Comparing Analytic Hierarchy Process and Discrete-Choice Experiment to Elicit Patient Preferences for Treatment Characteristics in Age-Related Macular Degeneration

ZusammenfassungVerfahren der multikriteriellen Entscheidungsanalyse erlauben die Bewertung und Saldierung von Nutzen und Schaden unter der Berücksichtigung von Präferenzen. Im Gesundheitswesen können beispielsweise die Patienten- oder Expertenpräferenzen in Bezug auf verschiedene Nutzen-, Schaden- oder Anwendungsaspekte einer Gesundheitstechnologie im Entscheidungsprozess berücksichtigt werden. Mögliche Ansätze zur Abwägung von Nutzen und Schaden einer Gesundheitstechnologie bieten Methoden wie der Analytic Hierarchy Process oder das Discrete Choice Experiment. Diese und andere Methoden erlauben den Vergleich einzelner Alternativen auf Basis des Gesamtnutzens. Dabei werden verschiedenen Zielkriterien numerische Teilnutzenwerte zugewiesen, welche in ein Gesamtmaß des Nutzens überführt werden, um so den direkten Vergleich der unterschiedlichen Handlungsoptionen zu ermöglichen.

Download Full-text

Patient and retina specialists’ preferences in neovascular age-related macular degeneration treatment. A discrete choice experiment

PLoS ONE ◽

10.1371/journal.pone.0261955 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261955

Author(s):

Roberto Gallego-Pinazo ◽

Begoña Pina-Marin ◽

Marta Comellas ◽

Susana Aceituno ◽

Laia Gómez-Baldó ◽

...

Keyword(s):

Macular Degeneration ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Visual Function ◽

Choice Experiment ◽

Age Related Macular Degeneration ◽

Monitoring Frequency ◽

Anti Vegf ◽

Treatment Characteristics ◽

Age Related

Introduction and objective Neovascular age-related macular degeneration (nAMD) leads to severe and permanent visual impairment, significantly impacting patients’ quality of life and functional independence. Although treatment with anti- vascular endothelial growth factor (VEGF) prevents and, in some cases, reverses visual damage, the need for frequent monitoring visits and intravitreal injections represents a significant burden on patients, caregivers and retina specialists. Objective To elicit preferences for nAMD treatment characteristics from the perspectives of patients and retina specialists. Method A discrete choice experiment was conducted. Participants (patients > 50 years with nAMD receiving anti-VEGF drugs for at least 2 years and without previous experience with anti-VEGF and retina specialists working in the Spanish National Healthcare System) were asked to select one of two hypothetical treatments resulting from the combination of five attributes (effects on visual function, effects on retinal fluid, treatment regimen, monitoring frequency, and cost); their levels were identified by reviewing the literature and two focus groups. The relative importance (RI) given to each attribute was estimated using a mixed logit model. The marginal rates of substitution (MRS) were calculated taking cost as the risk attribute. Results A total of 110 patients (P) [aged 79.0 (SD:7.4) years; 57.3% women; 2.3 (SD:0.7) years with nAMD; 2.1 years (SD:0.1) in treatment] and 66 retina specialists (RS) participated in the study. Participants gave greater RI to improvements in their visual function [60.0% (P); 52.7% (RS)], lower monitoring frequency [20.2% (P); 27.1% (RS)] and reduction in retinal fluid [9.8% (P); 13.0%(RS)]. Patients and retina specialists would agree to an increase in cost by 65.0% and 56.5%, respectively, in exchange for improvements of visual function; and 25.5% and 43.3% on delaying monitoring frequency by one month. Conclusions Efficacy of treatment, in terms of visual function improvements, is the main driver for treatment election for both patients and retina specialists. Treatment monitoring requirements are also considered, mainly from the retina specialist’s perspective. These results suggest that the use of more efficacious anti-VEGF agents with a longer duration of action may contribute to aligning treatment characteristics with patients/specialists’ preferences. A better alignment would facilitate better disease management, fulfilling the unmet needs of patients and retina specialists.

Download Full-text

Patient Preferences for Anti-Vascular Endothelial Growth Factor Treatment for Wet Age-Related Macular Degeneration in Japan: A Discrete Choice Experiment

Patient Preference and Adherence ◽

10.2147/ppa.s228890 ◽

2020 ◽

Vol Volume 14 ◽

pp. 553-567 ◽

Cited By ~ 1

Author(s):

Takeshi Joko ◽

Yoshimi Nagai ◽

Ryusaburo Mori ◽

Koji Tanaka ◽

Yuji Oshima ◽

...

Keyword(s):

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Age Related Macular Degeneration ◽

Vascular Endothelial ◽

Age Related ◽

Endothelial Growth Factor ◽

Growth Factor Treatment

Download Full-text

Patients Preferences for Long-Term Treatment After Acute Coronary Syndrome: A Discrete-Choice Experiment and Analytic Hierarchy Process

Value in Health ◽

10.1016/j.jval.2013.08.1329 ◽

2013 ◽

Vol 16 (7) ◽

pp. A534

Author(s):

A.C. Mühlbacher ◽

S. Bethge ◽

A. Kaczynski ◽

C. Juhnke

Keyword(s):

Acute Coronary Syndrome ◽

Analytic Hierarchy Process ◽

Discrete Choice ◽

Choice Experiment ◽

Term Treatment ◽

Analytic Hierarchy ◽

Coronary Syndrome ◽

Long Term Treatment ◽

Hierarchy Process

Download Full-text

Patient preferences for specialist outpatient video consultations: A discrete choice experiment

Journal of Telemedicine and Telecare ◽

10.1177/1357633x211022898 ◽

2021 ◽

pp. 1357633X2110228

Author(s):

Centaine L Snoswell ◽

Anthony C Smith ◽

Matthew Page ◽

Liam J Caffery

Keyword(s):

General Practitioner ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Healthcare Delivery ◽

General Practitioner Practice ◽

Specialist Care ◽

Time Away ◽

Out Of Pocket Costs

Introduction Telehealth has been shown to improve access to care, reduce personal expenses and reduce the need for travel. Despite these benefits, patients may be less inclined to seek a telehealth service, if they consider it inferior to an in-person encounter. The aims of this study were to identify patient preferences for attributes of a healthcare service and to quantify the value of these attributes. Methods We surveyed patients who had taken an outpatient telehealth consult in the previous year using a survey that included a discrete choice experiment. We investigated patient preferences for attributes of healthcare delivery and their willingness to pay for out-of-pocket costs. Results Patients ( n = 62) preferred to have a consultation, regardless of type, than no consultation at all. Patients preferred healthcare services with lower out-of-pocket costs, higher levels of perceived benefit and less time away from usual activities ( p < 0.008). Most patients preferred specialist care over in-person general practitioner care. Their order of preference to obtain specialist care was a videoconsultation into the patient’s local general practitioner practice or hospital ( p < 0.003), a videoconsultation into the home, and finally travelling for in-person appointment. Patients were willing to pay out-of-pocket costs for attributes they valued: to be seen by a specialist over videoconference ($129) and to reduce time away from usual activities ($160). Conclusion Patients value specialist care, lower out-of-pocket costs and less time away from usual activities. Telehealth is more likely than in-person care to cater to these preferences in many instances.

Download Full-text

Patient preferences for use of virtual consultations in an orthopaedic rehabilitation setting: Results from a discrete choice experiment

Journal of Health Services Research & Policy ◽

10.1177/13558196211035427 ◽

2021 ◽

pp. 135581962110354

Author(s):

Anthony W Gilbert ◽

Emmanouil Mentzakis ◽

Carl R May ◽

Maria Stokes ◽

Jeremy Jones

Keyword(s):

Conceptual Model ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Best Practice ◽

Time Of Day ◽

Problem Area ◽

Fractional Factorial ◽

The Impact

Objective Virtual Consultations may reduce the need for face-to-face outpatient appointments, thereby potentially reducing the cost and time involved in delivering health care. This study reports a discrete choice experiment (DCE) that identifies factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting. Methods Previous research from the CONNECT (Care in Orthopaedics, burdeN of treatmeNt and the Effect of Communication Technology) Project and best practice guidance informed the development of our DCE. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. The design was divided into two blocks of eight scenarios each, to reduce the impact of cognitive fatigue. Data analysis were conducted using binary logit regression models. Results Sixty-one paired response sets (122 subjects) were available for analysis. DCE factors (whether the therapist is known to the patient, duration of appointment, time of day) and demographic factors (patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs) were significant predictors of preference. We estimate that a patient is less than 1% likely to prefer a virtual consultation if the patient has a degree, is without access to the equipment and software to undertake a virtual consultation, does not have difficulties with day-to-day activities, is undergoing rehabilitation for one problem area, has to pay less than £5 to travel, is having a consultation with a therapist not known to them, in 1 weeks’ time, lasting 60 minutes, at 2 pm. We have developed a simple conceptual model to explain how these factors interact to inform preference, including patients’ access to resources, context for the consultation and the requirements of the consultation. Conclusions This conceptual model provides the framework to focus attention towards factors that might influence patient preference for virtual consultations. Our model can inform the development of future technologies, trials, and qualitative work to further explore the mechanisms that influence preference.

Download Full-text