On (Measurable) Multiattribute Value Functions: An Expository Argument

In this note, we provide an easy-to-understand introduction to strength-of-preference measures in the context of deterministic multiattribute value assessments, focusing on what they are and why they matter. Though these issues are well understood by some decision analysts, we believe that many do not understand or appreciate the role of strength-of-preference assumptions when assessing or interpreting multiattribute value functions. The note is structured around an argument between the two authors that took place when reviewing applications of multiattribute value functions.

Infants’ preference for speech is stable across the first year of life: Meta-analytic evidence

Previous work suggested that humans’ sophisticated speech perception abilities stem from an early capacity to pay attention to speech in the auditory environment. Previous studies have therefore tested if infants prefer speech to other sounds at a variety of ages, but provided contrasted results. In this paper, we make the hypothesis that speech is initially encoded similarly to other natural or vocal sounds, and that infants tune to speech during the first year of life as they acquire their native language. To test this hypothesis, we conducted a meta-analysis of experiments testing speech preference in infants, sorting experiments by whether they used native or foreign speech on the one hand, and vocal or non-vocal, natural or artificial sound on the other hand. Synthesizing data from 775 infants across 38 experiments, we found a medium effect size, confirming at the scale of the literature that infants reliably prefer speech over other sounds. However, this preference was not significantly moderated by the language used, nor vocal quality, or naturalness of the competitor. Strinkingly, we found no effect of age: infants showed the same strength of preference throughout the first year of life. Speech therefore appears to be preferred from birth, even to other natural or vocal sounds. These results suggest that speech is processed in a specific way by an innate dedicated system, dictinct from other sounds processing.

Opinions and preferences of British Columbia pharmacists and physicians on medication management services

Background: Medication management (MM) services are being provided by pharmacists across Canada in various forms, but pharmacist-physician collaboration is still not a routine practice in most jurisdictions. This survey aimed to gather pharmacists’ and physicians’ opinions and preferences for MM provision. Methods: Two parallel, cross-sectional online surveys, including best-worst scaling tasks, were designed for pharmacists and physicians in British Columbia to capture and compare their preferences for a number of attributes of MM. Results: Surveys were completed by 119 pharmacists and 146 physicians. Results indicate that pharmacists and physicians had similar opinions on many aspects of MM. Ninety-five percent of pharmacists and 69% of physicians believed that additional health services are needed to help patients optimize the use of their medications. However, the majority of each group felt that they were the most important health care professional in providing this service. Most pharmacists (79%) and some physicians (25%) thought that optimizing use of medications would result in both decreased costs and utilization to the health care system. Both pharmacists and physicians felt that the best attribute of an MM service would be if the services resulted in improved health and medication use for patients. Both groups were motivated by increased remuneration for MM; however, the relative strength of preference for this was higher among physicians. Interestingly, physicians valued improved medication adherence as a result of MM more highly than pharmacists did. Discussion and Conclusion: Most pharmacists and physicians agreed that improving patients’ health and medication use would be the best attribute of MM and that there is a need for such services. However, physicians also had strong preferences for being remunerated for participating in MM provision.

Assessment of Multiple Myeloma Patient Preferences on Treatment Choices: An International Discrete Choice Study

Introduction: Patients' individual preferences for specific treatment attributes are an important factor to consider in treatment decisions. This area of research is relatively underexplored for patients with multiple myeloma (MM). Aims: To understand MM patients' strength of preference for method of administration and for avoiding specific adverse events (AEs). Methods: AEs were selected from trials of MM treatments used globally across the disease course: lenalidomide (FIRST, MM-009/010), bortezomib (VISTA, APEX, MMY-3021), thalidomide (IFM 99-06), pomalidomide (MM-003), and carfilzomib (PX-171-003, -004, -005). AEs selected for evaluation were narrowed down to 12, based on discussions with MM patients, from a list of hematologic and non-hematologic AEs with a grade 3/4 incidence > 5% and the greatest difference in rate of occurrence across trials: bone pain, febrile neutropenia, hypokalemia, hyponatremia, infection, lymphopenia, neuralgia, neutropenia, peripheral neuropathy, renal adverse reaction, and thrombocytopenia and thromboembolic events. MM patients were recruited to complete an online survey. Following an introductory tutorial, patients completed 14 discrete choice cards on which they selected their preferred option between 2 hypothetical treatments with varying combinations of AEs (absent/present), route of administration (oral, subcutaneous [SC], intravenous [IV]), and progression-free survival (PFS; 22, 24, or 26 months, based on evidence of first-line MM treatment). Results were expressed as odds ratios (ORs) and coefficients. Strength of preference was converted into a willingness to trade (WTT) PFS months to receive preferred choice of treatment. Results: Four hundred patients from 8 countries participated in the survey: Canada (13; 3.3%), Denmark (9; 2.3%), France (68; 17.0%), Germany (65; 16.3%), Italy (89; 22.3%), Spain (81; 20.3%), Sweden (11; 2.8%), and the United Kingdom (64; 16.0%). Of the respondents, 28.8% were on their first treatment, 70.0% of patients reported having switched treatment. The majority (58.7%) were male, with a mean age of 40 years. Patients showed a preference for oral vs IV administration (OR, 0.875 [95% CI, 0.78-0.98]; P = .020), and there was a trend toward preferring oral over SC administration (OR, 0.897 [95% CI, 0.80-1.01]; P = .067). Strength of preference declined in patients with prior treatments. Patients expressed a statistically significant preference (P < .01) to avoid (OR < 1) all presented grade 3/4 AEs, except for hematologic AEs: thrombocytopenia (OR [P value]: 0.904 [.23]), neutropenia (0.911 [.30]), and lymphopenia (0.916 [.39]) for first treatment patients, and neutropenia (0.907 [.08]) for patients with prior therapy. The relative importance of bone pain, infection, and thromboembolic events was lower in patients with prior therapies, while the relative importance of grade 3/4 neuralgia, febrile neutropenia, and renal adverse reaction increased. The table shows patient preferences as coefficients, and by months of PFS WTT. Example: Patients on their first treatment would be WTT 4.33 mos of PFS to receive oral vs IV administration. Conclusions: Study results display important findings concerning preferences of younger, working-age MM patients on individual AEs and methods of administration. Patients expressed smaller preference for avoiding hematologic AEs, such as neutropenia, lymphopenia, and thrombocytopenia, and an increasing relative importance to avoiding some symptomatic AEs (eg, neuropathy, neuralgia, renal adverse reaction, and febrile neutropenia) over the course of their disease. Patient preference should be considered when making treatment decisions. Future analyses could explore subgroups based on demographics and disease history, including prior AEs. Figure 1. Figure 1. Disclosures Leleu: Amgen: Patents & Royalties; Novartis: Honoraria; Celgene Corporation: Honoraria; Janssen: Honoraria; BMS: Honoraria. Mateos:Janssen-Cilag: Consultancy, Honoraria; Onyx: Consultancy; Celgene: Consultancy, Honoraria; Takeda: Consultancy. Delforge:Novartis: Honoraria; Celgene Corporation: Honoraria; Janssen: Honoraria; Amgen: Honoraria. Lewis:Celgene Corporation: Employment, Equity Ownership. Schindler:Celgene Corporation: Employment, Equity Ownership. Gibson:Celgene Corporation: Employment, Equity Ownership. Yang:Analysis Group: Employment. Weisel:Amgen: Consultancy, Honoraria, Other: Travel Support; Celgene: Consultancy, Honoraria, Other: Travel Support, Research Funding; Novartis: Other: Travel Support; Onyx: Consultancy, Honoraria; BMS: Consultancy, Honoraria, Other: Travel Support; Janssen Pharmaceuticals: Consultancy, Honoraria, Other: Travel Support, Research Funding; Noxxon: Consultancy.