Choice Consistency in Discrete Choice Experiments: Does Numeracy Skill Matter? (VIH-2023-0494.R2).

OBJECTIVES: This study investigated the relationship between numeracy skills and choice consistency in discrete choice experiments (DCEs). METHODS: A DCE was conducted to explore patients' preferences for kidney transplantation in Italy. Patients completed the DCE and answered three-item numeracy questions. A Heteroskedastic Multinomial Logit (HMNL) model was used to investigate the effect of numeracy on choice consistency. RESULTS: Higher numeracy skills were associated with greater choice consistency, increasing the scale to 1.63 (p<0.001), 1.39 (p<0.001), and 1.18 (p<0.001) for patients answering 3/3, 2/3, and 1/3 questions correctly, respectively, compared to those with no correct answers. This corresponded to 63%, 39%, and 18% more consistent choices, respectively. Accounting for choice consistency resulted in varying willingness-to-wait (WTW) estimates for kidney transplant attributes. Patients with the lowest numeracy (0/3) were willing to wait approximately 42 months [95% CI: 29.37, 54.68] for standard infectious risk, compared to 33 months [95% CI: 28.48, 38.09] for 1/3, 28 months [95% CI: 25.13, 30.32] for 2/3, and 24 months [95% CI: 20.51, 27.25] for 3/3 correct answers. However, WTW differences for an additional year of graft survival and neoplastic risk were not statistically significant across numeracy levels. Supplementary analyses of two additional DCEs on COVID-19 vaccinations and rheumatoid arthritis, conducted online, supported these findings: higher numeracy skills were associated with more consistent choices across different disease contexts and survey formats. CONCLUSIONS: The findings suggested that combining patients with varying numeracy skills could bias WTW estimates, highlighting the need to consider numeracy in DCE data analysis and interpretation.

Current published evidence on barriers and proposed strategies for genetic testing implementation in health care settings: A scoping review.

BACKGROUND: The slow uptake of genetic testing in routine clinical practice warrants the attention of researchers and practitioners to find effective strategies to facilitate implementation. OBJECTIVES: This study aimed to identify the barriers to and strategies for pharmacogenetic testing implementation in a health care setting from published literature. METHODS: A scoping review was conducted in August 2021 with an expanded literature search using Ovid MEDLINE, Web of Science, International Pharmaceutical Abstract, and Google Scholar to identify studies reporting implementation of pharmacogenetic testing in a health care setting, from a health care system's perspective. Articles were screened using DistillerSR and findings were organized using the 5 major domains of Consolidated Framework for Implementation Research (CFIR). RESULTS: A total of 3536 unique articles were retrieved from the above sources, with only 253 articles retained after title and abstract screening. Upon screening the full texts, 57 articles (representing 46 unique practice sites) were found matching the inclusion criteria. We found that most reported barriers and their associated strategies to the implementation of pharmacogenetic testing surrounded 2 CFIR domains: intervention characteristics and inner settings. Factors relating to cost and reimbursement were described as major barriers in the intervention characteristics. In the same domain, another major barrier was the lack of utility studies to provide evidence for genetic testing uptake. Technical hurdles, such as integrating genetic information to medical records, were identified as an inner settings barrier. Collaborations and lessons from early implementers could be useful strategies to overcome majority of the barriers across different health care settings. Strategies proposed by the included implementation studies to overcome these barriers are summarized and can be used as guidance in future. CONCLUSION: Barriers and strategies identified in this scoping review can provide implementation guidance for practice sites that are interested in implementing genetic testing.

Accounting for Preference Heterogeneity in Discrete-Choice Experiments: An ISPOR Special Interest Group Report.

OBJECTIVES: Discrete choice experiments (DCEs) are increasingly used to elicit preferences for health and healthcare. Although many applications assume preferences are homogenous, there is a growing portfolio of methods to understand both explained (because of observed factors) and unexplained (latent) heterogeneity. Nevertheless, the selection of analytical methods can be challenging and little guidance is available. This study aimed to determine the state of practice in accounting for preference heterogeneity in the analysis of health-related DCEs, including the views and experiences of health preference researchers and an overview of the tools that are commonly used to elicit preferences. METHODS: An online survey was developed and distributed among health preference researchers and nonhealth method experts, and a systematic review of the DCE literature in health was undertaken to explore the analytical methods used and summarize trends. RESULTS: Most respondents (n = 59 of 70, 84%) agreed that accounting for preference heterogeneity provides a richer understanding of the data. Nevertheless, there was disagreement on how to account for heterogeneity; most (n = 60, 85%) stated that more guidance was needed. Notably, the majority (n = 41, 58%) raised concern about the increasing complexity of analytical methods. Of the 342 studies included in the review, half (n = 175, 51%) used a mixed logit with continuous distributions for the parameters, and a third (n = 110, 32%) used a latent class model. CONCLUSIONS: Although there is agreement about the importance of accounting for preference heterogeneity, there are noticeable disagreements and concerns about best practices, resulting in a clear need for further analytical guidance.

Tbo-filgrastim versus filgrastim for stem cell mobilization and engraftment in autologous hematopoietic stem cell transplant patients: A retrospective review.

INTRODUCTION: Filgrastim, a granulocyte colony-stimulating factor, is commonly used in autologous hematopoietic stem cell transplants (HSCTs) to assist with peripheral blood progenitor cell (PBPC) collection and to support stem cell engraftment. In the United States, tbo-filgrastim is approved under its own Biologic License Application and is limited to a single indication excluding the HSCT population. METHODS: Approximately one year after a system-wide formulary change to tbo-filgrastim for all on- and off-label indications, our institution conducted an IRB-approved retrospective comparison of tbo-filgrastim to filgrastim in the autologous HSCT setting. The study included 71 patients who received an autologous HSCT from 1 January 2013 to 31 December 2016 with a documented administration of tbo-filgrastim or filgrastim. RESULTS: There were no statistically significant differences noted on CD34 + counts during stem cell mobilization, neutrophil engraftment, infection rates during the engraftment phase, nor duration of hospitalization during the engraftment phase. More patients in the tbo-filgrastim group received plerixafor per protocol resulting in more patients meeting their PBPC collection goal in one day with fewer collection days overall, a result potentially confounded by institutional protocol changes. Utilizing tbo-filgrastim offered an average cost savings per patient of $2664.26 ($1907.33 for PBPC mobilization and $756.93 for stem cell engraftment) when comparing dollars spent on granulocyte colony-stimulating factor products only. CONCLUSION: Tbo-filgrastim demonstrates comparable efficacy with a cost savings benefit compared to filgrastim for autologous PBPC mobilization and stem cell engraftment.

The clinical impact of pharmacist services on mental health collaborative teams: A systematic review.

OBJECTIVE: To evaluate the clinical impact of mental health collaborative teams that include pharmacists. DATA SOURCES: PubMed, PsychInfo, Clinialtrials.gov, International Pharmaceutical Abstracts. STUDY SELECTIONS: Studies in which pharmacists were part of a mental health collaborative team (defined as 2 or more health care providers working together to provide enhanced mental health care services to patients), mental health clinical outcomes were measured with a validated tool, and the articles were written in English were included. Articles were searched from database inception to July 2019 and were excluded if a quantifiable comparison of mental health clinical outcomes was not included or collaboration was not described. DATA EXTRACTION: Two authors independently screened titles and abstracts for relevance. Full-text articles that potentially met inclusion criteria were retrieved, read, and evaluated for inclusion using the eligibility criteria. RESULTS: All 9 included studies reported improvements in mental health clinical outcomes when using collaborative teams that included pharmacists. Depression (n = 8) and post-traumatic stress disorder (PTSD) (n = 1) were the mental health conditions included in the studies. Overall, 5 of 7 of the randomized controlled trials (RCTs) had statistically significant improvement in mental health clinical outcomes between the intervention groups, which included the collaborative teams and a "usual care" groups, which did not. Four of the 5 studies were set in Veterans Affairs (VA) clinics. The 2 non-RCT pre-post studies showed improvements in clinical outcomes but did not achieve statistical significance. CONCLUSION: Evidence shows that collaborative teams that include pharmacists are effective at improving mental health outcomes in patients with depression and PTSD. Future studies should include non-VA settings and other mental health conditions to understand pharmacists' impact more broadly in mental health collaborative teams. Clarifying and understanding the overlapping roles and responsibilities of members of the team may be the next step to continue improving mental health clinical outcomes.

Comparing the Efficacy and Safety of Direct Oral Anticoagulants With Warfarin in the Morbidly Obese Population With Atrial Fibrillation.

BACKGROUND: The International Society of Thrombosis and Haemostasis recommends avoiding direct oral anticoagulants (DOACs) in morbidly obese patients with a body mass index (BMI) >40 kg/m2 or weight >120 kg because of limited clinical data in this group of patients. OBJECTIVES: The objective of this study was to evaluate the efficacy and safety of DOACs in morbidly obese patients with atrial fibrillation or flutter. METHODS: A retrospective, single-center cohort study was conducted of patients older than 18 years, with BMI >40 kg/m2 or weight >120 kg, who were diagnosed as having atrial fibrillation or flutter and who received warfarin or DOACs (ie, dabigatran, rivaroxaban, or apixaban). The primary efficacy outcome was the incidence of ischemic stroke or transient ischemic attack (TIA), whereas the primary safety outcome was the incidence of major bleeding. RESULTS: A total of 64 patients in each group were included in the study analysis. The incidence rate of ischemic stroke or TIA was 1.75%/year in the DOAC group compared with 2.07%/year in the warfarin group (rate ratio = 0.84; 95% CI = 0.23 to 3.14; P = 0.80). The incidence rate of major bleeding was 2.18%/year in the DOAC group, compared with 4.97%/year in the warfarin group (rate ratio = 0.44; 95% CI = 0.15 to 1.25; P = 0.11). Conclusion and Relevance: Apixaban and rivaroxaban may be considered as alternatives to warfarin for atrial fibrillation or flutter in morbidly obese patients. Dabigatran use in morbidly obese patients needs caution until further studies are conducted.

Evaluating the use of appropriate anticoagulation with lenalidomide and pomalidomide in patients with multiple myeloma.

BACKGROUND: Lenalidomide and pomalidomide are two immunomodulatory medications with the potential to improve outcomes for patients with multiple myeloma; however, a black box warning for venous thromboembolism exists. PURPOSE: The purpose of this study was to assess overall adherence to guideline recommendations for anticoagulation therapy with lenalidomide and pomalidomide in multiple myeloma patients. METHODS: This retrospective study at an ambulatory oncology clinic utilized chart reviews from the calendar years 2013-2016. The primary endpoint was prescription of appropriate anticoagulation upon initiation of therapy based on a list of predetermined risk factors. Secondary endpoints included incidence of deep venous thromboembolism, pulmonary embolism, myocardial infarction, stroke, and major bleed; initial anticoagulant prescribed; and whether or not anticoagulation was prescribed for another disease state. RESULTS: A total of 130 patients met inclusion criteria: 70.8% (n = 92) and 29.2% (n = 38) were prescribed lenalidomide and pomalidomide, respectively. A total risk score of two was most common (n = 54, 41.5%). Aspirin 81 mg oral tablet was prescribed most often (n = 53, 40.8%), followed by no anticoagulation (n = 30, 23.1%). Overall, 27 patients (20.8%) were prescribed anticoagulation in accordance with National Comprehensive Cancer Network guidelines. Incidence of deep venous thromboembolism was the most common adverse event (n = 4, 3.1%), followed by major bleed (n = 1, 0.8%). No reports of pulmonary embolism, myocardial infarction, or stroke were documented. CONCLUSIONS: Overall, a disparity exists between appropriate prescribing of prophylactic anticoagulation and current practice guidelines. However, documentation of thromboembolic events was lower than recorded in previously published literature.

Factors affecting consumers' decisions on the use of nutraceuticals: a systematic review.

There is a high and increasing global prevalence of nutraceuticals use. This study aims to systematically review and critically appraise all available evidence to identify the factors affecting consumers' decisions in taking nutraceuticals. Questionnaire, interview or focus group studies which directly reported factors affecting consumers' decisions in using nutraceuticals were included. A thematic synthesis method was employed to synthesis the findings from the included studies. Out of the 76 studies included, the key factors identified as the most important factors motivating consumers to take nutraceuticals were the perceived health benefits and safety of nutraceuticals, as well as the advice from healthcare professionals, friends and family. The identified barriers to take nutraceuticals were a lack of belief in the health benefit of nutraceuticals, the high cost of nutraceuticals and consumers' lack of knowledge about nutraceuticals. As a chief course of recommendation for the use of nutraceuticals, healthcare professionals should strive to utilise reliable information from clinical evidence to help consumers in making an informed decision in using nutraceuticals. Future studies should explore the possible ways to improve channelling clinical evidence information of nutraceuticals to the public.

Role of Bedside Preparation in Reducing "Door-to-Needle" Tissue-Type Plasminogen Activator (Alteplase) Administration Times and Association with Patient Outcomes.

INTRODUCTION: The purpose of this study is to assess the benefit of bedside alteplase preparation as a component of the acute stroke process. METHODS: A retrospective, single center study, designed to evaluate the impact of a bedside alteplase preparation protocol. Stroke patients receiving intravenous (IV) alteplase prepared at bedside were compared to pre-bedside alteplase preparation patients. The primary outcome was to compare door-to-needle (DTN) times between the groups. The secondary outcomes included comparison of pre-bedside alteplase preparation to post-bedside alteplase preparation on the following variables: imaging-to-drug times, order entry to drug administration times, percentage of patients achieving the 60 minute DTN goal, rate of intracranial hemorrhage (ICH), and patient discharge disposition. RESULTS: Patients in the pre-bedside preparation group included those who received IV alteplase between Jan. 1, 2012 and Jan. 31, 2015 and post-bedside preparation patients between Feb. 1, 2015 and March 31, 2016. Thirty-one patients were enrolled in the study, 16 in the pre-bedside preparation group and 15 in the post-beside preparation group. The mean DTN time in the post-bedside alteplase preparation group was significantly reduced, as compared to the pre-bedside preparation group (66.6 minutes vs. 95.9 minutes, p=0.024). Percent of patients meeting the 60 minute DTN time goal was significantly improved when alteplase was prepared at bedside (53.3 percent vs. 18.8 percent) (p=0.044). Rates of ICH were not significantly different between the two populations. CONCLUSIONS: Bedside alteplase preparation significantly reduced DTN times in an academic hospital emergency department.

Defining the scope of health technology assessment and types of health economic evaluation.

Health Technology Assessment (HTA) is a process that uses principles from across various disciplines, including medicine, sociology, economics, and ethics, to evaluate health technologies. Policy makers can use HTA as a tool to assess health technologies in a systematic, unbiased, transparent, and robust manner in order to make informed and evidence-based decisions. Generally, researchers begin an HTA by defining the overall scope of the assessment, after which they choose an appropriate type of health economic evaluation, one of the most important elements of HTA. The objective of this article is to provide recommendations about the scope of HTA as well as guidance on the kinds of health economic evaluation that are appropriate in the context of the new Thai HTA guidelines. A well-defined research question that addresses five major components-target population, technology or intervention, comparator outcome of interest, and perspective-is an essential

Using a patient-centered value assessment to optimize fair prices for Inflation Reduction Act's Medicare Drug Price Negotiation Program.

In the United States, various federal agencies, institutions, and foundations, including the Centers for Medicare & Medicaid Services (CMS), have supported the incorporation of patient perspective in health care decision-making. Despite a series of patient-focused listening sessions planned as part of the Inflation Reduction Act's Medicare Drug Price Negotiation Program, the details of these sessions in the guidance developed by CMS remain unclear. CMS has not specified how patients' inputs will be used to determine the maximum fair prices (MFPs) of selected drugs for the first round of the negotiations. In this Viewpoint article, we urge CMS to use patient-centered value assessment methods to optimize MFPs in the Medicare Drug Price Negotiation Program. We focused on a stated preference method, the discrete choice experiment, which has been increasingly used to determine patient preferences and patient's willingness to pay for drugs. We discussed an example using a discrete choice experiment as a patient-centered method to assess the value of Jardiance and optimize its MFP in the negotiation program.

Important Barriers to COVID-19 Vaccination Among African Americans in Black Belt Region.

BACKGROUND: To identify important barriers to COVID-19 vaccination among African Americans living in the Black Belt region. METHODS: A cross-sectional, web-based questionnaire survey was conducted using best-worst scaling case 1 (the object case). Thirty-two potential barriers to COVID-19 vaccination were identified from the literature and confirmed by an expert. A nested balanced incomplete block design was used to generate 62 sets of 16 choice tasks. Each choice task included six barriers. Participants were asked to choose the most and least important barriers to their COVID-19 vaccination in each choice task of one set. The natural logarithm of the square root of best counts divided by the worst counts of each barrier was calculated to rank the importance of barriers. RESULTS: Responses from a total of 808 participants were included. Among 32 barriers to COVID-19 vaccination, the five most important barriers were "safety concern of COVID-19 vaccines," "rapid mutation of COVID-19," "ingredients of COVID-19 vaccines," "Emergency Use Authorization (Fast-track approval) of COVID-19 vaccines," and "inconsistent information of COVID-19 vaccines." On the other hand, the five least important barriers were "religious reasons," "lack of time to get COVID-19 vaccine," "no support from my family and friends," "political reasons," and "fear of the needle." CONCLUSIONS: Important barriers to the COVID-19 vaccination for African Americans living in the Black Belt region centered around the issues that could be resolved by communication strategies.

Using a Patient-Centered Multicriteria Decision Analysis to Assess the Value of Multiple Sclerosis Treatments in the US: A Study Protocol.

OBJECTIVE: The engagement of patients and family caregivers in value assessment is pivotal since they provide valuable contributions to assessment acceptability and relevance. The proposed study aims to use patient-centered techniques and multicriteria decision analysis (MCDA) to evaluate the values of disease-modifying therapies (DMTs) for multiple sclerosis (MS) from the perspectives of patients and family caregivers living in three 'Deep South' States of the US-Alabama, Louisiana, and Mississippi. METHODS: This study will follow guidance from the Patient-Centered Outcomes Research Institute (PCORI) for patient engagement and two best practice reports for MCDA from the Professional Society for Health Economics and Outcomes Research (ISPOR) to complete value assessment. Throughout the study, we will engage multiple stakeholders, including patients, family caregivers, healthcare providers, and payers. Forty patients with MS and their family caregivers from Alabama, Louisiana, and Mississippi will be invited to participate in this study. We will intensively train them for value assessment knowledge and MCDA before we engage them in MCDA to determine the value of DMTs for MS. DISCUSSIONS: Our approach differs from common MCDA since we incorporated a patient-centered framework in this study. Unlike previous studies only briefly inform or prepare participants before the MCDA process, in this study, we will provide basic value assessment trainings for patients and family caregivers to ensure they can effectively engage throughout the patient-centered MCDA process. We expect this study will demonstrate that the patient-centered MCDA approach is feasible and likely leads to improved patients' and family caregivers' engagement in value assessment.

Descriptive Analysis of Health Disparities Between Black and White People With Multiple Sclerosis in the Deep South.

BACKGROUND: Black people with multiple sclerosis (MS) have a worse disease course and higher rates of progression than White people with MS. Contributing factors to health disparities are understudied. METHODS: Data were collected retrospectively from the electronic medical records of 500 people with MS treated between 2013 and 2022 at a university comprehensive MS center in a southern state. Multiple logistic regression analyses were used to determine the associations between 2 disability outcomes (ie, low vs high Expanded Disability Status Score [EDSS] and ambulatory assistance [AMB] requirements) and age, sex, body mass index (BMI), MS type, disease duration, hypertension status, diabetes status, smoking status, adjusted gross income, and health insurance type for Black people with MS and White people with MS. RESULTS: Of the cohort, 39.2% identified as Black people with MS and the rest were White people with MS. Approximately 80% of White people with MS had relapsing MS (RMS) vs almost 90% of Black people with MS. Black people with MS were more likely to have a higher EDSS (OR 5.0, CI 3.0-8.4) and AMB (OR, 2.8; 95% CI, 1.6-4.8) than White people with MS. Among White people with MS, women (OR, 0.5; 95% CI, 0.3-0.9) and people with RMS (OR, 0.13; 95% CI 0.06-0.3) were less likely to have higher EDSS scores. Among Black people with MS, neither female sex nor RMS status was associated with a lower risk of having a higher EDSS (OR, 0.685; P = .43 and OR, 0.394; P = .29, respectively). CONCLUSIONS: The disparity in disability outcomes between Black people with MS and White people with MS may be driven by more disabling courses for Black people with RMS and by female sex, though further study is needed to determine causes for this outcome.

A survey on awareness, knowledge and preferences toward genetic testing among the United States general public.

Aim: To understand awareness, knowledge and preferences regarding genetic testing among the USA general public. Methods: A cross-sectional online survey using a Qualtrics Panel. Results: Among 1600 respondents, 545 (34%) were White, 411 (26%) Black, 412 (26%) Hispanic or Latin(x) and 232 (15%) Asian. Most had heard of ancestry testing (87%) and genetic health risk testing (69%), but a third thought inherited genes were only a little or not at all responsible for obesity (36%) and mental health (33%). The majority preferred pre-emptive pharmacogenetic testing (n = 74%) compared with reactive testing. Statistically significant differences between racial/ethnic groups and rural-urban respondents were observed. Conclusion: Most preferred pre-emptive pharmacogenetic testing; however, about one-quarter preferred reactive testing. Preferences should be discussed during patient-clinician interactions.

What is this study about? This study presents a large online survey among the USA general public to understand their awareness, knowledge and preferences about genetic testing and how this may vary by racial/ethnic group and rural/urban status.What were the results? Most survey respondents had heard of ancestry testing (87%) and genetic health risk testing (69%). However, over a third of respondents thought that inherited genes may be only a little or not at all responsible for obesity (36%) and mental health (33%). When asked about preferences for pre-emptive compared with reactive pharmacogenetic testing, the majority preferred pre-emptive testing (n = 74%). Statistically significant differences between racial/ethnic groups as well as rural-urban respondents were seen.What do the results mean? The US general public may have a different understanding of genetic testing for different diseases, and have different preferences when it comes to the timing of testing. Appropriate educational content targeting the link between genetics and specific diseases should be prepared, and preferences for pre-emptive or reactive testing should be discussed during visits with healthcare providers.

A Preference-Based Value Assessment of the Fear of COVID-19 Contagion.

Purpose: To assess the preference-based value of the fear of COVID-19 contagion. Patients and Methods: We conducted a web-based, cross-sectional discrete choice experiment among 544 US adults. We used a Bayesian efficient design to generate choice sets. Each choice set comprised two hypothetical COVID-19 vaccine options characterized by seven attributes: chance of COVID-19 infection, chance of having severe symptoms from COVID-19 infection, vaccine protection duration, chance of mild to moderate adverse events from vaccination, chance of serious adverse events from vaccination, chance of future exposure to COVID-19 after vaccination, and out-of-pocket cost. We used mixed logit (ML) and latent class (LC) models to analyze data. Furthermore, we calculated the willingness-to-pay for eliminating the chance of future exposure to COVID-19, shedding light on the value attributed to the fear of contagion. Results: The ML model demonstrated all attributes, including the chance of future exposure to COVID-19, were statistically significant. The participants were willing to pay approximately $13,046 to eliminate the chance of future exposure to COVID-19 or their fear of contagion when COVID-19 was still pandemic. The LC model unveiled two participant classes with distinct preference weights for the chance of future exposure to COVID-19 and out-of-pocket cost attributes. Nevertheless, the chance of future exposure to COVID-19 exposure held a significant degree of importance in both classes. Conclusion: The chance of future exposure to COVID-19 exposure or fear of contagion was a significant element in the value assessment of COVID-19 vaccines. Further studies should be conducted to verify the value of fear of contagion and include it in the value assessment of healthcare technologies for infectious diseases.

Using a discrete choice experiment to elicit patients' preferences and willingness-to-pay for knee osteoarthritis treatments in Thailand.

Osteoarthritis is the most common type of joint disease among elderly patients around the world. In response to the need for patient-centered care, patients' and physicians' preferences for knee osteoarthritis treatments have been studied in multiple countries, but not in Thailand. The objective of this study was to investigate Thai patients' preferences and their willingness to pay (WTP) for knee osteoarthritis treatments by using a discrete choice experiment (DCE). Six knee osteoarthritis treatment attributes, including pain relief, delayed disease progression, gastrointestinal side effects, kidney side effects, cardiovascular side effects, and cost, were used to develop a paper-based, DCE questionnaire survey. Patients with knee osteoarthritis, who were at least 18 years old and who provided written informed consent, were recruited from the orthopedic department in a tertiary care hospital in Thailand via convenience sampling. The conditional logit model was used to determine patients' preferences and WTP. The Institutional Review Board at Chulalongkorn University approved this study before it started. A total of 232 patients were collected and analyzed in this study. Patients preferred treatments with a higher efficacy (pain relief and delayed disease progression), a lower probability of side effects (gastrointestinal, kidney, and cardiovascular side effects), and a lower cost. Regarding efficacy and side effects, the patients weighted the importance of a 1% change in cardiovascular side effects (- 0.08) more heavily than 1% changes in kidney (- 0.07) and gastrointestinal (- 0.02) side effects, delayed disease progression (0.02), and pain relief (0.01). Patients were willing to pay 29.56 Thai Baht (THB) and 41.84 THB per month for every 1% increase in pain relief and delayed disease progression, respectively. Conversely, patients were willing to pay 52.04 THB, 145.18 THB and 164.23 THB per month for every 1% decrease in gastrointestinal, kidney, and cardiovascular side effects, respectively. In conclusion, pain relief, delayed disease progression, gastrointestinal side effects, kidney side effects, cardiovascular side effects, and the cost of treatment were significant factors among patients undergoing knee osteoarthritis treatment. Additionally, patients had a higher WTP for delayed disease progression than pain relief and a higher WTP for a reduced probability of cardiovascular side effects than gastrointestinal and kidney side effects. These findings could be used to support treatment decisions for knee osteoarthritis patients in Thailand.

Understanding patient cost-sharing thresholds for diabetes treatment attributes via a discrete choice experiment.

BACKGROUND: The process used to prefer certain products across drug classes for diabetes is generally focused on comparative effectiveness and cost. However, payers rarely tie patient preference for treatment attributes to formulary management resulting in a misalignment of value defined by providers, payers, and patients. OBJECTIVES: To explore patients' willingness to pay (WTP) for the predetermined high-value and low-value type 2 diabetes mellitus (T2DM) treatments within a health plan. METHODS: A cross-sectional discrete choice experiment (DCE) survey was used to determine patient preference for the benefit, risk, and cost attributes of T2DM treatments. A comprehensive literature review of patient preference studies in diabetes and a review of guidelines and medical literature identified study attributes. Patients and diabetes experts were interviewed and instructed to identify, prioritize, and comment on which attributes of diabetes treatments were most important to T2DM patients. The patients enrolled in a health plan were asked to respond to the survey. A multinomial logit model was developed to determine the relative importance and the patient's WTP of each attribute. The patients' relative values based on WTPs for T2DM treatments were calculated and compared with the treatments by a health plan. RESULTS: A total of 7 attributes were selected to develop a web-based DCE questionnaire survey. The responses from a total of 58 patients were analyzed. Almost half (48.3%) of the respondents took oral medications and injections for T2DM. The most prevalent side effects due to diabetes medications were gastrointestinal (43.1%), followed by weight gain (39.7%) and nausea (32.8%). Patients were willing to pay more for treatments with proven cardiovascular benefit and for the risk reduction of hospitalization from heart failure. On the other hand, they would pay less for treatments with higher gastrointestinal side effects. Patients were willing to pay the most for sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide 1 receptor agonist agents and the least for dipeptidyl peptidase-4 inhibitors and thiazolidinediones. CONCLUSIONS: This study provides information to better align patient, provider, and payer preferences in both benefit design and value-based formulary strategy for diabetes treatments. A preferred placement of treatments with cardiovascular benefits and lower adverse gastrointestinal side effects may lead to increased adherence to medications and improved clinical outcomes at a lower overall cost to both patients and their health plan. DISCLOSURES: This study was supported by a grant from the PhRMA Foundation.

Service-level barriers to and facilitators of accessibility to treatment for problematic alcohol use: a scoping review.

Introduction: Services to treat problematic alcohol use (PAU) should be highly accessible to optimize treatment engagement. We conducted a scoping review to map characteristics of services for the treatment of PAU that have been reported in the literature to be barriers to or facilitators of access to treatment from the perspective of individuals with PAU. Methods: A protocol was developed a priori, registered, and published. We searched MEDLINE®, Embase, the Cochrane Library, and additional grey literature sources from 2010 to April 2022 to identify primary qualitative research and surveys of adults with current or past PAU requiring treatment that were designed to identify modifiable characteristics of PAU treatment services (including psychosocial and pharmacologic interventions) that were perceived to be barriers to or facilitators of access to treatment. Studies of concurrent PAU and other substance use disorders were excluded. Study selection was performed by multiple review team members. Emergent barriers were coded and mapped to the accessibility dimensions of the Levesque framework of healthcare access, then descriptively summarized. Results: One-hundred-and-nine included studies reported an extensive array of unique service-level barriers that could act alone or together to prevent treatment accessibility. These included but were not limited to lack of an obvious entry point, complexity of the care pathway, high financial cost, unacceptably long wait times, lack of geographically accessible treatment, inconvenient appointment hours, poor cultural/demographic sensitivity, lack of anonymity/privacy, lack of services to treat concurrent PAU and mental health problems. Discussion: Barriers generally aligned with recent reviews of the substance use disorder literature. Ranking of barriers may be explored in a future discrete choice experiment of PAU service users. The rich qualitative findings of this review may support the design of new or modification of existing services for people with PAU to improve accessibility. Systematic Review Registration: Open Science Framework doi: 10.17605/OSF.IO/S849R.