title: Preferences for antiviral therapy of chronic hepatitis C: a discrete choice experiment.
abstract: BACKGROUND
  The German Institute for Quality and Efficiency in Health Care (IQWiG) uses patient-relevant outcomes to inform decision-makers.
  
  
  OBJECTIVE
  IQWiG conducted a pilot study to examine whether discrete choice experiments (DCEs) can be applied in health economic evaluations in Germany to identify, weight, and prioritize multiple patient-relevant outcomes, using the example of antiviral therapy for chronic hepatitis C (HCV). A further objective was to contribute to a more structured approach towards eliciting and comparing preferences across key stakeholders.
  
  
  METHODS
  In autumn 2010, a DCE questionnaire was sent to patients with chronic HCV to estimate preferences across seven outcomes ("attributes"), including treatment efficacy [sustained viral response (SVR) at 6 months], adverse effects (flu-like symptoms, gastrointestinal symptoms, psychiatric symptoms, and skin symptoms/alopecia), and measures of treatment burden (duration of therapy, frequency of injections). A linear model and an effects coded full model were applied to assess the relative importance of the attributes.
  
  
  RESULTS
  In total N = 326 patients were included. A clear preference for SVR was shown; frequency of injections and duration of therapy shared the second rank, while psychiatric symptoms ranked third. The duration of flu-like symptoms was the least important attribute.
  
  
  CONCLUSIONS
  Our findings indicate that it is possible to perform a DCE at the national level in a health technology assessment agency. The weighting of multiple outcomes allows an indication-specific and evidence-based measure to be used in health economic evaluations. In decision-making in health care, the approach generally allows for consideration of patient-relevant trade-offs regarding the benefits and harms of medical interventions.
authors: Institute for Health Economics and Health Care Management (IGM), University of Applied Sciences Neubrandenburg, Brodaer Straße 2, 17033, Neubrandenburg, Germany. muehlbacher@hs-nb.de.|Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA. muehlbacher@hs-nb.de.
authors: Axel C
authors: AC
authors: Mühlbacher
authors: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: John F P
authors: JF
authors: Bridges
authors: Institute for Health Economics and Health Care Management (IGM), University of Applied Sciences Neubrandenburg, Brodaer Straße 2, 17033, Neubrandenburg, Germany.
authors: Susanne
authors: S
authors: Bethge
authors: Strategic Market Access Intelligence, Bayer Health Care, Leverkusen, Germany.|Department of Public Health, Faculty of Medicine, Heinrich-Heine University, Düsseldorf, Germany.
authors: Ch-Markos
authors: CM
authors: Dintsios
authors: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
authors: Anja
authors: A
authors: Schwalm
authors: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
authors: Andreas
authors: A
authors: Gerber-Grote
authors: Empirical Consulting mbH (GEB mbH), Freiburg, Germany.
authors: Matthias
authors: M
authors: Nübling
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002755:Choice Behavior; D003661:Decision Support Techniques; D005260:Female; D005858:Germany; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000523:psychology*; D010865:Pilot Projects; D012959:Socioeconomic Factors; D000072230:Sustained Virologic Response
chemical_list: D000998:Antiviral Agents; D007372:Interferons
keywords: Conjoint analysis (CA); Discrete choice experiment (DCE); Health technology assessment (HTA); Hepatitis C virus (HCV); Patient preferences; Priority setting