Discrete choice experiment to evaluate factors that influence preferences for antibiotic prophylaxis in pediatric oncology.
BACKGROUND
Bacterial and fungal infections in pediatric oncology patients cause morbidity and mortality. The clinical utility of antimicrobial prophylaxis in children is uncertain and the personal utility of these agents is disputed. Objectives were to use a discrete choice experiment to: (1) describe the importance of attributes to parents and healthcare providers when deciding between use and non-use of antibacterial and antifungal prophylaxis; and (2) estimate willingness-to-pay for prophylactic strategies.


METHODS
Attributes were chances of infection, death and side effects, route of administration and cost of pharmacotherapy. Respondents were randomized to a discrete choice experiment outlining hypothetical treatment options to prevent antibacterial or antifungal infections. Each respondent was presented 16 choice tasks and was asked to choose between two unlabeled treatment options and an opt-out alternative (no prophylaxis).


RESULTS
102 parents and 60 healthcare providers participated. For the antibacterial discrete choice experiment, frequency of administration was significantly associated with utility for parents but not for healthcare providers. Increasing chances of infection, death, side effects and cost were all significantly associated with decreased utility for parents and healthcare providers in both the antibacterial and antifungal discrete choice experiment. Parental willingness-to-pay was higher than healthcare providers for both strategies.


CONCLUSIONS
Chances of infection, death, side effects and costs were all significantly associated with utility. Parents have higher willingness-to-pay for these strategies compared with healthcare providers. This knowledge can help to develop prophylaxis programs.
Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Agency, Vancouver, British Columbia, Canada.
Dean A
DA
Regier
Caroline
C
Diorio
Marie-Chantal
MC
Ethier
Amanda
A
Alli
Sarah
S
Alexander
Katherine M
KM
Boydell
Adam
A
Gassas
Jonathan
J
Taylor
Charis
C
Kellow
Denise
D
Mills
Lillian
L
Sung
D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000494:pharmacology; D019072:Antibiotic Prophylaxis / Q000191:economics; D000935:Antifungal Agents / Q000191:economics / Q000494:pharmacology; D002648:Child; D002755:Choice Behavior; D005260:Female; D006282:Health Personnel; D006801:Humans; D016015:Logistic Models; D008297:Male; D008495:Medical Oncology; D057240:Patient Preference
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents