Preferences and Stated Adherence for Antibiotic Treatment of Cystic Fibrosis Pseudomonas Infections.

OBJECTIVE: Our objective was to quantify preferences and stated adherence for inhaled antibiotic treatments in cystic fibrosis (CF). METHODS: Adult CF patients and parents of pediatric patients in the US who were members of the Cystic Fibrosis Foundation and who had Pseudomonas aeruginosa at least twice a year completed an online, discrete-choice experiment survey (response rate 4.4 %). Respondents answered five treatment-choice questions evaluating pairs of hypothetical CF treatment profiles. Stated-adherence questions followed two randomly selected treatment-choice questions. Data were analyzed using random-parameters logit (RPL). For a combination of attribute levels, the utility is estimated by summing the relevant attribute-level parameter estimates. For the stated-adherence questions, we tabulated the changes in the percentages of respondents who would be 95 % adherent for various changes in inhaled antibiotic-medication administration features. RESULTS: The final sample was 271 adult patients and 209 parents. Switching from a 30-min nebulizer twice daily to a 10-min dry powder inhaler (DPI) twice daily was 6.3 times more important for patients and 2.0 times more important for parents than an improvement in dry cough side effect from moderate to mild. Stated adherence for respondents was 20-30 % greater for DPIs versus nebulizers. CONCLUSIONS: Lower frequency of administration, shorter administration times for a given device, and milder dry cough appear to improve stated adherence to antibiotic treatment of CF lung infections.

Physicians' stated trade-off preferences for chronic hepatitis B treatment outcomes in Germany, France, Spain, Turkey, and Italy.

OBJECTIVE: To quantify physicians' preferences among possible outcomes associated with chronic hepatitis B treatments and to determine which outcomes are most important to physicians in making treatment decisions. METHODS: Physicians in five countries who treat chronic hepatitis B patients completed a web-enabled, choice-format, conjoint-analysis survey. The survey presented physicians with four treatment-choice questions for three different patient types. Each treatment-choice question included a pair of hypothetical medication profiles. Medication outcomes included how long the medication has been studied (weight of evidence); the probability that a patient's viral load remains undetectable for 5 years, with a possible histological improvement or reversal of disease progression (long-term efficacy); the 5-year treatment-related risk of fracture; the 5-year treatment-related risk of renal dysfunction; and patient cost. Treatment-choice questions were derived from a predetermined experimental design with known statistical properties. For each country, the random-parameters logit was used to estimate preference weights for all outcome levels and the mean relative importance of each outcome. RESULTS: Long-term efficacy and risk of renal dysfunction were the most important outcomes for the 788 physicians completing the survey, whereas weight of evidence was the least important. However, physicians perceived significant differences in weight of evidence timeframes. Physicians in Germany and France ranked efficacy above side-effect risk, whereas physicians in Spain, Italy, and Turkey ranked side-effect risk above efficacy in importance. CONCLUSION: Physician preferences among treatment profiles indicate systematic differences in the relative importance of treatment outcomes. Physicians require higher efficacy for treatments with higher side-effect risk but somewhat less efficacy for treatments with longer evidence.