title: Patients' preferences and economic considerations play an important role in treatment decisions: a discrete choice experiment among rheumatologists.
abstract: To evaluate to what extent rheumatologists consider economic aspects and patients' preferences when choosing drug treatments in patients with active RA.
  
  
  
  In a discrete choice experiment, rheumatologists were asked to choose between two unlabelled drug treatment options for a hypothetical RA patient with moderate disease activity who failed two synthetic DMARDs. Attributes and levels of drug treatments were selected based on existing literature, rheumatologists' opinion and expert consensus. This resulted in five attributes each described by three levels: efficacy (level of improvement and achieved state on DAS28), safety (probability of a serious adverse event), patients' preference (level of agreement), annual medication costs and cost-effectiveness (incremental cost-effectiveness ratio). An efficient experimental design generated 14 treatment choices and a random parameter logit model estimated the relative importance of attributes.
  
  
  
  Sixty-three rheumatologists from the Netherlands contributed to the analysis; 44% were female and mean (sd) age was 49 (8) years. Drug efficacy had the strongest relative contribution to the drug choice (44%) followed by medication costs (24%), patients' preference (17%) and cost-effectiveness (14%). Patients' preferences were most relevant when patients disliked a proposed treatment. The risk of serious but uncommon or rare side effects only played a minor role in the treatment choice (1%).
  
  
  
  In addition to drug efficacy, rheumatologists account for economic aspects and for patients' preferences when deciding on drugs. Decisions are more influenced by absolute costs than relative cost-effectiveness and by patients' disliking as opposed to favouring the treatment.
authors.affiliation: CAPHRI Research Institute, Maastricht University monikahifinger@gmx.de.|Department of Internal Medicine, Maastricht University Medical Centre.
authors.forename: Monika
authors.initials: M
authors.lastname: Hifinger
authors.affiliation: CAPHRI Research Institute, Maastricht University.|Department of Health Services Research, Maastricht University, Maastricht.
authors.forename: Mickael
authors.initials: M
authors.lastname: Hiligsmann
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden.
authors.forename: Sofia
authors.initials: S
authors.lastname: Ramiro
authors.affiliation: Institute for Health Policy and Management, Erasmus Rotterdam University, Rotterdam.|iMTA-Institute of Medical Technology Assessment, Erasmus Rotterdam University, Rotterdam, The Netherlands.
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
authors.affiliation: GRC 08, Pierre Louis Institute of Epidemiology and Public Health, AP-HP, Department of Rheumatology, Pitie Salpetriere Hospital Paris, Pierre et Marie Curie University, France and.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.affiliation: Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Verity
authors.initials: V
authors.lastname: Watson
authors.affiliation: CAPHRI Research Institute, Maastricht University.|Department of Internal Medicine, Maastricht University Medical Centre.
authors.forename: Annelies
authors.initials: A
authors.lastname: Boonen
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D057240:Patient Preference; D010818:Practice Patterns, Physicians'; D019057:Quality-Adjusted Life Years; D000072140:Rheumatologists; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents
keywords: clinicians; cost-effectiveness; costs; discrete choice experiment; patient preference; rheumatoid arthritis