Background/Purpose
The cost-effectiveness of new interventions is increasingly assessed using the cost per quality-adjusted life year (QALY). QALYs are calculated by multiplying the length of time spent in a health state by the value of that health state, usually representative of the general public and estimated using a generic preference-based measure such as the EQ-5D. A limitation of generic preference based instruments is that they may fail to describe benefits of a treatment that patients experience and that society might value such as the method or convenience of treatment. The aim of this study was to determine the value society places on aspects of rheumatoid arthritis treatment, including mode of administration
Methods
A discrete choice experiment (DCE) was administered using a web survey in a representative sample of the Canadian general population using an online panel. Focus groups led to the development of a DCE with 7 attributes (route and frequency of administration, chance of benefit, chance of serious and minor side-effects, confidence in benefit and side-effect estimates (based on GRADE definitions), and life expectancy. An experimental design led to the development of 120 choice sets. Each respondent was randomized to complete 10 of these. A conditional logit regression model was used to estimate the significance and relative importance of attributes in influencing preferences. The life years attribute enables the DCE to estimate values on the health utility scale for use in QALY calculations.
Results
Responses from 733 respondents who provided rational responses to the choices in the experiment were included in the analysis. They were recruited from all provinces and territories in Canada, and their mean age (44), gender (55% female) and education (45% had up to a high school education) were representative of the general population. Six attribute levels within four attributes significantly influenced preferences for treatments. Respondents were willing to give up to a year of life expectancy over a 10 year period to increase the probability of benefitting from treatment, or two thirds of a year to reduce minor or serious side-effects to the lowest level or improve the confidence in benefit/side-effect estimates. There was some evidence of a preference for oral drug delivery and sub-group analysis suggested this preference was restricted to injection naive respondents.
Conclusion
As expected, our study found society values the benefits and side-effects of treatments. However, our study also found that people also value the degree of confidence in the estimates of risks and benefits of treatments, and to a lesser extent, the route of administration. Since economic evaluations typically focus only on the health outcomes of treatments, they may miss process aspects of treatment that are valued by society. This study provides important evidence to policy makers determining the cost-effectiveness of treatments in arthritis.
Disclosure:
M. Harrison,
None;
C. Marra,
Pfizer Inc,
2;
K. Shojania,
Abbvie, Janssen, BMS, UCB, Roche, Amgen.,
5;
N. Bansback,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/societal-preferences-for-rheumatoid-arthritis-treatments-evidence-from-a-discrete-choice-experiment/