title: Patient preferences and willingness-to-pay for a home or clinic based program of chronic heart failure management: findings from the Which? trial.
abstract: BACKGROUND
  Beyond examining their overall cost-effectiveness and mechanisms of effect, it is important to understand patient preferences for the delivery of different modes of chronic heart failure management programs (CHF-MPs). We elicited patient preferences around the characteristics and willingness-to-pay (WTP) for a clinic or home-based CHF-MP.
  
  
  RESULTS
  A Discrete Choice Experiment was completed by a sub-set of patients (n = 91) enrolled in the WHICH? trial comparing home versus clinic-based CHF-MP. Participants provided 5 choices between hypothetical clinic and home-based programs varying by frequency of nurse consultations, nurse continuity, patient costs, and availability of telephone or education support. Participants (aged 71±13 yrs, 72.5% male, 25.3% NYHA class III/IV) displayed two distinct preference classes. A latent class model of the choice data indicated 56% of participants preferred clinic delivery, access to group CHF education classes, and lower cost programs (p<0.05). The remainder preferred home-based CHF-MPs, monthly rather than weekly visits, and access to a phone advice service (p<0.05). Continuity of nurse contact was consistently important. No significant association was observed between program preference and participant allocation in the parent trial. WTP was estimated from the model and a dichotomous bidding technique. For those preferring clinic, estimated WTP was ≈AU$9-20 per visit; however for those preferring home-based programs, WTP varied widely (AU$15-105).
  
  
  CONCLUSIONS
  Patient preferences for CHF-MPs were dichotomised between a home-based model which is more likely to suit older patients, those who live alone, and those with a lower household income; and a clinic-based model which is more likely to suit those who are more socially active and wealthier. To optimise the delivery of CHF-MPs, health care services should consider their patients' preferences when designing CHF-MPs.
authors.affiliation: Centre for Applied Health Economics, School of Medicine, Griffith Health Institute, Griffith University, Meadowbrook, Queensland, Australia. j.whitty@griffith.edu.au
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Whitty
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Carrington
authors.forename: Alicia
authors.initials: A
authors.lastname: Calderone
authors.forename: Thomas
authors.initials: T
authors.lastname: Marwick
authors.forename: John D
authors.initials: JD
authors.lastname: Horowitz
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.forename: Peter S
authors.initials: PS
authors.lastname: Macdonald
authors.forename: Christopher
authors.initials: C
authors.lastname: Reid
authors.forename: Paul A
authors.initials: PA
authors.lastname: Scuffham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D012959:Socioeconomic Factors