheumatology, Pitie Salpetriere Hospital Paris, Pierre et Marie Curie University, France and. 9. Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
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 (sd) 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.
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 RApatient 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 (sd) 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.
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
Authors: In Ah Choi; Ji Hyoun Kim; Sung Hae Chang; Ran Song; You-Jung Ha; Hye Won Kim; Jeong Seok Lee; Byoongyong Choi; Yoon-Jeong Oh; Ki Won Moon Journal: Arch Rheumatol Date: 2021-06-24 Impact factor: 1.472
Authors: Yihua Xu; Lavanya Sudharshan; Ming-Ann Hsu; Andrew S Koenig; Joseph C Cappelleri; Wen F Liu; Timothy W Smith; Margaret K Pasquale Journal: Am Health Drug Benefits Date: 2018-11