title: Economic considerations and patients' preferences affect treatment selection for patients with rheumatoid arthritis: a discrete choice experiment among European rheumatologists.
abstract: OBJECTIVE
  To compare the value that rheumatologists across Europe attach to patients' preferences and economic aspects when choosing treatments for patients with rheumatoid arthritis.
  
  
  METHODS
  In a discrete choice experiment, European rheumatologists chose between two hypothetical drug treatments for a patient with moderate disease activity. Treatments differed in five attributes: efficacy (improvement and achieved state on disease activity), safety (probability of serious adverse events), patient's preference (level of agreement), medication costs and cost-effectiveness (incremental cost-effectiveness ratio (ICER)). A Bayesian efficient design defined 14 choice sets, and a random parameter logit model was used to estimate relative preferences for rheumatologists across countries. Cluster analyses and latent class models were applied to understand preference patterns across countries and among individual rheumatologists.
  
  
  RESULTS
  Responses of 559 rheumatologists from 12 European countries were included in the analysis (49% females, mean age 48 years). In all countries, efficacy dominated treatment decisions followed by economic considerations and patients' preferences. Across countries, rheumatologists avoided selecting a treatment that patients disliked. Latent class models revealed four respondent profiles: one traded off all attributes except safety, and the remaining three classes disregarded ICER. Among individual rheumatologists, 57% disregarded ICER and these were more likely from Italy, Romania, Portugal or France, whereas 43% disregarded uncommon/rare side effects and were more likely from Belgium, Germany, Hungary, the Netherlands, Norway, Spain, Sweden or UK.
  
  
  CONCLUSIONS
  Overall, European rheumatologists are willing to trade between treatment efficacy, patients' treatment preferences and economic considerations. However, the degree of trade-off differs between countries and among individuals.
authors.affiliation: CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands.|Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hifinger
authors.affiliation: CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands.|Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hiligsmann
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-8899-9087
authors.initials: S
authors.lastname: Ramiro
authors.affiliation: Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: V
authors.initials: V
authors.lastname: Watson
authors.affiliation: Institute for Health Policy and Management, Erasmus Rotterdam University, Rotterdam, The Netherlands.
authors.forename: J L
authors.initials: JL
authors.lastname: Severens
authors.affiliation: Department of Rheumatology, University Paris 6, GRC-UPMC08, Pierre Louis Institute of Epidemiology and Public Health-AP-HP, Pitie Salpetriere University Hospital, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Fautrel
authors.affiliation: National Advisory Unit for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo, Oslo, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Uhlig
authors.affiliation: Unit for Clinical Therapy Research Inflammatory Diseases, Karolinska Institute, Stockholm, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: van Vollenhoven
authors.affiliation: Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Jacques
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Detert
authors.affiliation: Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Canas da Silva
authors.affiliation: Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
authors.forename: C A
authors.initials: CA
authors.lastname: Scirè
authors.affiliation: Department of Rheumatology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
authors.forename: F
authors.initials: F
authors.lastname: Berghea
authors.affiliation: Department of Rheumatology, Instituto de Salud Musculoesqueletica, Madrid, Spain.
authors.forename: L
authors.identifier: http://orcid.org/0000-0002-4401-2551
authors.initials: L
authors.lastname: Carmona
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.|Department of Rheumatology, Flór Ferenc Hospital, Kistarcsa, Hungary.
authors.forename: M
authors.initials: M
authors.lastname: Péntek
authors.affiliation: Arthritis Centre, Northwick Park Hospital, Harrow, UK.
authors.forename: A
authors.initials: A
authors.lastname: Keat
authors.affiliation: CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands.|Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Boonen
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D010818:Practice Patterns, Physicians'; D000072140:Rheumatologists / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents
keywords: DMARDs (biologic); Economic Evaluations; Patient perspective; Rheumatoid Arthritis; Treatment