Preferences for antiviral therapy of chronic hepatitis C: a discrete choice experiment

• Published in: The European journal of health economics 2017-03, Vol.18 (2), p.155-165
• Main Authors: Mühlbacher, Axel C., Bridges, John F. P., Bethge, Susanne, Dintsios, Ch.-Markos, Schwalm, Anja, Gerber-Grote, Andreas, Nübling, Matthias
• Format: Article
• Language: English
• Subjects: Antiviral Agents - administration & dosage; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Antiviral drugs; Choice Behavior; Clinical trials; Conjoint analysis; Decision making; Decision Support Techniques; Drug therapy; Economic Policy; Economic theory; Economics; Experiments; Female; Germany; Global health; Health care; Health care delivery; Health Care Management; Health care policy; Health Economics; Health technology assessment; Hepatitis; Hepatitis C; Hepatitis C, Chronic - drug therapy; Hierarchies; Humans; Interferons - administration & dosage; Interferons - adverse effects; Interferons - therapeutic use; Male; Medical research; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Original Paper; Patient Preference - psychology; Patients; Pharmacoeconomics and Health Outcomes; Pilot Projects; Preferences; Public Finance; Public Health; Quality of care; Quality of life; Questionnaires; Socioeconomic Factors; Studies; Substance abuse treatment; Sustained Virologic Response; Technology assessment
• ISSN: 1618-7598; 1618-7601
• DOI: 10.1007/s10198-016-0763-8

Background The German Institute for Quality and Efficiency in Health Care (IQWiG) uses patient-relevant outcomes to inform decision-makers. Objective IQWiG conducted a pilot study to examine whether discrete choice experiments (DCEs) can be applied in health economic evaluations in Germany to identify, weight, and prioritize multiple patient-relevant outcomes, using the example of antiviral therapy for chronic hepatitis C (HCV). A further objective was to contribute to a more structured approach towards eliciting and comparing preferences across key stakeholders. Methods In autumn 2010, a DCE questionnaire was sent to patients with chronic HCV to estimate preferences across seven outcomes ("attributes"), including treatment efficacy [sustained viral response (SVR) at 6 months], adverse effects (flu-like symptoms, gastrointestinal symptoms, psychiatric symptoms, and skin symptoms/alopecia), and measures of treatment burden (duration of therapy, frequency of injections). A linear model and an effects coded full model were applied to assess the relative importance of the attributes. Results In total N = 326 patients were included. A clear preference for SVR was shown; frequency of injections and duration of therapy shared the second rank, while psychiatric symptoms ranked third. The duration of flu-like symptoms was the least important attribute. Conclusion Our findings indicate that it is possible to perform a DCE at the national level in a health technology assessment agency. The weighting of multiple outcomes allows an indication-specific and evidence-based measure to be used in health economic evaluations. In decision-making in health care, the approach generally allows for consideration of patient-relevant trade-offs regarding the benefits and harms of medical interventions.