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Patient Preferences for Managing Insomnia: A Discrete Choice Experiment

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Abstract

Background

Despite the rapid development of effective treatments, both pharmacological and non-pharmacological, insomnia management remains suboptimal at the practice interface. Patient preferences play a critical role in influencing treatment outcomes. However, there is currently a mismatch between patient preferences and clinician recommendations, partly perpetuated by a limited understanding of the patients’ decision-making process.

Objectives

The aim of our study was to empirically quantify patient preferences for treatment attributes common to both pharmacological and non-pharmacological insomnia treatments.

Method

An efficient dual-response discrete choice experiment was conducted to evaluate patient treatment preferences for managing insomnia. The sample included 205 patients with self-reported insomnia and an Insomnia Severity Index ≥ 14. Participants were presented with two unlabelled hypothetical scenarios with an opt-out option across 12 choice sets. Data were analyzed using a mixed multinomial logit model to investigate the influence of five attributes (i.e. time, onset of action, maintainability of improved sleep, length of treatment, and monthly cost) on treatment preferences.

Results

Treatments were preferentially viewed if they conferred long-term sleep benefits (p < 0.05); had an ongoing, as opposed to a predefined, duration of treatment course (p < 0.05); required some, as opposed to no, additional time commitment (p < 0.05); and had lower monthly out-of-pocket treatment costs (p < 0.001). However, treatment onset of action had no influence on preference. Age, help-seeking status, concession card status and fatigue severity significantly influenced treatment preference.

Conclusion

Participants’ prioritization of investing time in treatment and valuing the maintainability of therapeutic gains suggests a stronger inclination towards non-pharmacological treatment, defying current assumptions that patients prefer ‘quick-fixes’ for managing insomnia.

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Notes

  1. Benzodiazepine receptor agonists, e.g. temazepam and zolpidem.

  2. Cognitive behavioural treatment for insomnia (CBT-I).

  3. The Woolcock Institute of Medical Research (WIMR), Sydney, Australia, and Brain and Mind Centre (formerly Brain and Mind Research Institute), Sydney, Australia.

  4. General Practice Clinics and Community Pharmacy.

  5. Sleep Disorders Australia is a group that aims to provide information and support to individuals with sleep disorders and their families (https://www.sleepoz.org.au/)

  6. The attribute levels for cost (i.e. $15, $30, $60, $120 and $240) were informed by an estimation of the cost of a private prescription for zolpidem at $19, the recommended fee schedule of $181 for a 31- to 45-min consultation with a psychologist in 2015. We also accounted for patients’ willingness to pay $40 into the cost attribute levels.

  7. DASS-21 reported as three separate subscales for Depression, Anxiety and Stress symptoms.

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Acknowledgements

The current study was undertaken with financial support in the form of ‘seed funding’ provided by the National Health and Medical Research Council, CIRUS, Centre for Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia (grant number 571421). Bandana Saini is the chief investigator and Janet M. Y. Cheung is the associate investigator.

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Authors and Affiliations

  1. Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Sydney, NSW, 2006, Australia

    Janet M. Y. Cheung & Bandana Saini

  2. CIRUS, Centre for Integrated Research and Understanding of Sleep, The Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia

    Janet M. Y. Cheung, Delwyn J. Bartlett & Bandana Saini

  3. Clinical Management Group, The Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia

    Carol L. Armour

  4. Sydney Local Health District, Sydney, NSW, Australia

    Carol L. Armour

  5. The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia

    Tracey-Lea Laba

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  1. Janet M. Y. Cheung
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  3. Carol L. Armour
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  4. Bandana Saini
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  5. Tracey-Lea Laba
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Contributions

JC conducted the research, analysis and writing of the initial draft of the manuscript. TL and JC conceptualized the initial econometric design for the research instrument. TL, JC BS, DB, CA refined the econometric design for the research instrument. TL provided expert advice on the econometric modelling technique and guided the data analysis. JC carried out the initial analysis and interpretation of the data. TL, DB, CA and BS provided advice on the interpretation of the data. All authors critically revised the manuscript.

Corresponding author

Correspondence to Janet M. Y. Cheung.

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Conflict of interest

Janet M.Y. Cheung, Delwyn J. Bartlett, Carol L. Armour, Bandana Saini and Tracey-Lea Laba have no further financial or intellectual conflicts of interest to declare.

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Cheung, J.M.Y., Bartlett, D.J., Armour, C.L. et al. Patient Preferences for Managing Insomnia: A Discrete Choice Experiment. Patient 11, 503–514 (2018). https://doi.org/10.1007/s40271-018-0303-y

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