title: Patient preferences for osteoporosis in Spain: a discrete choice experiment.
abstract: In Spain, various treatments are available to prevent osteoporotic fractures. A discrete choice experiment (DCE) was used to investigate the importance of different treatment aspects and its influence on patients' preferences. All attributes included as type and place of drug administration as well as costs showed to be significant predictors of choice. Spanish osteoporosis patients have well-defined preferences and accept trade-offs among attributes.
  
  
  BACKGROUND
  This study was designed to identify patient preferences for different aspects of osteoporosis treatments in Spain.
  
  
  METHODS
  Main attributes of severe osteoporosis treatments were determined by literature review and consultations with nurses. The discrete choice experiment included three attributes: type of drug administration, place of administration, plus a cost attribute in order to estimate willingness to pay for improvements in attribute levels. A pilot study with 50 patients was performed to identify the areas of misunderstanding. One hundred sixty-six patients with a diagnosis of osteoporosis and severe osteoporosis were presented with pairs of hypothetical treatment profiles with different type of administration levels, places of administration and costs. Questions to collect socio-demographic and disease-related treatment data were also included. Data were analysed using a random effects probit model.
  
  
  RESULTS
  All attributes had the expected polarity and were significant predictors of choice. Patients were willing to pay 183 euro/month to have a subcutaneous injection once per day rather than an intravenous injection once per year. Patients with osteoporosis were willing to pay 121 euro/month to have medical support when administering the drug treatment at home rather than being admitted several hours to a hospital for drug administration.
  
  
  CONCLUSIONS
  Spanish osteoporosis patients have well-defined preferences among treatment attributes and are willing to accept trade-offs among attributes. Participants indicated that they are willing to accept self medication with medical support rather than being hospitalised for several hours. The perspective of the patients should be taken into account when making treatment decisions.
authors.affiliation: Department of Economics, Universitat de Barcelona, Diagonal 690, 08034 Barcelona, Spain. darba@ub.edu
authors.forename: J
authors.initials: J
authors.lastname: Darbà
authors.forename: G
authors.initials: G
authors.lastname: Restovic
authors.forename: L
authors.initials: L
authors.lastname: Kaskens
authors.forename: M A
authors.initials: MA
authors.lastname: Balbona
authors.forename: A
authors.initials: A
authors.lastname: Carbonell
authors.forename: P
authors.initials: P
authors.lastname: Cavero
authors.forename: M
authors.initials: M
authors.lastname: Jordana
authors.forename: C
authors.initials: C
authors.lastname: Prieto
authors.forename: A
authors.initials: A
authors.lastname: Molina
authors.forename: I
authors.initials: I
authors.lastname: Padró
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002755:Choice Behavior; D004334:Drug Administration Schedule; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D058866:Osteoporotic Fractures / Q000517:prevention & control; D057240:Patient Preference / Q000191:economics / Q000706:statistics & numerical data*; D012646:Self Administration; D012959:Socioeconomic Factors; D013030:Spain
chemical_list: D050071:Bone Density Conservation Agents