title: Patients' preferences for anti-osteoporosis drug treatment: a cross-European discrete choice experiment.
abstract: To estimate the preferences of osteoporotic patients for medication attributes, and analyse data from seven European countries.
  
  
  
  A discrete choice experiment was conducted in Belgium, France, Ireland, the Netherlands, Spain, Switzerland and the UK. Patients were asked to choose repeatedly between two hypothetical unlabelled drug treatments (and an opt-out option) that varied with respect to four attributes: efficacy in reducing the risk of fracture, type of potential common side effects, and mode and frequency of administration. In those countries in which patients contribute to the cost of their treatment directly, a fifth attribute was added: out-of-pocket cost. A mixed logit panel model was used to estimate patients' preferences.
  
  
  
  In total, 1124 patients completed the experiment, with a sample of between 98 and 257 patients per country. In all countries, patients preferred treatment with higher effectiveness, and 6-monthly subcutaneous injection was always preferred over weekly oral tablets. In five countries, patients also preferred a monthly oral tablet and yearly i.v. injections over weekly oral tablets. In the three countries where the out-of-pocket cost was included as an attribute, lower costs significantly contributed to the treatment preference. Between countries, there were statistically significant differences for 13 out of 42 attribute/level interactions.
  
  
  
  We found statistically significant differences in patients' preferences for anti-osteoporosis medications between countries, especially for the mode of administration. Our findings emphasized that international treatment recommendations should allow for local adaptation, and that understanding individual preferences is important if we want to improve the quality of clinical care for patients with osteoporosis.
authors.affiliation: Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht.
authors.forename: Mickaël
authors.initials: M
authors.lastname: Hiligsmann
authors.affiliation: Department of Business Economics, Erasmus School of Economics, Erasmus Rotterdam University, Rotterdam.
authors.forename: Benedict G
authors.initials: BG
authors.lastname: Dellaert
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
authors.affiliation: Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Verity
authors.initials: V
authors.lastname: Watson
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, CAPHRI, Maastricht, The Netherlands.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Bours
authors.affiliation: Department of Rheumatology and Endocrinology, Ghent University Hospital, Gent.
authors.forename: Stefan
authors.initials: S
authors.lastname: Goemaere
authors.affiliation: Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Reginster
authors.affiliation: Department of Rheumatology, Paris Descartes University, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Roux
authors.affiliation: The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co Leitrim, Ireland.
authors.forename: Bernie
authors.initials: B
authors.lastname: McGowan
authors.affiliation: The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co Leitrim, Ireland.
authors.forename: Carmel
authors.initials: C
authors.lastname: Silke
authors.affiliation: The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co Leitrim, Ireland.
authors.forename: Bryan
authors.initials: B
authors.lastname: Whelan
authors.affiliation: Musculoskeletal Research Unit and RETICEF, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Diez-Perez
authors.affiliation: Musculoskeletal Research Unit and RETICEF, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Torres
authors.affiliation: Service of Endocrinology, Diabetology and Metabolism, CHUV, Lausanne University Hospital, Lausanne.
authors.forename: Georgios
authors.initials: G
authors.lastname: Papadakis
authors.affiliation: Division of Bone Diseases, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Rene
authors.initials: R
authors.lastname: Rizzoli
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Gill
authors.initials: G
authors.lastname: Pearson
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, CAPHRI, Maastricht, The Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: Boonen
mesh_terms: D015502:Absorptiometry, Photon; D000284:Administration, Oral; D000368:Aged; D001294:Attitude to Health; D001530:Belgium; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D005602:France; D006801:Humans; D007275:Injections, Intravenous; D038622:Internationality; D007494:Ireland; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D057240:Patient Preference; D018570:Risk Assessment; D012720:Severity of Illness Index; D013030:Spain; D011795:Surveys and Questionnaires
chemical_list: D050071:Bone Density Conservation Agents
keywords: cross-country comparison; discrete choice experiment; drug treatment; osteoporosis; patients; preferences