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      Evaluating Patient Preferences of Maintenance Therapy for the Treatment of Chronic Obstructive Pulmonary Disease: A Discrete Choice Experiment in the UK, USA and Germany

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          With increasing availability of different treatments for chronic obstructive pulmonary disease (COPD), we sought to understand patient preferences for COPD treatment in the UK, USA, and Germany using a discrete choice experiment (DCE).


          Qualitative research identified six attributes associated with COPD maintenance treatments: ease of inhaler use, exacerbation frequency, frequency of inhaler use, number of different inhalers used, side effect frequency, and out-of-pocket costs. A DCE using these attributes, with three levels each, was designed and tested through cognitive interviews and piloting. It comprised 18 choice sets, selected using a D-efficient experimental design. Demographics and disease history were collected and the final DCE survey was completed online by participants recruited from panels in the UK, USA and Germany. Responses were analyzed using mixed logit models, with results expressed as odds ratios (ORs).


          Overall, 450 participants (150 per country) completed the DCE; most (UK and Germany, 97.3%; USA, 98.0%) were included in the final analysis. Based on relative attribute importance, avoidance of side effects was found to be most important (UK: OR 11.65; USA: OR 7.17; Germany: OR 11.45; all p<0.0001), followed by the likelihood of fewer exacerbations (UK: OR 2.22; USA: OR 1.63; Germany: OR 2.54; all p<0.0001) and increased ease of use (UK: OR 1.84; USA: OR 1.84; Germany: OR 1.60; all p<0.0001). Number of inhalers, out-of-pocket costs, and frequency of inhaler use were found to be less important. Preferences were relatively consistent across the three countries. All participants required a reduction in exacerbations to accept more frequent inhaler use or use of more inhalers.


          When selecting COPD treatment, individuals assigned the highest value to the avoidance of side effects, experiencing fewer exacerbations, and ease of inhaler use. Ensuring that patients’ preferences are considered may encourage treatment compliance.

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          Most cited references 9

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          A Framework for Instrument Development of a Choice Experiment: An Application to Type 2 Diabetes.

          Choice experiments are increasingly used to obtain patient preference information for regulatory benefit-risk assessments. Despite the importance of instrument design, there remains a paucity of literature applying good research principles. We applied a novel framework for instrument development of a choice experiment to measure type 2 diabetes mellitus treatment preferences.
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            Improving the quality of discrete-choice experiments in health: how can we assess validity and reliability?

            The recent endorsement of discrete-choice experiments (DCEs) and other stated-preference methods by regulatory and health technology assessment (HTA) agencies has placed a greater focus on demonstrating the validity and reliability of preference results. Areas covered: We present a practical overview of tests of validity and reliability that have been applied in the health DCE literature and explore other study qualities of DCEs. From the published literature, we identify a variety of methods to assess the validity and reliability of DCEs. We conceptualize these methods to create a conceptual model with four domains: measurement validity, measurement reliability, choice validity, and choice reliability. Each domain consists of three categories that can be assessed using one to four procedures (for a total of 24 tests). We present how these tests have been applied in the literature and direct readers to applications of these tests in the health DCE literature. Based on a stakeholder engagement exercise, we consider the importance of study characteristics beyond traditional concepts of validity and reliability. Expert commentary: We discuss study design considerations to assess the validity and reliability of a DCE, consider limitations to the current application of tests, and discuss future work to consider the quality of DCEs in healthcare.
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              The Internal Validity of Discrete Choice Experiment Data: A Testing Tool for Quantitative Assessments

              To develop a tool for testing internal validity of discrete choice experiment (DCE) data, deploy the program, and collect summary test results from a sample of active health researchers to demonstrate the practical utility of the tool in a wide range of health applications.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of Chronic Obstructive Pulmonary Disease
                18 March 2020
                : 15
                : 595-604
                [1 ]Patient Centred Outcomes, ICON plc ., London, UK
                [2 ]Value Evidence and Outcomes, GlaxoSmithKline plc ., Brentford, UK
                [3 ]Value Evidence and Outcomes, GlaxoSmithKline plc ., Uxbridge, UK
                [4 ]Patient Centred Outcomes, ICON plc ., Gaithersburg, MD, USA
                [5 ]Patient Centred Outcomes, ICON plc ., Abingdon, UK
                [6 ]Respiratory Therapy Area, GlaxoSmithKline plc ., Brentford, UK
                [7 ]Value Evidence and Outcomes, GlaxoSmithKline plc ., Collegeville, PA, USA
                [8 ]Department of Health Research Methods, Evidence and Impact, McMaster University , Hamilton, ON, Canada
                Author notes
                Correspondence: Afisi S Ismaila Value Evidence and Outcomes, GlaxoSmithKline plc ., 1250 South Collegeville Road, Collegeville, PA19426-0989, USATel +1 919 932 0430 Email
                © 2020 Lewis et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (

                Page count
                Figures: 3, Tables: 4, References: 20, Pages: 10
                The study was funded by GlaxoSmithKline plc. ( NCT03046069; GlaxoSmithKline plc. study CTT206455). Editorial support (in the form of writing assistance, collating author comments, assembling tables/figures, grammatical editing, and referencing) was provided by Molly Macpherson, BSc, of Gardiner–Caldwell Communications (Macclesfield, UK), and was funded by GlaxoSmithKline plc. Trade marks are owned by or licensed to their respective owners (the GSK group of companies or AstraZeneca PLC).
                Original Research


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