Mickaël Hiligsmann1, Benedict G Dellaert2, Carmen D Dirksen3, Verity Watson4, Sandrine Bours5, Stefan Goemaere6, Jean-Yves Reginster7, Christian Roux8, Bernie McGowan9, Carmel Silke9, Bryan Whelan9, Adolfo Diez-Perez10, Elisa Torres10, Georgios Papadakis11, Rene Rizzoli12, Cyrus Cooper13, Gill Pearson13, Annelies Boonen5. 1. Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht. 2. Department of Business Economics, Erasmus School of Economics, Erasmus Rotterdam University, Rotterdam. 3. Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands. 4. Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK. 5. Department of Internal Medicine, Maastricht University Medical Centre, CAPHRI, Maastricht, The Netherlands. 6. Department of Rheumatology and Endocrinology, Ghent University Hospital, Gent. 7. Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium. 8. Department of Rheumatology, Paris Descartes University, Paris, France. 9. The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co Leitrim, Ireland. 10. Musculoskeletal Research Unit and RETICEF, Universitat Autònoma de Barcelona, Barcelona, Spain. 11. Service of Endocrinology, Diabetology and Metabolism, CHUV, Lausanne University Hospital, Lausanne. 12. Division of Bone Diseases, Geneva University Hospitals, Geneva, Switzerland. 13. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
Abstract
Objectives: To estimate the preferences of osteoporotic patients for medication attributes, and analyse data from seven European countries. Methods: A discrete choice experiment was conducted in Belgium, France, Ireland, the Netherlands, Spain, Switzerland and the UK. Patients were asked to choose repeatedly between two hypothetical unlabelled drug treatments (and an opt-out option) that varied with respect to four attributes: efficacy in reducing the risk of fracture, type of potential common side effects, and mode and frequency of administration. In those countries in which patients contribute to the cost of their treatment directly, a fifth attribute was added: out-of-pocket cost. A mixed logit panel model was used to estimate patients' preferences. Results: In total, 1124 patients completed the experiment, with a sample of between 98 and 257 patients per country. In all countries, patients preferred treatment with higher effectiveness, and 6-monthly subcutaneous injection was always preferred over weekly oral tablets. In five countries, patients also preferred a monthly oral tablet and yearly i.v. injections over weekly oral tablets. In the three countries where the out-of-pocket cost was included as an attribute, lower costs significantly contributed to the treatment preference. Between countries, there were statistically significant differences for 13 out of 42 attribute/level interactions. Conclusion: We found statistically significant differences in patients' preferences for anti-osteoporosis medications between countries, especially for the mode of administration. Our findings emphasized that international treatment recommendations should allow for local adaptation, and that understanding individual preferences is important if we want to improve the quality of clinical care for patients with osteoporosis.
Objectives: To estimate the preferences of osteoporoticpatients for medication attributes, and analyse data from seven European countries. Methods: A discrete choice experiment was conducted in Belgium, France, Ireland, the Netherlands, Spain, Switzerland and the UK. Patients were asked to choose repeatedly between two hypothetical unlabelled drug treatments (and an opt-out option) that varied with respect to four attributes: efficacy in reducing the risk of fracture, type of potential common side effects, and mode and frequency of administration. In those countries in which patients contribute to the cost of their treatment directly, a fifth attribute was added: out-of-pocket cost. A mixed logit panel model was used to estimate patients' preferences. Results: In total, 1124 patients completed the experiment, with a sample of between 98 and 257 patients per country. In all countries, patients preferred treatment with higher effectiveness, and 6-monthly subcutaneous injection was always preferred over weekly oral tablets. In five countries, patients also preferred a monthly oral tablet and yearly i.v. injections over weekly oral tablets. In the three countries where the out-of-pocket cost was included as an attribute, lower costs significantly contributed to the treatment preference. Between countries, there were statistically significant differences for 13 out of 42 attribute/level interactions. Conclusion: We found statistically significant differences in patients' preferences for anti-osteoporosis medications between countries, especially for the mode of administration. Our findings emphasized that international treatment recommendations should allow for local adaptation, and that understanding individual preferences is important if we want to improve the quality of clinical care for patients with osteoporosis.
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