MO561PREFERENCES OF DIALYSIS-DEPENDENT PATIENTS FOR TREATMENT OF ANAEMIA OF CHRONIC KIDNEY DISEASE IN AUSTRALIA AND CANADA: A DISCRETE CHOICE EXPERIMENT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Simon Fifer ◽  
Bronwyn West ◽  
Juan Jose Garcia Sanchez ◽  
Eric Wittbrodt ◽  
Purav Bhatt ◽  
...  
Keyword(s):  
Side Effects ◽  
Discrete Choice ◽  
Heart Attack ◽  
Choice Experiment ◽  
Ldl Cholesterol ◽  
Rescue Therapy ◽  
Treatment Options ◽  
Current Treatment ◽  
Opt Out ◽  
The Cost

Abstract Background and Aims Anaemia is a common complication of chronic kidney disease (CKD) and is associated with reduced quality of life, cardiovascular complications, early mortality and a high economic burden for patients. Current treatment options for anaemia of CKD include subcutaneous (SC) or intravenous (IV) erythropoiesis-stimulating agents (ESAs) with or without supplementary iron and blood transfusions. New oral therapies for anaemia, such as hypoxia-inducible factor prolyl hydroxylase inhibitors, are in development and may have advantages for patients compared with ESAs. It is therefore crucial to understand the treatment attributes that patients consider most important. This study aimed to investigate patient preferences for potential anaemia of CKD treatments in adults with dialysis-dependent (DD) CKD in Australia and Canada. Method Adult patients with DD CKD completed a discrete choice experiment (DCE) online survey. In each scenario, patients were asked to choose between three hypothetical treatment alternatives (‘oral pill’, ‘subcutaneous injection’ and ‘intravenous injection’) with differing levels of attributes and an opt-out option (none of these treatments/current treatment) to treat anaemia of CKD. Treatment attributes focused on administration (where, how often and by whom), purchasing (where it is collected and the cost per month), additional benefits (e.g. whether it reduces ‘bad’/LDL cholesterol), side effects (chance of hospitalization from a heart attack or stroke due to the medicine) and the need for rescue therapy (IV iron or blood transfusion). The attributes and their levels were derived from existing market research, the literature and expert opinion. A mixed multinomial logit model, which allows for preference heterogeneity, was used to quantify the overall value of such treatments and the relative importance of each of the defining attributes. Australian patients were divided into those who were eligible for reduced prescription charges under the Pharmaceutical Benefits Scheme, such as the elderly or those on low incomes (referred to as concessions), and those who were not (general patients). Prescription charge concessions did not apply for Canadian patients. Results This preliminary analysis included 61 patients with DD CKD from Australia (n = 22) and Canada (n = 39). The majority of patients were receiving haemodialysis (Australia, 72.7%; Canada, 61.5%), and more than half received their dialysis in a clinic or hospital (Australia, 54.5%; Canada, 76.9%); 50% of the Australian patients were concessions. In both countries, patients were likely to choose a new treatment alternative over the opt-out, with the greatest preference for oral treatment among Australian general and Canadian patients, all else being equal. For Australian concession patients, cost per month was the most important attribute across all treatment options; the risk of side effects (i.e. hospitalization from a heart attack or stroke) was the second most important attribute, with patients preferring treatments with the lowest possible risk. For Australian general and Canadian patients, the risk of side effects and the cost per month were the two most important attributes, and had similar levels of importance. Patients in both countries were also concerned about the risk of needing rescue therapy, and valued reductions in the amount of ‘bad’/LDL cholesterol. Conclusion Results from this DCE study showed that the risk of side effects and the costs of treatment are the most important attributes for hypothetical anaemia of CKD treatment for patients with DD CKD. Australian general and Canadian patients showed a preference for oral therapy over SC or IV injection, all other factors being equal. These findings may help to guide clinicians when selecting treatments for anaemia of CKD for their patients, and may provide useful information when assessing the value of new or future treatments.

scholarly journals Understanding what women want: eliciting preference for delivery health facility in a rural subcounty in Kenya, a discrete choice experiment

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038865
Author(s):  
Jackline Oluoch-Aridi ◽  
Mary B Adam ◽  
Francis Wafula ◽  
Gilbert Kokwaro
Keyword(s):  
Quality Of Care ◽  
Health Facility ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Home Delivery ◽  
Process Indicator ◽  
Opt Out ◽  
Women’S Preferences

ObjectiveTo identify what women want in a delivery health facility and how they rank the attributes that influence the choice of a place of delivery.DesignA discrete choice experiment (DCE) was conducted to elicit rural women’s preferences for choice of delivery health facility. Data were analysed using a conditional logit model to evaluate the relative importance of the selected attributes. A mixed multinomial model evaluated how interactions with sociodemographic variables influence the choice of the selected attributes.SettingSix health facilities in a rural subcounty.ParticipantsWomen aged 18–49 years who had delivered within 6 weeks.Primary outcomeThe DCE required women to select from hypothetical health facility A or B or opt-out alternative.ResultsA total of 474 participants were sampled, 466 participants completed the survey (response rate 98%). The attribute with the strongest association with health facility preference was having a kind and supportive healthcare worker (β=1.184, p<0.001), second availability of medical equipment and drug supplies (β=1.073, p<0.001) and third quality of clinical services (β=0.826, p<0.001). Distance, availability of referral services and costs were ranked fourth, fifth and sixth, respectively (β=0.457, p<0.001; β=0.266, p<0.001; and β=0.000018, p<0.001). The opt-out alternative ranked last suggesting a disutility for home delivery (β=−0.849, p<0.001).ConclusionThe most highly valued attribute was a process indicator of quality of care followed by technical indicators. Policymakers need to consider women’s preferences to inform strategies that are person centred and lead to improvements in quality of care during delivery.

scholarly journals Duration of Treatment Effect Should Be Considered in the Design and Interpretation of Clinical Trials: Results of a Discrete Choice Experiment

2019 ◽  
Vol 39 (4) ◽  
pp. 461-473 ◽  
Author(s):  
Bethan Copsey ◽  
James Buchanan ◽  
Raymond Fitzpatrick ◽  
Sarah E. Lamb ◽  
Susan J. Dutton ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Disease Severity ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Treatment Effect ◽  
Heart Attack ◽  
Choice Experiment ◽  
Ulcer Bleeding ◽  
Duration Of Treatment ◽  
Duration Of Effect

Objective. This study examined whether duration of treatment effect should be considered in a benefit-risk assessment using a case study of osteoarthritis medications. Study Design and Setting. A discrete choice experiment was completed by 300 residents of the United Kingdom with hip and/or knee osteoarthritis. In 16 choice tasks, participants selected their preferred option from 2 medications. Medications were described in terms of effect on pain, stiffness, and function; duration of treatment effect; and risk of heart attack and stomach ulcer bleeding. The analysis used mixed-effects logistic regression. Results. Pain, disease severity, and duration of treatment effect had the greatest influence on medication preferences, whereas stiffness did not significantly affect medication choice. Participants were willing to accept an increase in the risk of heart attack of 2.6% (95% confidence interval: 2.0% to 3.2%) to increase the duration of treatment effect from 1 month to 12 months. Reducing pain from moderate to mild was valued the same as increasing duration of effect from 1 month to 3 months; both were seen as equivalent to an absolute reduction of 1.2% in the risk of heart attack in the next year. Subgroup analysis suggested disease severity influenced patient preferences. Conclusions. Along with treatment benefits and risks, the results suggest that duration of treatment effect is an important factor in the medication choices of people with osteoarthritis. This could have implications for the design and interpretation of clinical trials, for example, incorporating longer-term surveillance of trial participants and accounting for duration of treatment effect in risk-benefit assessments. Future research is needed to assess whether these findings are generalizable to other samples, disease areas, and levels of duration of effect.

scholarly journals IV Paracetamol for closure of patent ductus arteriosus in preterm neonates admitted to a tertiary care centre

2018 ◽  
Vol 5 (2) ◽  
pp. 294 ◽  
Author(s):  
Sunil B. ◽  
Shruthi Patel ◽  
Girish N.
Keyword(s):  
Side Effects ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Treatment Options ◽  
Tertiary Care ◽  
Current Treatment ◽  
Preterm Neonates ◽  
Tertiary Care Centre ◽  
Vascular Connection ◽  
Intravenous Paracetamol

Background: Ductus arteriosus is a vascular connection between the pulmonary artery and descending aorta. The incidence is inversely related to birth weight and gestational age (GA). In preterm infants it varies between 40% and 60% on the third day of life. At present, the choice of treatment of clinically significant PDA is with either ibuprofen or indomethacin, but they carry many contraindications and potential side effects. Hence it is important to consider that paracetamol may be used as an alternative to other non steroidal anti-inflammatory drugs and is effective in ductal closure with minimal side effects.Methods:Thirty six preterm infants with hemodynamically significant PDA(hs-PDA) were treated with intravenous paracetamol and subsequent closure was evaluated clinically and by follow-up 2D-Echo.Results: PDA closure following intravenous paracetamol was evident in 27 babies (75%). There were no significant side effects noted with paracetamol therapy.Conclusions: This study shows that paracetamol could offer favourable safety profile in comparison to current treatment options. Therefore, paracetamol may be accepted as a first-line drug treatment for PDA in preterm infants. 

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

2014 ◽  
Vol 17 (3) ◽  
pp. A93
Author(s):  
L.J. Havrilesky ◽  
A.A. Secord ◽  
J. Ehrisman ◽  
A. Berchuck ◽  
F.A. Valea ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Treatment Options ◽  
Relative Influence

scholarly journals Optimizing the Design of a Contraceptive Microarray Patch: A Discrete Choice Experiment on Women’s Preferences in India and Nigeria

2020 ◽  
Author(s):  
Rebecca L. Callahan ◽  
Aurélie Brunie ◽  
Victoria Lebrun ◽  
Mario Chen ◽  
Christine L. Godwin ◽  
...  
Keyword(s):  
Side Effects ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Hierarchical Bayes ◽  
New Delhi ◽  
Pain Location ◽  
Optimal Product Design ◽  
Women’S Preferences ◽  
Ibadan Nigeria

Abstract Background: Efforts are underway to develop an easy-to-use contraceptive microarray patch (MAP) that could expand the range of self-administrable methods. This paper presents results from a discrete choice experiment (DCE) designed to support optimal product design.Methods: We conducted a DCE survey of users and non-users of contraception in New Delhi, India (496 women) and Ibadan, Nigeria (two versions with 530 and 416 women, respectively) to assess stated preferences for up to six potential product attributes: effect on menstruation, duration of effectiveness, application pain, location, rash after application, and patch size. We estimated Hierarchical Bayes coefficients (utilities) for each attribute level and ran simulations comparing women’s preferences for hypothetical MAPs with varying attribute combinations.Results: The most important attributes of the MAP were potential for menstrual side effects (55% of preferences in India and 42% in Nigeria) and duration (13% of preferences in India and 24% in Nigeria). Women preferred a regular period over an irregular or no period, and a six-month duration to three or one month. Simulations show that the most ideal design would be a small patch, providing 6 months of protection, that would involve no pain on administration, result in a one-day rash, and be applied to the foot. Conclusions: To the extent possible, MAP developers should consider method designs and formulations that limit menstrual side effects and provide more than one month of protection.

scholarly journals Preferences based interventions to address the use of antibiotics without prescription: a discrete choice experiment

2021 ◽  
Vol 19 (3) ◽  
pp. 2401
Author(s):  
Johanna Aponte-González ◽  
Paul Brown ◽  
Javier Eslava-Schmalbach
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Antibiotic Use ◽  
Self Medication ◽  
Inappropriate Use ◽  
Patients At Risk ◽  
Potential Risks ◽  
The Cost ◽  
Attention Level

Background: In many countries, concerns have arisen over the population using antibiotics without consulting a physician. This practice can place patients at risk and increase antibiotic resistance in the community. Objective: To evaluate individuals' preferences regarding the use of antibiotics. The study also assessed the likely effectiveness of interventions aimed at reducing inappropriate use of antibiotics. Methods: A discrete choice experiment (DCE) was conducted in Bogotá, Colombia. The attributes were determined by a systematic literature review and four focus group sessions. The DCE included nine factors – cost, time to get attention, level of symptoms, efficacy, safety, among others- and one label -using or not antibiotics. Data analysis was carried out using a generalized multinomial logit (GMNL) model. Marginal probabilities of different sets of attributes' levels were compared to estimate the likely effectiveness of interventions. Results: The survey was administered to 222 participants from diverse socioeconomic backgrounds. The results suggest that participants preferred not taking antibiotics and having a physician as an advisor, but the probability of inappropriate antibiotic use increased as the waiting time or the cost of receiving advice rose. The pharmacy was the preferred source of antibiotics, and participants chose the pharmacy worker (nonprofessional) as an advisor over the nurse on the phone. In the absence of any interventions aimed at reducing the use of antibiotics, approximately 47.3% of people would misuse antibiotics. This reduces to 26.5% when people perceive the efficacy of the antibiotics as low and the potential risks of self-medicating as high. An alternative model using a nursing service would likely lower inappropriate use of antibiotics. Conclusions: Even though people prefer not using antibiotics or visiting a physician in case of disease rather than self-medicating, current access conditions might discourage them from appropriately use antibiotics. The results suggest that interventions that informing people about the risks of self-medication and the low efficacy might significantly reduce inappropriate use of antibiotics. Our results also suggest that programs that empower other health professionals to provide access to antibiotics would likely further lower inappropriate use.

Preference of Patients and Physicians Concerning Treatment Options for Relapsed Follicular Lymphoma: A Discrete Choice Experiment.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4350-4350
Author(s):  
Mona Shafey ◽  
Douglas A. Stewart ◽  
Thuan Do ◽  
Sasha Lupichuk
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Follicular Lymphoma ◽  
Cell Transplantation ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Research Funding ◽  
Treatment Options ◽  
High Dose

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.

Individual-level determinants of waterpipe smoking demand in four Eastern-Mediterranean countries

2018 ◽  
Vol 34 (6) ◽  
pp. 1157-1166 ◽  
Author(s):  
Ramzi G Salloum ◽  
Rima Nakkash ◽  
Niveen M E Abu-Rmeileh ◽  
Randah R Hamadeh ◽  
Muhammad W Darawad ◽  
...  
Keyword(s):  
Young Adult ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Eastern Mediterranean ◽  
Waterpipe Smoking ◽  
Individual Level ◽  
Nicotine Content ◽  
Mediterranean Countries ◽  
Opt Out

Abstract The prevalence of waterpipe tobacco smoking in the Eastern Mediterranean Region is at alarmingly high levels, especially among young people. The objective of this research was to evaluate the preferences of young adult waterpipe smokers with respect to potential individual-level determinants of waterpipe smoking using discrete choice experiment methodology. Participants were young adult university students (18–29 years) who were ever waterpipe smokers, recruited from universities across four Eastern Mediterranean countries: Jordan, Oman, Palestine and the United Arab Emirates. The Internet-based discrete choice experiment, with 6 × 3 × 2 block design, evaluated preferences for choices of waterpipe smoking sessions, presented on hypothetical waterpipe café menus. Participants evaluated nine choice sets, each with five fruit-flavored options, a tobacco flavored option (non-flavored), and an opt-out option. Choices also varied based on nicotine content (0.0% vs. 0.05% vs. 0.5%) and price (low vs. high). Participants were randomized to receive menus with either a pictorial + text health-warning message or no message (between-subjects attribute). Multinomial logit regression models evaluated the influence of these attributes on waterpipe smoking choices. Across all four samples (n = 1859), participants preferred fruit-flavored varieties to tobacco flavor, lower nicotine content and lower prices. Exposure to the health warning did not significantly predict likelihood to opt-out. Flavor accounted for 81.4% of waterpipe smoking decisions. Limiting the use of fruit flavors in waterpipe tobacco, in addition to accurate nicotine content labeling and higher pricing may be effective at curbing the demand for waterpipe smoking among young adults.

Older People’s Preferences for Side Effects Associated with Antimuscarinic Treatments of Overactive Bladder: A Discrete-Choice Experiment

Drugs & Aging ◽  
2017 ◽  
Vol 34 (8) ◽  
pp. 615-623 ◽  
Author(s):  
Veerle H. Decalf ◽  
Anja M. J. Huion ◽  
Dries F. Benoit ◽  
Marie-Astrid Denys ◽  
Mirko Petrovic ◽  
...  
Keyword(s):  
Side Effects ◽  
Overactive Bladder ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment

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

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
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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