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Preferences for antiviral therapy of chronic hepatitis C: a discrete choice experiment

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Abstract

Background

The German Institute for Quality and Efficiency in Health Care (IQWiG) uses patient-relevant outcomes to inform decision-makers.

Objective

IQWiG conducted a pilot study to examine whether discrete choice experiments (DCEs) can be applied in health economic evaluations in Germany to identify, weight, and prioritize multiple patient-relevant outcomes, using the example of antiviral therapy for chronic hepatitis C (HCV). A further objective was to contribute to a more structured approach towards eliciting and comparing preferences across key stakeholders.

Methods

In autumn 2010, a DCE questionnaire was sent to patients with chronic HCV to estimate preferences across seven outcomes (“attributes”), including treatment efficacy [sustained viral response (SVR) at 6 months], adverse effects (flu-like symptoms, gastrointestinal symptoms, psychiatric symptoms, and skin symptoms/alopecia), and measures of treatment burden (duration of therapy, frequency of injections). A linear model and an effects coded full model were applied to assess the relative importance of the attributes.

Results

In total N = 326 patients were included. A clear preference for SVR was shown; frequency of injections and duration of therapy shared the second rank, while psychiatric symptoms ranked third. The duration of flu-like symptoms was the least important attribute.

Conclusion

Our findings indicate that it is possible to perform a DCE at the national level in a health technology assessment agency. The weighting of multiple outcomes allows an indication-specific and evidence-based measure to be used in health economic evaluations. In decision-making in health care, the approach generally allows for consideration of patient-relevant trade-offs regarding the benefits and harms of medical interventions.

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Notes

  1. Note The present pilot study on the treatment of HCV uses attributes and outcomes that might not necessarily correspond to patient-relevant outcomes pursuant to SGB V (i.e., outcomes describing morbidity, mortality, and health-related quality of life). It cannot be concluded from the language used in the present paper that IQWiG would regard the attributes and outcomes applied to represent (patient-relevant) outcomes in the event of a benefit assessment.

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Acknowledgments

Christin Juhnke, Anika Kaczynski, Andrew Sadler, Fülöp Scheibler, and Beate Wiegard provided technical assistance.

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Authors and Affiliations

  1. Institute for Health Economics and Health Care Management (IGM), University of Applied Sciences Neubrandenburg, Brodaer Straße 2, 17033, Neubrandenburg, Germany

    Axel C. Mühlbacher & Susanne Bethge

  2. Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA

    Axel C. Mühlbacher

  3. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    John F. P. Bridges

  4. Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany

    Anja Schwalm & Andreas Gerber-Grote

  5. Strategic Market Access Intelligence, Bayer Health Care, Leverkusen, Germany

    Ch.-Markos Dintsios

  6. Department of Public Health, Faculty of Medicine, Heinrich-Heine University, Düsseldorf, Germany

    Ch.-Markos Dintsios

  7. Empirical Consulting mbH (GEB mbH), Freiburg, Germany

    Matthias Nübling

Authors
  1. Axel C. Mühlbacher
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  2. John F. P. Bridges
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  4. Ch.-Markos Dintsios
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  7. Matthias Nübling
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Corresponding author

Correspondence to Axel C. Mühlbacher.

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Funding

This study was funded by the German Institute for Quality and Efficiency in Health Care (IQWiG).

Conflict of interest

AS and AGG are employees of IQWiG. CMD was employed by IQWiG until 31 July 2011 and is now employed by Bayer Health Care as well as the Heinrich-Heine University of Düsseldorf. AS, AGG, and CMD have received remuneration from IQWiG for their work as external experts. JB is an employee of Johns Hopkins University. MN and AM are employees of Empirical Consulting mbH. AM and SB are employees of the University of Applied Sciences Neubrandenburg.

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Mühlbacher, A.C., Bridges, J.F.P., Bethge, S. et al. Preferences for antiviral therapy of chronic hepatitis C: a discrete choice experiment. Eur J Health Econ 18, 155–165 (2017). https://doi.org/10.1007/s10198-016-0763-8

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  • DOI: https://doi.org/10.1007/s10198-016-0763-8

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