title: Societal preferences for rheumatoid arthritis treatments: evidence from a discrete choice experiment.
abstract: OBJECTIVE
  There is a concern that cost-effectiveness analysis using quality-adjusted life years does not capture all valuable benefits of treatments. The objective of this study was to determine the value society places on aspects of RA treatment to inform policymaking.
  
  
  METHODS
  A discrete choice experiment was administered to a representative sample of the Canadian general population. The discrete choice experiment, developed using focus groups, had seven attributes (route and frequency of administration, chance of benefit, chance of serious and minor side effects, confidence in evidence and life expectancy). A conditional logit regression model was used to estimate the significance and relative importance of attributes in influencing preferences on the quality-adjusted life years scale.
  
  
  RESULTS
  Responses from 733 respondents who provided rational responses were analysed. Six attribute levels within four attributes significantly influenced preferences for treatments: a willingness to trade a year of life expectancy over a 10-year period to increase the probability of benefiting from treatment, or two-thirds of a year to reduce minor or serious side effects to the lowest level or improve the confidence in benefit/side-effect estimates. There was also some evidence of a preference for oral drug delivery, though a subgroup analysis suggested this preference was restricted to injection-naive respondents.
  
  
  CONCLUSIONS
  Our results suggest society values the degree of confidence in the estimates of risks and benefits of RA treatments and the route of administration, as well as benefits and side effects. This study provides important evidence to policymakers determining the cost-effectiveness of treatments in arthritis.
authors.affiliation: Faculty of Pharmaceutical Sciences, University of British Columbia, Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada, Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Harrison
authors.affiliation: Faculty of Pharmaceutical Sciences, University of British Columbia, Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada, Arthritis Research Centre of Canada.
authors.forename: Carlo
authors.initials: C
authors.lastname: Marra
authors.affiliation: Arthritis Research Centre of Canada, Division of Rheumatology, University of British Columbia and.
authors.forename: Kam
authors.initials: K
authors.lastname: Shojania
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada, Arthritis Research Centre of Canada, School of Population and Public Health, University of British Columbia, Vancouver, Canada nick.bansback@ubc.ca.
authors.forename: Nick
authors.initials: N
authors.lastname: Bansback
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics / Q000523:psychology*; D002170:Canada; D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D019057:Quality-Adjusted Life Years; D012044:Regression Analysis; D012307:Risk Factors; D066262:Social Norms; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents
keywords: arthritis; biologics; decision making; discrete choice experiment; health economics; mode of administration; preference; risk-benefit assessment; societal preferences