Are Patients' Preferences Transferable Between Countries? A Cross-European Discrete-Choice Experiment to Elicit Patients' Preferences for Osteoporosis Drug Treatment

Abstract

Objectives: Discrete-choice experiments are increasingly used to assess preferences in health care. To date, very little is known about the transferability of patients' preferences between jurisdictions. In this study, we aim to evaluate the preferences of patients with, or at risk of, osteoporosis for medication attributes in six European countries, and to assess whether preferences are transferable across these countries Methods: A discrete-choice experiment was conducted using a questionnaire in Belgium, France, Ireland, Spain, Switzerland and United Kingdom. Patients were asked to choose between two hypothetical unlabelled drug treatments (and an opt-out option) that vary in several attributes: efficacy in reducing the risk of fracture, type of potential common side-effects, mode and frequency of administration and out-of-pocket costs (only in countries with patients-contribution on the cost of treatment). An efficient design was used to construct the treatment option choice sets and a mixed logit model was used to estimate patients' preferences. Results: A total of 1,124 patients completed the experiment, with at least 100 patients per country. As expected, in all countries, patients preferred treatment with higher effectiveness and lower cost was preferred in the three countries in which a cost-attribute was part of the experiment. In all countries, patients preferred 6-monthly subcutaneous injection over weekly oral tablets. In most countries, patients also preferred monthly oral tablet and yearly intravenous injections over weekly oral tablets. Patients disliked being at risk of gastro-intestinal disorders more than being at risk of skin reactions and flu-like symptoms, except in Spain. There were significant differences between countries for some levels of attributes. Conclusions: This study suggests that the preferences of patients for osteoporotic drug therapy did not substantially differ between six European countries. However, for levels of some attributes, significant differences were observed.