PATIENT PRIORITIES FOR TREATMENT ATTRIBUTES IN ADJUNCTIVE DRUG THERAPY OF SEVERE HYPERCHOLESTEROLEMIA IN GERMANY: AN ANALYTIC HIERARCHY PROCESS

• Published in: International journal of technology assessment in health care 2018-01, Vol.34 (3), p.267-275
• Main Authors: Mühlbacher, Axel C., Kaczynski, Anika, Dippel, Franz-Werner, Bethge, Susanne
• Format: Article
• Language: English
• Subjects: Aged; Analytic hierarchy process; Anticholesteremic Agents - administration & dosage; Anticholesteremic Agents - adverse effects; Anticholesteremic Agents - therapeutic use; Apheresis; Blood; Blood Component Removal - methods; Cardiovascular disease; Cardiovascular diseases; Cholesterol, LDL - blood; Clinical trials; Cognition; Combined Modality Therapy; Coronary artery disease; Data collection; Decision Making; Drug therapy; Experts; Female; Fuzzy sets; Germany; Health care; Heart; Heart diseases; Hierarchies; Humans; Hypercholesterolemia; Hypercholesterolemia - therapy; Identification methods; Lipids; Literature reviews; Low density lipoprotein; Male; Method; Middle Aged; Multiple criteria decision making; Muscular Diseases - chemically induced; Myopathy; Neurocognitive Disorders - chemically induced; Patient Preference; Patients; Priorities; Quality of life; Reduction; Risk Factors; Severity of Illness Index; Side effects; Socioeconomic Factors; Subgroups; Systematic review; Task forces; Therapy; Time Factors
• ISSN: 0266-4623; 1471-6348
• DOI: 10.1017/S0266462318000247

Severe hypercholesterolemia is a major cause of death in coronary heart disease. New adjunctive drug therapies have passed authorization processes and been launched recently. So far it is not known which properties of the new treatment options generate the highest benefit for patients. The aim was to evaluate patient priorities in the field of adjunctive drug therapy with apheresis. Therapy characteristics were examined as to their relevance to hypercholesterolemia patients. To identify all potential patient-relevant treatment characteristics, a systematic literature review and ten interviews with patients were conducted. Seven key characteristics were identified from the patient perspective. Patients' priorities were elicited using an analytic hierarchy process (AHP). In total, N = 61 patients diagnosed with severe hypercholesterolemia and undergoing apheresis participated in the study. The analysis showed predominance for the attribute "reduction of LDL-C level in blood" (Wglobal:0.362). The "risk of myopathy" (Wglobal:0.164), "risk of neurocognitive impairment" (Wglobal:0.161) and "frequency of apheresis" (Wglobal:0.119) were ranked second, third and fourth. Subgroup analyses revealed that "frequency of apheresis" is of greater importance to younger patients, men and/or patients who indicated a reduction in quality of life due to apheresis. The essential decision criteria for optimal therapy from the patients' perspective were obtained. "Reduction of lipoprotein in blood" was ranked highest compared with the "mode of administration" and "side effects" characteristics. The study offers a transparent approach for the identification of patient priorities for adjunctive PCSK9-inhibitor therapy in apheresis-treated hypercholesterolemia. The project can be used by healthcare decision makers to understand the importance of each patient-relevant endpoint.