Relative Influence of Factors Determining a Woman’s Preference for Treatment Options in Ovarian Cancer: A Discrete Choice Experiment

Abstract Abstract 4350 Background Patients with symptomatic relapsed follicular lymphoma, together with their physicians, must choose between a variety of treatment options, including conventional chemotherapy, radioimmunotherapy, and high-dose chemotherapy with subsequent autologous or allogeneic transplantation. These treatments vary with respect to effectiveness and tolerability. The purpose of this study was to elicit preference for the treatment options particular to relapsed follicular lymphoma and the attributes associated with the treatment options amongst patients in Alberta, and hematologists and medical oncologists in Canada who treat lymphoma, using a discrete choice experiment (DCE). Methods Background information and a questionnaire containing the DCE was mailed to 180 patients age 18 to 65 years and 252 hematologists and medical oncologists. The treatment attributes chosen for the DCE included: administration protocol, toxicity, average remission length and cost. For administration protocol and toxicity, there were 4 categorical levels describing the varying scenarios for standard chemotherapy (CT), radio-immunotherapy (RIT), high dose chemotherapy and autologous stem cell transplantation (AUTO), and allogeneic stem cell transplantation (ALLO). For average remission length, there were two numerical levels: 1 year (CT/RIT) and 5 years (AUTO/ALLO). For cost, four numerical levels were chosen to reflect current clinic/hospital expenditure: $5000 (CT), $25,000 (RIT), $50,000 (AUTO) and $150,000 (ALLO). A fractional factorial design was chosen to examine main effects and a fold-over technique was used to create multiple choice questions. In the series of multiple choice questions, respondents were asked to choose between two unlabeled treatment options, described according to the attributes where the attribute levels were different for each option. Descriptive statistics were applied to participant demographic and clinical data. The DCE was analyzed using a random effects logit model. Marginal rates of substitution calculated from regression coefficients provided information about preference for the treatment attributes. A post-estimation technique was used to predict uptake of the four treatment options. Results 81 patients (45%) and 48 physicians (19%) completed the questionnaire. Responding patients had a mean age of 54.7 years and were on average 4.4 years from initial diagnosis. 93% of patients received prior chemotherapy and 24% had received a prior stem cell transplant. 48% of patients had not yet relapsed and 33% were currently symptomatic. Physicians were predominantly hematologists (93%) who have been in practice on average for 12.2 years. 46% of physicians reported being in a practice that includes stem cell transplantation. Preferences of patients and physicians were similar. For all participants, remission length and the lesser toxicity of RIT compared with CT were found to be positive influences on choice (p<0.0001 and p=0.057, respectively). Negative influences on choice included toxicity of both AUTO and ALLO compared with CT (p=0.047 and p<0.0001, respectively), and cost (p<0.0001). Participants required a remission length of 0.6 years to accept the toxicity of AUTO but 3.9 years to accept the toxicity of ALLO. In relation to cost, participants thought it was acceptable for the health care system to pay $340, 000 per each 1 year increase in remission length. Post-estimation technique to evaluate distribution of preference for treatment options revealed that patients were most likely to choose AUTO (69%) and less likely to choose RIT (14%), CT (11%), and ALLO (7%). The distribution for physicians was similar: AUTO (56%), RIT (20%), CT (19%), and ALLO (4%). Conclusions This discrete choice experiment shows that patients with relapsed follicular lymphoma are able to consider the advantages and disadvantages of various treatment options, and appear to be willing to trade off the toxicity associated with autologous transplantation in order to benefit from increased remission length. Disclosures: Shafey: Glaxo-Smith-Kline: Research Funding. Stewart:Glaxo-Smith-Kline: Research Funding. Do:Roche: Honoraria; Sanofi-Aventis: Honoraria, Research Funding.

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Patient Preferences for Nonvitamin K Antagonist Oral Anticoagulants in Stroke Prevention: A Multicountry Discrete Choice Experiment

Cardiology Research and Practice ◽

10.1155/2019/5719624 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Thomas Wilke ◽

Anna-Katharina Meinecke ◽

Bernhard Schaefer ◽

Sandra Buchwald ◽

Daniel Eriksson ◽

...

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Oral Anticoagulants ◽

Treatment Options ◽

Once Daily ◽

The United Kingdom ◽

Dosing Regimens ◽

Logit Regression Model

Purpose. The patient’s perspective is becoming increasingly important in clinical and policy decisions. This study examined atrial fibrillation (AF) patient preferences for different characteristics of nonvitamin K antagonist oral anticoagulants (NOACs). Methods. A discrete choice experiment (DCE) addressing AF patients treated with NOACs in France, Germany, and the United Kingdom was conducted. The DCE included the following attributes: frequency of administration (once/twice daily), size of tablet/capsule (6–9 mm/20 mm), meal-related intake (intake with food required/independent), and distance to treating physician (1 km/10 km). Preferences were analyzed based on a conditional logit regression model. Results. In total, 758 patients (males: 57.3%; mean age: 71.4 years) with an average disease duration of 5.5 years were included (apixaban/dabigatran/edoxaban/rivaroxaban: 34.0%/14.5%/6.6%/44.9%, respectively). Patients preferred NOAC treatment options characterized by once-daily dosing regimens (42.8%; p<0.001), shorter distance to treating physicians (25.0%; p<0.001), a small-sized tablet (21.5%; p<0.001), and intake independent of food (10.6%; p<0.001). Conclusions. Patients primarily prefer a once-daily NOAC regimen. Individual preferences should be considered for the treatment of AF patients as this may result in improved treatment adherence and consequently better effectiveness and safety in routine clinical practice.

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Preferences of patients and physicians concerning treatment options for relapsed follicular lymphoma: a discrete choice experiment

Bone Marrow Transplantation ◽

10.1038/bmt.2010.225 ◽

2010 ◽

Vol 46 (7) ◽

pp. 962-969 ◽

Cited By ~ 16

Author(s):

M Shafey ◽

S M Lupichuk ◽

T Do ◽

C Owen ◽

D A Stewart

Keyword(s):

Follicular Lymphoma ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Treatment Options

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Metastatic prostate cancer men’s attitudes towards treatment of the local tumour and metastasis evaluative research (IP5-MATTER): protocol for a prospective, multicentre discrete choice experiment study

BMJ Open ◽

10.1136/bmjopen-2021-048996 ◽

2021 ◽

Vol 11 (11) ◽

pp. e048996

Author(s):

Martin John Connor ◽

Mesfin G Genie ◽

Michael Gonzalez ◽

Naveed Sarwar ◽

Kamalram Thippu Jayaprakash ◽

...

Keyword(s):

Prostate Cancer ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Systemic Therapy ◽

Choice Experiment ◽

Service Providers ◽

De Novo ◽

Treatment Options ◽

Trade Offs ◽

Stereotactic Ablative Body Radiotherapy

IntroductionSystemic therapy with androgen deprivation therapy (ADT) and intensification with agents such as docetaxel, abiraterone acetate and enzalutamide has resulted in improved overall survival in men with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC). Novel local cytoreductive treatments and metastasis-directed therapy are now being evaluated. Such interventions may provide added survival benefit or delay the requirement for further systemic agents and associated toxicity but can confer additional harm. Understanding men’s preferences for treatment options in this disease state is crucial for patients, clinicians, carers and future healthcare service providers.MethodsUsing a prospective, multicentre discrete choice experiment (DCE), we aim to determine the attributes associated with treatment that are most important to men with mHSPC. Furthermore, we plan to determine men’s preferences for, and trade-offs between, the attributes (survival and side effects) of different treatment options including systemic therapy, local cytoreductive approaches (external beam radiotherapy, cytoreductive radical prostatectomy or minimally invasive ablative therapy) and metastases-directed therapies (metastasectomy or stereotactic ablative body radiotherapy). All men with newly diagnosed mHSPC within 4 months of commencing ADT and WHO performance status 0–2 are eligible. Men who have previously consented to a cytoreductive treatment or have developed castrate-resistant disease will be excluded. This study includes a qualitative analysis component, with patients (n=15) and healthcare professionals (n=5), to identify and define the key attributes associated with treatment options that would warrant trade-off evaluation in a DCE. The main phase component planned recruitment is 300 patients over 1 year, commencing in January 2021, with planned study completion in March 2022.Ethics and disseminationEthical approval was obtained from the Health Research Authority East of England, Cambridgeshire and Hertfordshire Research Ethics Committee (Reference: 20/EE/0194). Project information will be reported on the publicly available Imperial College London website and the Heath Economics Research Unit (HERU website including the HERU Blog). We will use the social media accounts of IP5-MATTER, Imperial Prostate London, HERU and the individual researchers to disseminate key findings following publication. Findings from the study will be presented at national/international conferences and peer-reviewed journals. Authorship policy will follow the recommendations of the International Committee of Medical Journal Editors.Trial registration numberNCT04590976.

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Patients’ and clinicians’ preferences for treatment for Graves’ disease: A discrete choice experiment

Acta Endocrinologica ◽

10.1530/eje-20-1490 ◽

2021 ◽

Author(s):

Caroline M.j. van Kinschot ◽

Vikas R. Soekhai ◽

Esther W. de Bekker-Grob ◽

W. Edward Visser ◽

Robin P. Peeters ◽

...

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Important Determinant ◽

Remission Rate ◽

Treatment Options ◽

Treatment Choice ◽

Preference Heterogeneity ◽

Antithyroid Drugs ◽

Graves Disease

Objective: Treatment options for Graves’ disease (GD) consist of antithyroid drugs (ATD), radioactive iodine (RAI) and total thyroidectomy (TT). Guidelines recommend to discuss these options with patients, taking into account patients’ preferences. This study aims to evaluate and compare patients’ and clinicians’ preferences and the trade-offs made in choosing treatment. Design and methods: A discrete choice experiment (DCE) was performed with GD patients with a first diagnosis or recurrence in the previous year, and with clinicians. Participants were offered hypothetical treatment options which differed in type of treatment, rates of remission, severe side effects, permanent voice changes and hypocalcemia. Preference heterogeneity was assessed by latent-class analysis. Results: 286 (82%) patients and 61 (18%) clinicians participated in the DCE. All treatment characteristics had a significant effect on treatment choice (p<0.05). Remission rate was the most important determinant and explained 37% and 35% of choices in patients and clinicians, respectively. Both patients and clinicians preferred ATD over surgery and RAI. A strong negative preference towards RAI treatment was observed in a subclass of patients, whereas clinicians preferred RAI over surgery. Conclusion: In both patients and clinicians, remission rate was the most important determinant of treatment choice and ATD was the most preferred treatment option. Patients had a negative preference towards RAI compared to alternatives, whereas clinicians preferred RAI over surgery. Clinicians should be aware that their personal attitude towards RAI differs from their patients. This study on patients’ and clinicians’ preferences can support shared decision making and thereby improve clinical treatment.

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PMD180 - THE VALUE TO WOMEN WITH OVARIAN CANCER OF GENE VARIANTS WITH KNOWN AND UNKNOWN SIGNIFICANCE: A DISCRETE CHOICE EXPERIMENT

Value in Health ◽

10.1016/j.jval.2018.09.1629 ◽

2018 ◽

Vol 21 ◽

pp. S274

Author(s):

B.A. Davidson ◽

J. Ehrisman ◽

S.D. Reed ◽

J. Yang ◽

F.R. Johnson ◽

...

Keyword(s):

Ovarian Cancer ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Gene Variants ◽

Unknown Significance

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Using Nominal Group Technique to Identify Key Attributes of Oncology Treatments for a Discrete Choice Experiment

MDM Policy & Practice ◽

10.1177/2381468319837925 ◽

2019 ◽

Vol 4 (1) ◽

pp. 238146831983792

Author(s):

Camilla Somers ◽

Susan Chimonas ◽

Emma McIntosh ◽

Anna Kaltenboeck ◽

Andrew Briggs ◽

...

Keyword(s):

Focus Groups ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Treatment Options ◽

Nominal Group Technique ◽

Nominal Group ◽

Health Gains ◽

Multiple Value ◽

Group Technique

Background. Responding to rising oncology therapy costs, multiple value frameworks are emerging. However, input from economists in their design and conceptualization has been limited, and no existing framework has been developed using preference weightings as legitimate indicators of value. This article outlines use of the nominal group technique to identify valued treatment attributes (such as treatment inconvenience) and contextual considerations (such as current life expectancy) to inform the design of a discrete choice experiment to develop a preference weighted value framework for future decision makers. Methods. Three focus groups were conducted in 2017 with cancer patients, oncology physicians, and nurses. Using the nominal group technique, participants identified and prioritized cancer therapy treatment and delivery attributes as well as contextual issues considered when choosing treatment options. Results. Focus groups with patients ( n = 8), physicians ( n = 6), and nurses ( n = 10) identified 30 treatment attributes and contextual considerations. Therapy health gains was the first priority across all groups. Treatment burden/inconvenience to patients and their families and quality of evidence were prioritized treatment attributes alongside preferences for resource use and cost (to patients and society) attributes. The groups also demonstrated that contextual considerations when choosing treatment varied across the stakeholders. Patients prioritized existence of alternative treatments and oncologist/center reputation while nurses focused on administration harms, communication, and treatment innovation. The physicians did not prioritize any contextual issues in their top rankings. Conclusions. The study demonstrates that beyond health gains, there are treatment attributes and contextual considerations that are highly prioritized across stakeholder groups. These represent important candidates for inclusion in a discrete choice experiment seeking to provide weighted preferences for a value framework for oncology treatment that goes beyond health outcomes.

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