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      Patients’ preferences for osteoporosis drug treatment: a discrete-choice experiment


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          The patient’s perspective is becoming increasingly important in clinical and policy decisions. In this study, we aimed to evaluate the preferences of patients with, or at risk of, osteoporosis for medication attributes, and to establish how patients trade between these attributes.


          A discrete choice experiment survey was designed and patients were asked to choose between two hypothetical unlabelled drug treatments (and an opt-out option) that vary in five attributes: efficacy in reducing the risk of fracture, type of potential common side-effects, mode and frequency of administration and out-of-pocket costs. An efficient experimental design was used to construct the treatment option choice sets and a mixed logit panel data model was used to estimate patients’ preferences and trade-offs between attributes.


          A total of 257 patients with, or at risk of, osteoporosis completed the experiment. As expected, patients preferred treatment with higher effectiveness and lower cost. They also preferred either an oral monthly tablet or 6-month subcutaneous injection above weekly oral tablets, 3-month subcutaneous, 3-month intravenous or yearly intravenous injections. Patients disliked being at risk of gastro-intestinal disorders more than being at risk of skin reactions and flu-like symptoms. There was significant variation in preferences across the sample for all attributes except subcutaneous injection.


          This study revealed that osteoporotic patients preferred 6-month subcutaneous injection and oral monthly tablet, and disliked gastro-intestinal disorders. Moreover, patients were willing to pay a personal contribution or to trade treatment efficacy for better levels of other attributes. Preferences for treatment attributes varied across patients and this highlights the importance of clinical decision-making taking individual preferences into account to improve osteoporosis care.

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          Most cited references17

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          Discrete choice experiments in health care.

          Mandy Ryan (2004)
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            Conjoint Analysis Applications in Health - How are Studies being Designed and Reported?: An Update on Current Practice in the Published Literature between 2005 and 2008.

            Despite the increased popularity of conjoint analysis in health outcomes research, little is known about what specific methods are being used for the design and reporting of these studies. This variation in method type and reporting quality sometimes makes it difficult to assess substantive findings. This review identifies and describes recent applications of conjoint analysis based on a systematic review of conjoint analysis in the health literature. We focus on significant unanswered questions for which there is neither compelling empirical evidence nor agreement among researchers.We searched multiple electronic databases to identify English-language articles of conjoint analysis applications in human health studies published since 2005 through to July 2008. Two independent reviewers completed the detailed data extraction, including descriptive information, methodological details on survey type, experimental design, survey format, attributes and levels, sample size, number of conjoint scenarios per respondent, and analysis methods. Review articles and methods studies were excluded. The detailed extraction form was piloted to identify key elements to be included in the database using a standardized taxonomy.We identified 79 conjoint analysis articles that met the inclusion criteria. The number of applied studies increased substantially over time in a broad range of clinical applications, cancer being the most frequent. Most used a discrete-choice survey format (71%), with the number of attributes ranging from 3 to 16. Most surveys included 6 attributes, and 73% presented 7-15 scenarios to each respondent. Sample size varied substantially (minimum = 13, maximum = 1258), with most studies (38%) including between 100 and 300 respondents. Cost was included as an attribute to estimate willingness to pay in approximately 40% of the articles across all years.Conjoint analysis in health has expanded to include a broad range of applications and methodological approaches. Although we found substantial variation in methods, terminology, and presentation of findings, our observations on sample size, the number of attributes, and number of scenarios presented to respondents should be helpful in guiding researchers when planning a new conjoint analysis study in health.
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              A systematic review of persistence and compliance with bisphosphonates for osteoporosis.

              Fourteen reports utilizing data from de-identified administrative databases were reviewed. Studies contained at least one measure of patient persistence or compliance with bisphosphonates or bisphosphonates and other anti-osteoporosis medications. These studies confirm that women with osteoporosis have suboptimal persistence and compliance rates with bisphosphonate therapy. This review summarizes patient persistence and compliance with bisphosphonates for the treatment of osteoporosis. We conducted a MEDLINE search for the period from January 1998 to May 2006, using a detailed list of terms related to persistence and compliance with anti-osteoporosis medications. Studies were included if they contained at least one measure of persistence or compliance derived from de-identified administrative databases containing patient demographics and prescription information. We reviewed 14 reports, which described 14 databases. The percentage of patients persisting with therapy for 1 year ranged from 17.9% to 78.0%. Compliance, assessed as mean medication possession ratio (MPR), ranged from 0.59 to 0.81. When comparing compliance with weekly and daily bisphosphonates, the mean MPR was consistently higher for weekly versus daily therapy (0.58 to 0.76 versus 0.46 to 0.64 for patients receiving weekly and daily bisphosphonate therapy respectively). Persistence was also improved in patients receiving weekly bisphosphonates, assessed by both length of persistence (194 to 269 days [weekly] and 134 to 208 days [daily]) and percentage of persistent patients at the end of the follow-up period (35.7% to 69.7% [weekly] and 26.1% to 55.7% [daily]). Although patients using weekly bisphosphonate medication follow their prescribed dosing regimens better than those using daily therapy, overall compliance and persistence rates were suboptimal.

                Author and article information

                Arthritis Res Ther
                Arthritis Res. Ther
                Arthritis Research & Therapy
                BioMed Central
                31 January 2014
                : 16
                : 1
                : R36
                [1 ]Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
                [2 ]Department of Business Economics, Erasmus Rotterdam University, Rotterdam, the Netherlands
                [3 ]Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, the Netherlands
                [4 ]Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
                [5 ]Department of Rheumatology and Endocrinology, Ghent University Hospital, Gent, Belgium
                [6 ]Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium
                [7 ]Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
                [8 ]Department of Internal Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
                Copyright © 2014 Hiligsmann et al.; licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 13 July 2013
                : 10 January 2014
                Research Article



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