Jan Ostermann1, Axel Mühlbacher2, Derek S Brown3, Dean A Regier4, Amy Hobbie5, Andrew Weinhold5, Noor Alshareef1, Caroline Derrick6, Nathan M Thielman7. 1. Department of Health Services, Policy and Management, University of South Carolina, Columbia, SC, USA. 2. Institute of Health Economics and Healthcare Management, Hochschule Neubrandenburg, Neubrandenburg, Germany. 3. Brown School, Washington University in St. Louis, St. Louis, MO, USA. 4. Cancer Research Centre, University of British Columbia, Vancouver, BC, Canada. 5. Duke Global Health Institute, Duke University, Durham, NC, USA. 6. Department of Medicine, University of South Carolina, Columbia, SC, USA. 7. Duke Global Health Institute, Duke University, Durham, NC, USA. Electronic address: n.thielman@duke.edu.
Abstract
OBJECTIVE: Limited data describe patient preferences for the growing number of antiretroviral therapies (ARTs). We quantified preferences for key characteristics of modern ART deemed relevant to shared decision making. METHODS: A discrete choice experiment survey elicited preferences for ART characteristics, including dosing (frequency and number of pills), administration characteristics (pill size and meal requirement), most bothersome side effect (from diarrhea, sleep disturbance, headaches, dizziness/difficulty thinking, depression, or jaundice), and most bothersome long-term effect (from increased risk of heart attacks, bone fractures, renal dysfunction, hypercholesterolemia, or hyperglycemia). Between March and August 2017, the discrete choice experiment was fielded to 403 treatment-experienced persons living with human immunodeficiency virus (HIV), enrolled from 2 infectious diseases clinics in the southern United States and a national online panel. Participants completed 16 choice tasks, each comparing 3 treatment options. Preferences were analyzed using mixed and latent class logit models. RESULTS: Most participants were male (68%) and older (interquartile range: 42-58 years), and had substantial treatment experience (interquartile range: 7-21 years). In mixed logit analyses, all attributes were associated with preferences. Side and long-term effects were most important, with evidence of substantial preference heterogeneity. Latent class analysis identified 5 preference classes. For classes 1 (40%), 2 (24%), and 3 (21%), side effects were most important, followed by long-term effects. For class 4 (10%), dosing was most important. Class 5 (4%) was largely indifferent to ART characteristics. CONCLUSION: Overall, treatment-experienced persons living with HIV valued minimizing side effects and long-term toxicities over dosing and administration characteristics. Preferences varied widely, highlighting the need to elicit individual patient preferences in models of shared antiretroviral decision making.
OBJECTIVE: Limited data describe patient preferences for the growing number of antiretroviral therapies (ARTs). We quantified preferences for key characteristics of modern ART deemed relevant to shared decision making. METHODS: A discrete choice experiment survey elicited preferences for ART characteristics, including dosing (frequency and number of pills), administration characteristics (pill size and meal requirement), most bothersome side effect (from diarrhea, sleep disturbance, headaches, dizziness/difficulty thinking, depression, or jaundice), and most bothersome long-term effect (from increased risk of heart attacks, bone fractures, renal dysfunction, hypercholesterolemia, or hyperglycemia). Between March and August 2017, the discrete choice experiment was fielded to 403 treatment-experienced persons living with human immunodeficiency virus (HIV), enrolled from 2 infectious diseases clinics in the southern United States and a national online panel. Participants completed 16 choice tasks, each comparing 3 treatment options. Preferences were analyzed using mixed and latent class logit models. RESULTS: Most participants were male (68%) and older (interquartile range: 42-58 years), and had substantial treatment experience (interquartile range: 7-21 years). In mixed logit analyses, all attributes were associated with preferences. Side and long-term effects were most important, with evidence of substantial preference heterogeneity. Latent class analysis identified 5 preference classes. For classes 1 (40%), 2 (24%), and 3 (21%), side effects were most important, followed by long-term effects. For class 4 (10%), dosing was most important. Class 5 (4%) was largely indifferent to ART characteristics. CONCLUSION: Overall, treatment-experienced persons living with HIV valued minimizing side effects and long-term toxicities over dosing and administration characteristics. Preferences varied widely, highlighting the need to elicit individual patient preferences in models of shared antiretroviral decision making.
Authors: Jan Ostermann; Brian P Flaherty; Derek S Brown; Bernard Njau; Amy M Hobbie; Tara B Mtuy; Max Masnick; Axel C Mühlbacher; Nathan M Thielman Journal: J Choice Model Date: 2021-07-11
Authors: Jan Ostermann; Bernard Njau; Amy Hobbie; Tara Mtuy; Martha L Masaki; Aisa Shayo; Marco van Zwetselaar; Max Masnick; Brian Flaherty; Derek S Brown; Axel C Mühlbacher; Nathan M Thielman Journal: BMJ Open Date: 2020-11-06 Impact factor: 2.692