Patient preferences for outcomes of depression treatment in Germany: A choice-based conjoint analysis study

• Published in: Journal of affective disorders 2013-06, Vol.148 (2), p.210-219
• Main Authors: Zimmermann, Thomas M, Clouth, Johannes, Elosge, Michael, Heurich, Matthias, Schneider, Edith, Wilhelm, Stefan, Wolfrath, Anette
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Antidepressants; Antidepressive Agents - therapeutic use; Bayes Theorem; Biological and medical sciences; Choice Behavior; Choice-based conjoint analysis; Depression; Depression - complications; Depression - drug therapy; Discrete choice analysis; Female; Germany; Humans; Male; Medical sciences; Middle Aged; Mood disorders; Moods; Neuropharmacology; Pain; Pain - etiology; Patient Preference - psychology; Patient Preference - statistics & numerical data; Patient preferences; Pharmacology. Drug treatments; Psychiatry; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Qualitative Research; Side effects; Sleep problems; Treatment Outcome; Treatment preferences; Young Adult
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2012.11.062

Abstract Background In general, treatment efficacy in depressed patients is evaluated mainly based on the core symptoms of depression. However, patients might consider different outcomes. This study used choice-based conjoint analysis (CBC) to evaluate patient preferences for depression treatment outcomes. Methods Adult subjects from Germany, currently or previously on antidepressant treatment, were presented with 18 pairs of hypothetical treatment outcome scenarios, differing in eight attributes (2–3 factor levels each): depressed mood, loss of interest and enjoyment, loss of energy/fatigue, sleep disturbance, feelings of guilt, depression-related pain, treatment duration, side effects after 2 weeks. Attributes and factor levels were defined by literature review, expert consultations, and in-depth subject interviews. Data were analyzed using multinomial logit modeling; individual part-worth utilities were estimated using hierarchical Bayes routines. Results Two hundred twenty-seven subjects (89.4% currently treated with antidepressants, 30.0% with depression-related pain) completed the survey. They valued the relative importance of outcomes as follows: loss of energy/fatigue 18.5%, side effects after 2 weeks 14.2%, loss of interest and enjoyment 13.5%, depression-related pain 12.0%, sleep disturbance 12.0%, feelings of guilt 11.5%, treatment duration 9.9%, depressed mood 8.5%. Limitations Participants were not required to meet ICD-10 or DSM-IV criteria for depression and had heterogeneous disease severity. Conclusions CBC analysis was able to reveal patient preferences for outcomes of depression treatment. Subjects valued the ability to cope with activities of everyday living highest. They considered being free of depression-related pain and side effects more important than being free of depressed mood. These findings should be considered when making treatment decisions.