title: Preferences for antimuscarinic therapy for overactive bladder.
abstract: OBJECTIVE • To examine patient preferences and strength of preferences for treatment for the various symptoms of overactive bladder and adverse events associated with the use of antimuscarinic treatments. PATIENTS AND METHODS • A discrete choice experiment (DCE) survey was developed that detailed treatment choices in terms of attributes relating to their efficacy in reducing symptoms and the likelihood of experiencing typical adverse events. Levels for each attribute were based on a literature review, qualitative interviews and a meta-analysis of clinical trial data. • Attributes were combined into choice sets using a fractional orthogonal design that had been folded over. Pairs of choice sets were presented to overactive bladder (OAB) patients (n= 332), who indicated which treatment alternative they preferred. Data were analysed using the conditional logit model. RESULTS • Participants expressed the strongest preference for the avoidance of urgency incontinence episodes, followed by preference for a reduction in the experience of urinary urgency and the number of micturition episodes. The influence of the likelihood of experiencing an adverse event on treatment preference was also estimated. • Finally, marginal rates of substitution were calculated to demonstrate the relative value of trade-offs between the various attributes. • Treatment preferences were found to be broadly similar across two patient age groups (i.e. under 45 s and 45 and over). CONCLUSION • The study demonstrates that individuals with OAB place significant emphasis on the prospect of reduction in symptoms. Avoidance of incontinence episodes is particularly valued and equivalent to a much greater reduction in the frequency of micturition or experience of urgency. However, even a modest increase in the likelihood of experiencing an adverse event could easily motivate a change in treatment preference.
authors.affiliation: Oxford Outcomes Ltd, Oxford, UK. Paul.Swinburn@oxfordoutcomes.com
authors.forename: Paul
authors.initials: P
authors.lastname: Swinburn
authors.forename: Andrew
authors.initials: A
authors.lastname: Lloyd
authors.forename: Shehzad
authors.initials: S
authors.lastname: Ali
authors.forename: Noreen
authors.initials: N
authors.lastname: Hashmi
authors.forename: David
authors.initials: D
authors.lastname: Newal
authors.forename: Hiba
authors.initials: H
authors.lastname: Najib
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D057240:Patient Preference; D010865:Pilot Projects; D016032:Randomized Controlled Trials as Topic; D053201:Urinary Bladder, Overactive / Q000188:drug therapy / Q000523:psychology*; D014549:Urinary Incontinence / Q000523:psychology
chemical_list: D018727:Muscarinic Antagonists