title: First and Foremost Battle the Virus: Eliciting Patient Preferences in Antiviral Therapy for Hepatitis C Using a Discrete Choice Experiment.
abstract: BACKGROUND
  There has been tremendous progress regarding treatment options for hepatitis C virus (HCV) infection. Several interferon-free regimens are awaiting regulatory approval. These innovations promise substantial reductions in the burden of disease and side effects as well as a decrease in treatment duration.
  
  
  OBJECTIVE
  The aim of this quantitaitive study was to elicit patient preferences for attributes of innovative antiviral therapies for hepatitis C.
  
  
  METHODS
  A systematic literature search and 14 semi-structured interviews were performed, resulting in eight patient-relevant characteristics. For the discrete choice experiment, an experimental design (3×3 + 5×6) was generated using Ngene software. The survey was conducted in August 2014 through computer-assisted personal interviews. The data were effects-coded in a random parameter logit estimation.
  
  
  RESULTS
  Participants were patients with HCV (N = 561; 58.1% men) in different treatment states. The analysis revealed a predominance of the attribute "reaching sustained virological response." When considering confidence intervals, the results showed three different preference ranks. At first place was "sustained virological response" (level difference [LD] 3.98), second was "anemia" (LD 1.10), followed by "number of interferon injections" (LD 0.92), "rash" (LD 0.82), "nausea and/or diarrhea" (LD 0.79), and "duration of antiviral therapy" (LD 0.78). The last position was occupied by both "tiredness/fatigue" (LD 0.31) and "headache" (LD 0.34).
  
  
  CONCLUSIONS
  From the patients' point of view, sustained virological response is the most essential criterion for choosing an HCV therapy. It was ranked at the highest, dominating all side effects and modes of administration. Furthermore, this study proved that patients consider both the probability of occurrence and the severity of treatment-induced side effects. Results clearly point to valuation of probabilities that is separate from that of severity.
authors.affiliation: Health Economics and Healthcare Management, Hochschule Neubrandenburg, Neubrandenburg, Germany. Electronic address: muehlbacher@hs-nb.de.
authors.forename: Axel
authors.initials: A
authors.lastname: Mühlbacher
authors.affiliation: Health Economics and Healthcare Management, Hochschule Neubrandenburg, Neubrandenburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Bethge
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002755:Choice Behavior; D017281:Cost of Illness; D005260:Female; D016174:Hepacivirus / Q000187:drug effects; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D057240:Patient Preference
chemical_list: D000998:Antiviral Agents; D007372:Interferons
keywords: discrete choice experiment (DCE); hepatitis C; patient preferences; stated preferences