Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Patient Preferences for Biologic Agents in Rheumatoid Arthritis: A Discrete Choice Experiment.

Navarta2,  David A., Augustovski3,  Federico, Beratarrechea3,  Andrea, Irazola3,  Vilma, Rubinstein3,  Fernando, Tesolin3,  Pablo, Gonzalez6,  Juan M.

Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio, Buenos Aires, Capital Federal, Argentina
Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio, Buenos Aires, Argentina, Argentina
Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
Instituto Rehabilitacion Psicofisica, Buenos Aires, Argentina
Instituto Rehabilitacion Psicofisica, Buenos Aires, Argentina
RTI Health Solutions, NC

Background:

Rheumatoid Arthritis (RA) is a chronic condition which requires a substantial degree of adherence to different recommendations. RA patients' preferences among available treatment options have been previously explored using different approaches. Discrete choice experiments (DCEs) allow systematic assessment of preferences by asking respondents to choose between scenarios with different attributes. We conducted a DCE to elicit RA patients' preferences regarding treatment with Biologic Agents (BA).

Methods:

We designed a DCE, in which RA patients had to choose between hypothetical drug profiles that could differ in seven treatment attributes (with three to four levels each): effectiveness, route of administration, frequency of administration, local and systemic adverse effects, severe infections and out-of-pocket costs. We included RA patients older than 18 years who had never received BA from one private and one public hospital in Buenos Aires, Argentina. A Multinomial probit regression model (MNP) was used to analyze the relative importance of treatment attributes, and their willingness to pay (WTP).

Results:

240 RA patients were included. Mean age was 56.2 (SD: 13.5) years, 87% were women, and median disease duration was 9 years. All patients were receiving conventional DMARDs (84.5% Metotrexate); median Clinical Disease Activity Index was 7.5 (interquartile range [IQR]: 3.5–16), and median HAQ was 0.5 (IQR: 0–1.225). Mean family monthly income was 645 US dollars ($). All the attributes showed to be significant factors affecting choice of treatment. Most attributes levels showed coefficients with the expected signs and were statistically significant. Attributes importance ranking was in the following order: cost, systemic adverse events, frequency of administration, efficacy, route of administration, local adverse events and serious infection.

Patients had relatively high monthly WTP for treatments that significantly reduced the risk of systemic adverse events: mean 331 (95% CI: 212–499) US dollars ($) for a reduction from 30% to 10%; of decreasing dose frequency: mean $ 302 (95% CI: 183–461) for going from weekly to monthly administration; increasing treatment efficacy: mean: $ 386 (95% CI:285–532) for 40 vs 20 mm reduction in patient global assessment VAS, and also for switching from an intravenous to an oral therapy: mean $ 262 (95% CI: 262–555).

Conclusion:

Different treatment attributes had a significant and different influence in RA patients choice of BA. The results of the DCE indicated that most respondents would be willing to pay for treatments that importantly reduced the risk of systemic adverse effects, dose frequency, with increased treatment efficacy, and with an oral route of administration.

Table. Model main results. Results expressed the mean distance and CI 95% of the most favored level and the least favored level of each attribute.

AttributeMeanLower limit 95% CIUpper limit 95% CI
Cost0.80580.68840.9245
Systemic adverse events0.66540.56960.7573
Frequency of administration0.61450.51640.7124
Efficacy0.41740.32530.5094
Route of administration0.41290.30530.5208
Local adverse events0.39810.30680.4875
Serious infection0.29380.21900.3701

To cite this abstract, please use the following information:
Navarta, David A., Augustovski, Federico, Beratarrechea, Andrea, Irazola, Vilma, Rubinstein, Fernando, Tesolin, Pablo, et al; Patient Preferences for Biologic Agents in Rheumatoid Arthritis: A Discrete Choice Experiment. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :324
DOI: 10.1002/art.28093

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