Patients’ Preferences for Anti-Osteoporosis Drug Treatment: A Cross-European Discrete-Choice Experiment

Abstract

Objectives.To estimate the preferences of osteoporotic patients for medication attributes, and analysedata from seven European countries.Methods.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 hypotheticalunlabelled drug treatments (and an opt-out option) that varied with respect to four attributes: efficacy inreducing the risk of fracture, type of potential common side effects, and mode and frequency of admin-istration. In those countries in which patients contribute to the cost of their treatment directly, a fifthattribute was added: out-of-pocket cost. A mixed logit panel model was used to estimate patients’preferences.Results.In total, 1124 patients completed the experiment, with a sample of between 98 and 257 patientsper country. In all countries, patients preferred treatment with higher effectiveness, and 6-monthly subcuta-neous injection was always preferred over weekly oral tablets. In five countries, patients also preferred amonthly 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.Conclusion.We found statistically significant differences in patients’ preferences for anti-osteoporosismedications between countries, especially for the mode of administration. Our findings emphasized thatinternational treatment recommendations should allow for local adaptation, and that understanding individ-ual preferences is important if we want to improve the quality of clinical care for patients with osteoporosis.