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ABSTRACT: Patients with ulcerative colitis (UC) frequently require long-term therapy to prevent relapse. Treatments such as 5-aminosalicylic acid (5-ASA [mesalazine]) are efficacious and well tolerated, but adherence to treatment is often poor.
This discrete-choice experiment (DCE) was conducted to estimate differences in patient preferences for 5-ASA treatment in mild-to-moderate UC based on levels of self-reported adherence. Inclusion of patients residing in the US, UK, Germany, and Canada allowed for assessment of possible cultural differences in patient preferences.
DCE attributes were determined through literature review, clinician consultation, and patient interviews. Six treatment attributes were identified: ease of swallowing, time of day, quantity, extent of flare resolution, likelihood of flare occurrence, and cost. A total of 400 patients in four countries completed the DCE and adherence (Modified Morisky Scale) surveys. Data were analyzed using generalized estimating equations to estimate patient preference and willingness to pay (WTP) by levels of self-reported adherence and country of residence.
All attributes had expected polarity and were significant predictors of patient preference. Self-reported 'good' versus 'poor' adherers significantly preferred symptom control (p = 0.0108) and mucosal healing (p = 0.0190) attributes. All patients stated preference for symptom control/mucosal healing and flare risk attributes; the latter attribute was significantly preferred across all countries. Country differences in patient preference for convenience versus clinical attributes were found. Overall, patients were willing to pay £29.24 ($US46.27) per month for symptom control and mucosal healing, and an additional £78.81 ($US124.70) per month for reduction in flare risk to 10% per year (WTP costs were equalized between each country using the published 2008 purchasing power parity). Those with flares in the past year significantly preferred avoiding future flares (p < 0.0001) versus other attributes, as well as lower risk of flares (10%, likelihood ratio: 0.64-0.70).
Findings indicate that self-reported adherers to UC therapy have a stronger preference for clinical benefits over other treatment attributes, suggesting that positive patient assessment of effectiveness may influence adherence. Ongoing clinician assessment of patient preferences for treatment attributes, as well as education on the importance of adherence, may help improve treatment outcomes in UC.
The patient 10/2011; 5(1):33-44. · 0.57 Impact Factor
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ABSTRACT: Extended-release therapies avoid the need for children with attention-deficit/hyperactivity disorder (ADHD) to take medication at school. Recently a transdermal delivery system has been developed which can allow symptom control all day long but with greater dosing flexibility. This study explored the parents' preferences regarding oral and transdermal therapy.
A nonsystematic and qualitative literature review and in-depth interviews with parents and physicians helped identify salient treatment attributes for a discrete choice experiment. Treatment attributes included mode of administration (tablet or transdermal), speed of onset (30-90 min); duration (lasts until 3-9 pm) and ability to tailor the drug to different needs (no flexibility, limited flexibility, easy to adjust to different days). A convenience sample of parents of children treated for ADHD (n = 200) were recruited using a recruitment agency. Data were analyzed using generalized estimating equations (GEE).
Parents' preferred once-a-day oral therapy (odds ratio [OR] = 1.76 [95 percent confidence interval {CI}, 1.43 - 2.18]); rapid speed of onset (OR = 1.22 [95 percent CI, 1.07 - 1.39]), and symptom control until 9 pm (OR = 3.79 [95 percent CI, 2.98 - 4.82]). Analyses identified that 30 percent of parents preferred transdermal treatment and this subgroup preferred treatments with a fast onset of action.
This survey demonstrates that parents of ADHD children have different preferences for the ADHD treatments prescribed for their children. A distinct subgroup of parents prefer the transdermal therapy. These parents were less likely to be working and so monitoring compliance and doing after school activities may have been easier.
International Journal of Technology Assessment in Health Care 07/2011; 27(3):215-23. · 1.37 Impact Factor
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ABSTRACT: Patients with moderate to severe allergic asthma have persistent poorly controlled asthma despite inhaled or systemic corticosteroid therapy. New therapies are becoming more widely available to treat such patients, but their value needs to be formally assessed in an economic evaluation. Within a publicly funded health care system such an analysis should reflect societal preferences when measuring treatment benefits. The aim of this study was to elicit societal preferences for the symptom burden associated with moderate to severe allergic asthma.
Existing daily symptom diary data from a clinical trial were used to develop health state descriptions for evaluation in a standard gamble interview. Five health states were produced that reflected five distinct levels of control ranging from 'complete control of asthma' to 'worsening of asthma', as defined by another outcome measure. The symptom diary data were also used as attributes in a discrete choice experiment (DCE) to estimate willingness to pay for improvements in symptoms. Members of the general public (n = 101) completed the interview.
Thirteen participants failed the consistency checks and were excluded from the analysis. Societal utility ratings for the health states ranged from 0.71 (worsening of asthma) to 0.78 (complete control of asthma). The participants were also willing to pay 160 pounds a month for the avoidance of all symptoms.
The range of utility values (0.71-0.78) demonstrates the severity of moderate to severe allergic asthma. However the spread of scores between complete control of asthma and worsening of asthma was lower than was expected. The community sample placed only a moderate value on the avoidance of all asthma symptoms in the DCE survey. The results suggest that the community sample may not have fully understood the benefits of control over asthma symptoms and the limitations such symptoms can impose on everyday life.
The European Journal of Health Economics 09/2008; 9(3):275-84. · 1.50 Impact Factor
