How Do Physicians Weigh Benefits and Risks Associated with Treatments in Patients with Osteoarthritis in the United Kingdom?

2012 ◽  
Vol 39 (5) ◽  
pp. 1056-1063 ◽  
Author(s):  
NIGEL K. ARDEN ◽  
A. BRETT HAUBER ◽  
ATEESHA F. MOHAMED ◽  
F. REED JOHNSON ◽  
PAUL M. PELOSO ◽  
...  
Keyword(s):  
Discrete Choice ◽  
Choice Experiment ◽  
Bleeding Ulcer ◽  
Relative Importance ◽  
Random Parameters ◽  
The United Kingdom ◽  
Final Sample ◽  
Related Risk ◽  
History Of ◽  
Model Treatment

Objective.To quantify the relative importance that UK physicians attach to the benefits and risks of current drugs when making treatment decisions for patients with osteoarthritis (OA).Methods.Physicians treating at least 10 patients with OA per month completed an online discrete-choice experiment survey and answered 12 treatment-choice questions comparing medication profiles. Medication profiles were defined by 4 benefits (reduction in ambulatory pain, resting pain, stiffness, and difficulty doing daily activities) and 3 treatment-related risks [bleeding ulcer, stroke, and myocardial infarction (MI)]. Each physician made medication choices for 3 of 9 hypothetical patients (varied by age, history of MI, hypertension, and history of gastrointestinal bleeding). Importance weights were estimated using a random-parameters logit model. Treatment-related risks physicians were willing to accept in exchange for various reductions in ambulatory and resting pain also were calculated.Results.The final sample was 475. A reduction in ambulatory pain from 75 mm to 25 mm (1.6 units) was 1.1 times as important as an increase in MI risk from 0% to 1.5% (1.5 units). The greatest importance was for eliminating a 3% treatment-related risk of MI or stroke. On average, physicians were willing to accept an increase in bleeding ulcer risk of 0.7% (95% CI 0.4%–1.7%) for a reduction in ambulatory pain of 75 mm to 50 mm.Conclusion.When presented with well-known benefits and risks of OA treatments, physicians placed greater importance on the risks than on the analgesic properties of the drug. This has implications for the reporting of the results of clinical research to physicians.

scholarly journals Discrete choice experiment for eliciting preference for health services for patients with ALS and their informal caregivers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katy Tobin ◽  
Sinead Maguire ◽  
Bernie Corr ◽  
Charles Normand ◽  
Orla Hardiman ◽  
...  
Keyword(s):  
Health Services ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Strong Preference ◽  
Multidisciplinary Teams ◽  
Relative Importance ◽  
Trade Offs ◽  
Als Patients ◽  
The Impact

Abstract Background Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative condition with a mean life expectancy of 3 years from first symptom. Understanding the factors that are important to both patients and their caregivers has the potential to enhance service delivery and engagement, and improve efficiency. The Discrete Choice Experiment (DCE) is a stated preferences method which asks service users to make trade-offs for various attributes of health services. This method is used to quantify preferences and shows the relative importance of the attributes in the experiment, to the service user. Methods A DCE with nine choice sets was developed to measure the preferences for health services of ALS patients and their caregivers and the relative importance of various aspects of care, such as timing of care, availability of services, and decision making. The DCE was presented to patients with ALS, and their caregivers, recruited from a national multidisciplinary clinic. A random effects probit model was applied to estimate the impact of each attribute on a participant’s choice. Results Patients demonstrated the strongest preferences about timing of receiving information about ALS. A strong preference was also placed on seeing the hospice care team later rather than early on in the illness. Patients also indicated their willingness to consider the use of communication devices. Grouping by stage of disease, patients who were in earlier stages of disease showed a strong preference for receipt of extensive information about ALS at the time of diagnosis. Caregivers showed a strong preference for engagement with healthcare professionals, an attribute that was not prioritised by patients. Conclusions The DCE method can be useful in uncovering priorities of patients and caregivers with ALS. Patients and caregivers have different priorities relating to health services and the provision of care in ALS, and patient preferences differ based on the stage and duration of their illness. Multidisciplinary teams must calibrate the delivery of care in the context of the differing expectations, needs and priorities of the patient/caregiver dyad.

scholarly journals Understanding the influence of physical resources and social supports on primary food providers’ snack food provision: a discrete choice experiment

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Brittany J. Johnson ◽  
Rebecca K. Golley ◽  
Dorota Zarnowiecki ◽  
Gilly A. Hendrie ◽  
Elisabeth K. Huynh
Keyword(s):  
Discrete Choice ◽  
Significant Influence ◽  
Choice Experiment ◽  
Social Supports ◽  
Social Condition ◽  
Parent Support ◽  
Relative Importance ◽  
Utility Weight ◽  
Physical Resources ◽  
Choice Tasks

Abstract Background Snack eating occasions contribute approximately a third of children’s energy intake, with approximately half of all unhealthy foods consumed during snack times. Therefore, it is critical to understand the drivers of primary food providers’ snack provision. The study aims were to determine the relative importance of physical resources and social supports when primary food providers are choosing snacks to provide to their child, and to investigate how these attributes differ in social versus non-social occasions, and between subgroups of primary food providers based on socio-economic position. Methods Primary food providers of three to seven-year olds completed an online discrete choice experiment, by making trade-offs when completing repeated, hypothetical choice tasks on the choice of snacks to provide to their child in: 1) non-social and 2) social condition. Choice tasks included two alternatives consisting of varying attribute (i.e. factor) levels, and an opt-out option. The order of conditions shown were randomized across participants. Multinomial logit model analyses were used to determine utility weights for each attribute. Results Two-hundred and twenty-five primary food providers completed the study, providing 1125 choice decisions per condition. In the non-social condition, the top three ranked attributes were type of food (utility weight 1.94, p < 0.001), child resistance (− 1.62, p < 0.001) and co-parent support (0.99, p < 0.001). In the social condition, top ranking attributes were child resistance (utility weight − 1.50, p < 0.001), type of food (1.38, p < 0.001) and co-parent support (1.07, p < 0.001). In both conditions, time was not a significant influence and cost was of lowest relative importance. Subgroup analyses revealed cost was not a significant influence for families from higher socio-economic backgrounds. Conclusions Type of food, child resistance and co-parent support were of greatest relative importance in primary food providers’ snack provision decision-making, regardless of social condition or socio-economic position. In designing future interventions to reduce unhealthy snacks, researchers should prioritize these influences, to better support primary food providers in changing their physical and social opportunity. Trial registration Australian New Zealand Clinical Trials Registry no. ACTR N12618001173280

scholarly journals SARS-CoV-2 Testing Service Preferences of Adults in the United States: Discrete Choice Experiment (Preprint)

2020 ◽  
Author(s):  
Rebecca Zimba ◽  
Sarah Kulkarni ◽  
Amanda Berry ◽  
William You ◽  
Chloe Mirzayi ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Turnaround Time ◽  
Urgent Care ◽  
Relative Importance ◽  
Test Type ◽  
Specimen Type ◽  
Testing Uptake ◽  
Community Transmission

BACKGROUND Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission. OBJECTIVE This study aims to determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission. METHODS We used a discrete choice experiment to assess preferences for SARS-CoV-2 test type, specimen type, testing venue, and results turnaround time. Participants (n=4793) from the US national longitudinal Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study completed our online survey from July 30 to September 8, 2020. We estimated the relative importance of testing method attributes and part-worth utilities of attribute levels, and simulated the uptake of an optimized testing scenario relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal swab in a provider’s office or urgent care clinic with results in &gt;5 days. RESULTS Test result turnaround time had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). In simulations, immediate or same-day test results, both PCR and serology, or oral specimens substantially increased testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same-day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test. CONCLUSIONS Testing strategies that offer both PCR and serology with noninvasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2.

scholarly journals Barriers and Facilitators to the Adoption of Mobile Health Among Health Care Professionals From the United Kingdom: Discrete Choice Experiment

10.2196/17704 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e17704 ◽  
Author(s):  
Simon Leigh ◽  
Liz Ashall-Payne ◽  
Tim Andrews
Keyword(s):  
Health Care ◽  
Discrete Choice ◽  
Mobile Health ◽  
Health Care Professionals ◽  
Choice Experiment ◽  
Patient Age ◽  
Health Apps ◽  
The United Kingdom ◽  
Patient Âgé ◽  
Subgroup Analyses

Background Despite the increasing availability of mobile health services, clinical engagement remains minimal. Objective This study aims to identify and weight barriers to and drivers of health app use among health care professionals (HCPs) from the United Kingdom. Methods A discrete choice experiment was conducted with 222 HCPs using a web-based survey between March 2019 and June 2019. Participants were recruited to take part via social media and asked to choose their preferred option of 2 hypothetical health apps to prescribe to a hypothetical patient or to prescribe neither. Choices were characterized by differing levels of patient age, cost, published evidence bases, whether they had a National Health Service (NHS) stamp of approval, personal familiarity with the technology, and whether they were recommended by a fellow HCP. The results were analyzed using a mixed logit model, with subgroup analyses to account for heterogeneity. Results We received 230 responses, a total of 96.5% (n=222/230) of respondents understood the survey task and passed the test of rationality. The median age was between 36 and 45 years, and 62.6% (n=139/222) of the health care providers responding to the survey had previously recommended the use of health apps to patients. Health apps were most likely to be prescribed to patients if they had an NHS stamp of approval or if they were recommended by another HCP (both P<.001). Published studies detailing clinical effectiveness were important (P<.001), but it would take five published studies to have the same impact on prescribing behavior as an NHS stamp of approval and two studies to be as convincing as having used the technology personally. Increasing patient age and costs resulted in significant reductions in digital health prescribing (P<.001), none more so than among allied health professionals. Willingness-to-pay for health apps increased by £124.61 (US $151.14) if an NHS stamp of approval was present and by £29.20 (US $35.42) for each published study. Overall, 8.1% (n=18/222) of respondents were reluctant to use health apps, always choosing the I would prescribe neither option, particularly among older HCPs, nurses, and those who do not use health apps personally. Subgroup analyses revealed significant differences in preferences among HCPs of differing ages and clinical backgrounds. Conclusions An NHS stamp of approval, published studies, and recommendations from fellow HCPs are significant facilitators of digital prescribing, whereas increasing costs and patient age are significant barriers to engagement. These findings suggest that demonstrating assurances of health apps and supporting both the dissemination and peer-to-peer recommendation of evidence-based technologies are critical if the NHS is to achieve its long-term digital transformation ambitions.

What matters most to patients when choosing treatment for mild–moderate asthma? Results from a discrete choice experiment

Thorax ◽  
2020 ◽  
Vol 75 (10) ◽  
pp. 842-848
Author(s):  
Christina Baggott ◽  
Paul Hansen ◽  
Robert J Hancox ◽  
Jo Katherine Hardy ◽  
Jenny Sparks ◽  
...  
Keyword(s):  
Treatment Regimen ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Controlled Trial ◽  
Final Analysis ◽  
Mild Asthma ◽  
Relative Importance ◽  
Shortness Of Breath ◽  
Moderate Asthma

BackgroundAn as-needed combination preventer and reliever regimen was recently introduced as an alternative to conventional daily preventer treatment for mild asthma. In a subgroup analysis of the PRACTICAL study, a pragmatic randomised controlled trial of budesonide–formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild asthma, we recently reported that about two-thirds preferred as-needed combination preventer and reliever therapy. The aim of this study was to determine the relative importance of attributes associated with these two asthma therapies in this subgroup of participants who indicated their preferred treatment in the PRACTICAL study.MethodsAt their final study visit, a subgroup of participants indicated their preferred treatment and completed a discrete choice experiment using the Potentially All Pairwise RanKings of all possible Alternatives method and 1000minds software. Treatment attributes and their levels were selected from measurable study outcomes, and included: treatment regimen, shortness of breath, steroid dose and likelihood of asthma flare-up.ResultsThe final analysis dataset included 288 participants, 64% of whom preferred as-needed combination preventer and reliever. Of the attributes, no shortness of breath and lowest risk of asthma flare-up were ranked highest and second highest, respectively. However, the relative importance of the other two attributes varied by preferred therapy: treatment regimen was ranked higher by participants who preferred as-needed treatment than by participants who preferred maintenance treatment.ConclusionsKnowledge of patient preferences for treatment attributes together with regimen characteristics can be used in shared decision-making regarding choice of treatment for patients with mild–moderate asthma.Trial registration numberACTRN12616000377437.

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.

scholarly journals The policy-seeking voter: evaluations of government performance beyond the economy

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Niels Markwat
Keyword(s):  
Public Opinion ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Value Congruence ◽  
Government Performance ◽  
Relative Importance ◽  
Retrospective Voting ◽  
Individual Preferences ◽  
Promising Development

AbstractVoters hold governments to account through elections, but which criteria are most important to voter evaluations of incumbent performance? While (economic) outcomes have long been central to studies of retrospective voting, recent studies have considered the influence of policy output—the policies implemented by incumbents to achieve their goals. Building on this promising development, this study identifies three ways in which policy output is expected to affect voter evaluations of incumbent performance—the congruence between implemented policy and (1) individual preferences; (2) public opinion; and (3) election pledges. A discrete choice experiment was designed to assess the relative importance of these three aspects of policy output in comparison to each other; as well as to two important economic indicators. Overall, the findings support the notion that policy output matters to voters even beyond outcomes. The findings also show that voters value congruence between policy and their personal preferences considerably more than policy congruence with public opinion; and election pledge fulfillment. This indicates that voters are egotropic in their evaluation of implemented policy, and more policy-seeking than accounted for in much of the empirical retrospective voting literature. These results inform our understanding of how policy output matters to voters, as well as of how voters hold governments accountable for their performance.

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