Janet M Y Cheung1,2, Delwyn J Bartlett3, Carol L Armour4,5, Bandana Saini6,3, Tracey-Lea Laba7. 1. Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Sydney, NSW, 2006, Australia. janet.cheung@sydney.edu.au. 2. CIRUS, Centre for Integrated Research and Understanding of Sleep, The Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia. janet.cheung@sydney.edu.au. 3. CIRUS, Centre for Integrated Research and Understanding of Sleep, The Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia. 4. Clinical Management Group, The Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia. 5. Sydney Local Health District, Sydney, NSW, Australia. 6. Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Sydney, NSW, 2006, Australia. 7. The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia.
Abstract
BACKGROUND: Despite the rapid development of effective treatments, both pharmacological and non-pharmacological, insomnia management remains suboptimal at the practice interface. Patient preferences play a critical role in influencing treatment outcomes. However, there is currently a mismatch between patient preferences and clinician recommendations, partly perpetuated by a limited understanding of the patients' decision-making process. OBJECTIVES: The aim of our study was to empirically quantify patient preferences for treatment attributes common to both pharmacological and non-pharmacological insomnia treatments. METHOD: An efficient dual-response discrete choice experiment was conducted to evaluate patient treatment preferences for managing insomnia. The sample included 205 patients with self-reported insomnia and an Insomnia Severity Index ≥ 14. Participants were presented with two unlabelled hypothetical scenarios with an opt-out option across 12 choice sets. Data were analyzed using a mixed multinomial logit model to investigate the influence of five attributes (i.e. time, onset of action, maintainability of improved sleep, length of treatment, and monthly cost) on treatment preferences. RESULTS: Treatments were preferentially viewed if they conferred long-term sleep benefits (p < 0.05); had an ongoing, as opposed to a predefined, duration of treatment course (p < 0.05); required some, as opposed to no, additional time commitment (p < 0.05); and had lower monthly out-of-pocket treatment costs (p < 0.001). However, treatment onset of action had no influence on preference. Age, help-seeking status, concession card status and fatigue severity significantly influenced treatment preference. CONCLUSION: Participants' prioritization of investing time in treatment and valuing the maintainability of therapeutic gains suggests a stronger inclination towards non-pharmacological treatment, defying current assumptions that patients prefer 'quick-fixes' for managing insomnia.
BACKGROUND: Despite the rapid development of effective treatments, both pharmacological and non-pharmacological, insomnia management remains suboptimal at the practice interface. Patient preferences play a critical role in influencing treatment outcomes. However, there is currently a mismatch between patient preferences and clinician recommendations, partly perpetuated by a limited understanding of the patients' decision-making process. OBJECTIVES: The aim of our study was to empirically quantify patient preferences for treatment attributes common to both pharmacological and non-pharmacological insomnia treatments. METHOD: An efficient dual-response discrete choice experiment was conducted to evaluate patient treatment preferences for managing insomnia. The sample included 205 patients with self-reported insomnia and an Insomnia Severity Index ≥ 14. Participants were presented with two unlabelled hypothetical scenarios with an opt-out option across 12 choice sets. Data were analyzed using a mixed multinomial logit model to investigate the influence of five attributes (i.e. time, onset of action, maintainability of improved sleep, length of treatment, and monthly cost) on treatment preferences. RESULTS: Treatments were preferentially viewed if they conferred long-term sleep benefits (p < 0.05); had an ongoing, as opposed to a predefined, duration of treatment course (p < 0.05); required some, as opposed to no, additional time commitment (p < 0.05); and had lower monthly out-of-pocket treatment costs (p < 0.001). However, treatment onset of action had no influence on preference. Age, help-seeking status, concession card status and fatigue severity significantly influenced treatment preference. CONCLUSION:Participants' prioritization of investing time in treatment and valuing the maintainability of therapeutic gains suggests a stronger inclination towards non-pharmacological treatment, defying current assumptions that patients prefer 'quick-fixes' for managing insomnia.
Authors: Janet M Y Cheung; Kristina Atternäs; Madeleine Melchior; Nathaniel S Marshall; Romano A Fois; Bandana Saini Journal: Aust J Prim Health Date: 2014 Impact factor: 1.307
Authors: Christopher N Kaufmann; Adam P Spira; G Caleb Alexander; Lainie Rutkow; Ramin Mojtabai Journal: Pharmacoepidemiol Drug Saf Date: 2015-12-29 Impact factor: 2.890
Authors: Jack D Edinger; J Todd Arnedt; Suzanne M Bertisch; Colleen E Carney; John J Harrington; Kenneth L Lichstein; Michael J Sateia; Wendy M Troxel; Eric S Zhou; Uzma Kazmi; Jonathan L Heald; Jennifer L Martin Journal: J Clin Sleep Med Date: 2021-02-01 Impact factor: 4.062