discrete choice experiment
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OBJECTIVE: To explore preferences of gastroenterologists for biosimilar drugs in Crohn's disease. MATERIAL AND METHODS: Discrete choice experiment was carried out involving 51 Hungarian gastroenterologists in May 2014. The following attributes were used to describe hypothetical choice sets: 1) type of the treatment (biosimilar/originator), 2) severity of disease, 3) availability of continuous medicine supply, 4) frequency of the efficacy check-ups. Multinomial logit model was used to differentiate between three attitude types: 1) always opting for the originator, 2) willing to consider biosimilar for biological-naïve patients only, 3) willing to consider biosimilar treatment for both types of patients. Conditional logit model was used to estimate the probabilities of choosing a given profile. RESULTS: Men, senior consultants, working in inflammatory bowel disease center and treating more patients were more likely willing to consider biosimilar for biological-naïve patients only. Treatment type (originator/biosimilar) was the most important determinant of choice for patients already treated with biologicals, and the availability of continuous medicine supply in case of biological-naïve patients. The probabilities of choosing the biosimilar with all the benefits offered over the originator under current reimbursement conditions are 89% versus 11% for new patients, and 44% versus 56% for patients already treated with biological. CONCLUSIONS: For gastroenterologist, the continuous medical supply would be one of the major benefits of biosimilars. However, benefits offered in the scenarios do not compensate for the change from the originator to the biosimilar treatment of patients already treated with biologicals.
- MeSH
- biosimilární léčivé přípravky ekonomika terapeutické užití MeSH
- Crohnova nemoc farmakoterapie ekonomika MeSH
- dospělí MeSH
- infliximab ekonomika terapeutické užití MeSH
- lékaři MeSH
- lékařská praxe - způsoby provádění statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- monoklonální protilátky ekonomika terapeutické užití MeSH
- průzkumy a dotazníky MeSH
- senioři MeSH
- výběrové chování * MeSH
- zdraví - znalosti, postoje, praxe * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Maďarsko MeSH
BACKGROUND: In time, we may be able to detect the early onset of symptoms of depression and even predict relapse using behavioural data gathered through mobile technologies. However, barriers to adoption exist and understanding the importance of these factors to users is vital to ensure maximum adoption. METHOD: In a discrete choice experiment, people with a history of depression (N = 171) were asked to select their preferred technology from a series of vignettes containing four characteristics: privacy, clinical support, established benefit and device accuracy (i.e., ability to detect symptoms), with different levels. Mixed logit models were used to establish what was most likely to affect adoption. Sub-group analyses explored effects of age, gender, education, technology acceptance and familiarity, and nationality. RESULTS: Higher level of privacy, greater clinical support, increased perceived benefit and better device accuracy were important. Accuracy was the most important, with only modest compromises willing to be made to increase other factors such as privacy. Established benefit was the least valued of the attributes with participants happy with technology that had possible but unknown benefits. Preferences were moderated by technology acceptance, age, nationality, and educational background. CONCLUSION: For people with a history of depression, adoption of technology may be driven by the desire for accurate detection of symptoms. However, people with lower technology acceptance and educational attainment, those who were younger, and specific nationalities may be willing to compromise on some accuracy for more privacy and clinical support. These preferences should help shape design of mHealth tools.
- MeSH
- deprese * diagnóza terapie MeSH
- lidé MeSH
- pacientova volba MeSH
- stupeň vzdělání MeSH
- telemedicína * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: In middle-income countries, access to biological therapy is limited in ulcerative colitis in terms of the number of patients and the length of therapy. Because of their cost advantages, biosimilars have the potential to improve access to therapy, but physicians have concerns toward their use because of the lack of evidence from randomized clinical trials. OBJECTIVES: To explore the preferences of gastroenterologists for biosimilar drugs in ulcerative colitis as well as to compare our results with results of previous studies on gastroenterologists' preferences toward biosimilars. METHODS: A discrete choice experiment was carried out involving 51 Hungarian gastroenterologists treating patients with inflammatory bowel disease in May 2014 with the following attributes: type of treatment (biosimilar/originator), severity of disease, availability of continuous medicine supply, and the stopping rule (whether the treatment is covered after 12 months). A conditional logit model was used to estimate the probabilities of choosing a given profile. RESULTS: According to the results, the stopping rule was the most important attribute. The type of treatment mattered only for patients already on biologicals. The probabilities of choosing the biosimilar option with all the benefits offered in the discrete choice experiment over the originator option under the present reimbursement conditions are 85% for new patients and 63% for patients already treated. CONCLUSIONS: Most gastroenterologists have concerns about using biosimilars. They, however, are willing to consider the use of biosimilars if they could reallocate the potential savings to provide their patients better access to biological treatment.
- MeSH
- biosimilární léčivé přípravky terapeutické užití MeSH
- Crohnova nemoc MeSH
- gastroenterologové * MeSH
- gastrointestinální látky MeSH
- idiopatické střevní záněty MeSH
- infliximab MeSH
- lékařská praxe - způsoby provádění * MeSH
- lidé MeSH
- monoklonální protilátky MeSH
- ulcerózní kolitida farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Maďarsko MeSH
BACKGROUND: There is increasing interest in the potential uses of mobile health (mHealth) technologies, such as wearable biosensors, as supplements for the care of people with neurological conditions. However, adherence is low, especially over long periods. If people are to benefit from these resources, we need a better long-term understanding of what influences patient engagement. Previous research suggests that engagement is moderated by several barriers and facilitators, but their relative importance is unknown. OBJECTIVE: To determine preferences and the relative importance of user-generated factors influencing engagement with mHealth technologies for 2 common neurological conditions with a relapsing-remitting course: multiple sclerosis (MS) and epilepsy. METHODS: In a discrete choice experiment, people with a diagnosis of MS (n=141) or epilepsy (n=175) were asked to select their preferred technology from a series of 8 vignettes with 4 characteristics: privacy, clinical support, established benefit, and device accuracy; each of these characteristics was greater or lower in each vignette. These characteristics had previously been emphasized by people with MS and or epilepsy as influencing engagement with technology. Mixed multinomial logistic regression models were used to establish which characteristics were most likely to affect engagement. Subgroup analyses explored the effects of demographic factors (such as age, gender, and education), acceptance of and familiarity with mobile technology, neurological diagnosis (MS or epilepsy), and symptoms that could influence motivation (such as depression). RESULTS: Analysis of the responses to the discrete choice experiment validated previous qualitative findings that a higher level of privacy, greater clinical support, increased perceived benefit, and better device accuracy are important to people with a neurological condition. Accuracy was perceived as the most important factor, followed by privacy. Clinical support was the least valued of the attributes. People were prepared to trade a modest amount of accuracy to achieve an improvement in privacy, but less likely to make this compromise for other factors. The type of neurological condition (epilepsy or MS) did not influence these preferences, nor did the age, gender, or mental health status of the participants. Those who were less accepting of technology were the most concerned about privacy and those with a lower level of education were prepared to trade accuracy for more clinical support. CONCLUSIONS: For people with neurological conditions such as epilepsy and MS, accuracy (ie, the ability to detect symptoms) is of the greatest interest. However, there are individual differences, and people who are less accepting of technology may need far greater reassurance about data privacy. People with lower levels of education value greater clinician involvement. These patient preferences should be considered when designing mHealth technologies.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: In addition to cost-effectiveness, national guidelines often include other factors in reimbursement decisions. However, weights attached to these are rarely quantified, thus decisions can depend strongly on decision-maker preferences. OBJECTIVE: To explore the preferences of policymakers and healthcare professionals involved in the decision-making process for different efficiency and equity attributes of interventions and to analyse cross-country differences. METHOD: Discrete choice experiments (DCEs) were carried out in Austria, Hungary, and Norway with policymakers and other professionals working in the health industry (N = 153 respondents). Interventions were described in terms of different efficiency and equity attributes (severity of disease, target age of the population and willingness to subsidise others, potential number of beneficiaries, individual health benefit, and cost-effectiveness). Parameter estimates from the DCE were used to calculate the probability of choosing a healthcare intervention with different characteristics, and to rank different equity and efficiency attributes according to their importance. RESULTS: In all three countries, cost-effectiveness, individual health benefit and severity of the disease were significant and equally important determinants of decisions. All countries show preferences for interventions targeting young and middle aged populations compared to those targeting populations over 60. However, decision-makers in Austria and Hungary show preferences more oriented to efficiency than equity, while those in Norway show equal preferences for equity and efficiency attributes. CONCLUSION: We find that factors other than cost-effectiveness seem to play an equally important role in decision-making. We also find evidence of cross-country differences in the weight of efficiency and equity attributes.
- MeSH
- analýza nákladů a výnosů MeSH
- efektivita organizační * MeSH
- lidé MeSH
- přidělování zdravotní péče ekonomika organizace a řízení MeSH
- rozhodování * MeSH
- směrnice jako téma MeSH
- stupeň závažnosti nemoci MeSH
- věkové faktory MeSH
- výběrové chování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
Young adults are a substantial driver of lagging vaccination against COVID-19 worldwide. We aimed to understand what vaccine or vaccination environment attributes may affect young adults' vaccine inclination. We contacted a convenience sample of 1415 students to recruit a minimum of 150 individuals for a web-based discrete choice experiment. The respondents were asked to choose one of two hypothetical vaccines, defined by six attributes-vaccine efficacy, risk of mild side effects, protection duration, administration route, recommender, and travel time to the vaccination site. Individual preferences were calculated with the Markov chain Monte Carlo hierarchical Bayes estimation. A total of 445 individuals (mean age 24.4 years, 272 (61.1%) women) completed the survey between 22 March and 3 May 2021. Vaccine protection duration (28.3 (95% CI, 27.0-29.6)) and vaccine efficacy in preventing COVID-19 (27.5 (95% CI, 26.3-28.8)) were the most important, followed by the risk of vaccine side effects (17.3 (95% CI, 16.2-18.4)). Individuals reluctant or unsure about vaccination (21.1%) prioritized the potential for mild side effects higher and vaccine efficacy lower than the vaccine-inclined individuals. New vaccination programs that target young adults should emphasize the protection duration, low risk of vaccine side effects, and high efficacy.
- Publikační typ
- časopisecké články MeSH
While economic inequality continues to rise within countries, efforts to address it have been largely ineffective, particularly those involving behavioral approaches. It is often implied but not tested that choice patterns among low-income individuals may be a factor impeding behavioral interventions aimed at improving upward economic mobility. To test this, we assessed rates of ten cognitive biases across nearly 5000 participants from 27 countries. Our analyses were primarily focused on 1458 individuals that were either low-income adults or individuals who grew up in disadvantaged households but had above-average financial well-being as adults, known as positive deviants. Using discrete and complex models, we find evidence of no differences within or between groups or countries. We therefore conclude that choices impeded by cognitive biases alone cannot explain why some individuals do not experience upward economic mobility. Policies must combine both behavioral and structural interventions to improve financial well-being across populations.
Arteriální hypertenze je svojí vysokou prevalencí velkým problémem moderní společnosti. Prevalence arteriální hypertenze v České republice je v posledních letech udávána až 30–50 % dospělé populace. Zavedením moderních léčebných postupů došlo k zásadnímu zlepšení v prognóze hypertenzních nemocných. V rámci těchto globálních trendů byla opakovaně modernizována „Doporučení pro léčbu hypertenze“, která jsou vodítkem pro správnost a efektivnost léčby. I v jejich poslední verzi je jako zcela rovnoprávná skupina antihypertenziv zařazena skupina antagonistů receptorů pro angiotenzin II (sartanů). Tyto látky jsou specifickými a selektivními blokátory angiotenzinového receptoru subtypu AT1. V době realizace této studie byli v České republice běžně používáni dva zástupci antagonistů receptoru AT1: losartan a telmisartan. Výběr sartanu přidávaného ke stávající medikaci byl zcela na rozhodnutí ošetřujícího lékaře. Telmisartanem bylo léčeno více než 96 % nemocných, proto analyzujeme pouze tyto pacienty. Do našeho sledování byli zařazeni hypertonici léčení v ambulancích praktických lékařů, internistů, kardiologů, diabetologů a endokrinologů v krajích Středočeském, Jihočeském, Plzeňském, Libereckém, Ústeckém, Olomouckém, Pardubickém, Jihomoravském a v kraji Vysočina. Efektivita léčby hypertenze byla sledována po dobu 6 měsíců a byl sledován celý zdravotně sociální dopad kvality léčby hypertenze, kterému není zatím v naší republice věnována dostatečná pozornost.
Arterial hypertension with its high prevalence is an important concern for the modern society. In the Czech Republic, over the last years, the prevalence rates of arterial hypertension are 30–50 % in the adult population. The advent of modern therapies considerably improved prognosis in hypertensive patients. In view of these global trends, the Guidelines for the treatment of hypertension that provide recommendations for adequate and effective management of the condition were repeatedly revised. The most recent version of these guidelines ranks sartans, angiotensin II receptor antagonists, as an equal option to other groups of antihypertensives. Sartans act as specific and selective AT1 angiotensin receptor blockers. At the time of the trial, two AT1 angiotensin receptor antagonists, i.e. losartan and telmisartan, were commonly used in the Czech Republic. One of these drugs was added to the existing pharmacotherapy, with the choice being left to the discretion of the attending physician. As telmisartan was prescribed to more than 96 % of hypertensive patients, only these patients were analyzed. The study subjects were hypertensive patients treated by general practitioners, internists, cardiologists, diabetologists and endocrinologists from the following administrative regions: Central Bohemia, South Bohemia, Plzeň, Liberec, Ústí nad Labem, Olomouc, Pardubice, South Moravia and Highlands. Efficacy of antihypertensive therapy was followed up for 6 months and the focus was on
- MeSH
- antihypertenziva aplikace a dávkování MeSH
- benzimidazoly terapeutické užití MeSH
- benzoáty terapeutické užití MeSH
- blokátory receptoru typu 2 pro angiotensin II MeSH
- krevní tlak účinky záření MeSH
- kyselina močová krev MeSH
- lidé MeSH
- metabolismus lipidů účinky léků MeSH
- poměr pasu a boků MeSH
- receptor angiotensinu typ 2 terapeutické užití MeSH
- tělesná hmotnost účinky léků MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
INTRODUCTION: Rare diseases (RDs) collectively impact over 30 million people in Europe. Most individual conditions have a low prevalence which has resulted in a lack of research and expertise in this field, especially regarding genetic newborn screening (gNBS). There is increasing recognition of the importance of incorporating patients' needs and general public perspectives into the shared decision-making process regarding gNBS. This study is part of the Innovative Medicine Initiative project Screen4Care which aims at shortening the diagnostic journey for RDs by accelerating diagnosis for patients living with RDs through gNBS and the use of digital technologies, such as artificial intelligence and machine learning. Our objective will be to assess expecting parent's perspectives, attitudes and preferences regarding gNBS for RDs in Italy and Germany. METHODS AND ANALYSIS: A mixed method approach will assess perspectives, attitudes and preferences of (1) expecting parents seeking genetic consultation and (2) 'healthy' expecting parents from the general population in two countries (Germany and Italy). Focus groups and interviews using the nominal group technique and ranking exercises will be performed (qualitative phase). The results will inform the treatment of attributes to be assessed via a survey and a discrete choice experiment (DCE). The total recruitment sample will be 2084 participants (approximatively 1000 participants in each country for the online survey). A combination of thematic qualitative and logit-based quantitative approaches will be used to analyse the results of the study. ETHICS AND DISSEMINATION: This study has been approved by the Erlangen University Ethics Committee (22-246_1-B), the Freiburg University Ethics Committee (23-1005 S1-AV) and clinical centres in Italy (University of FerraraCE: 357/2023/Oss/AOUFe and Hospedale Bambino Gesu: No.2997 of 2 November 2023, Prot. No. _902) and approved for data storage and handling at the Uppsala University (2022-05806-01). The dissemination of the results will be ensured via scientific journal publication (open access).
BACKGROUND: Previous studies in multiple sclerosis (MS) showed that therapeutic inertia (TI) affects 60-90% of neurologists and up to 25% of daily treatment decisions. The objective of this study was to determine the most common factors and attribute levels associated with decisions to treatment escalation in an international study in MS care. METHODS: 300 neurologists with MS expertise from 20 countries were invited to participate. Participants were presented with 12 pairs of simulated MS patient profiles described by 13 clinically relevant factors. We used disaggregated discrete choice experiments to estimate the weight of factors and attributes affecting physicians' decisions when considering treatment selection. Participants were asked to select the ideal candidate for treatment escalation from modest to higher-efficacy therapies. RESULTS: Overall, 229 neurologists completed the study (completion rate: 76.3%). The top 3 weighted factors associated with treatment escalation were: previous relapses (20%), baseline expanded disability status scale [EDSS] (18%), and MRI activity (13%). Patient demographics and desire for pregnancy had a modest influence (≤ 3%). We observed differences in the weight of factors associated with treatment escalation between MS specialists and non-MS specialists. CONCLUSIONS: Our results provide critical information on factors influencing neurologists' treatment decisions and should be applied to continuing medical education strategies.
- MeSH
- lidé MeSH
- neurologové * MeSH
- recidiva MeSH
- roztroušená skleróza * farmakoterapie terapie MeSH
- specializace MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
