Introduction: Currently, around the world, the majority of patients with type 2 diabetes mellitus T2DM receives standardized care, based on evidence-based, disease-specific

BackgroundEconomic considerations and patient preferences are increasingly important when choosing treatments. It is not known to what extent rheumatologists across Europe account for these factors when changing drug therapies in patients with active rheumatoid arthritis (RA).ObjectivesTo evaluate the extent to which rheumatologists across Europe consider costs, cost-effectiveness and patient preferences in addition to efficacy and safety in treatment decisions in RA.MethodsIn a discrete choice experiment, rheumatologists were asked to choose iteratively between two unlabelled drug treatment options for a hypothetical RA patient with moderate disease activity who failed two synthetic DMARDs. The treatment options were characterized by five attributes further specified by three levels; efficacy (level of improvement and achieved state on DAS28), safety (probability of a serious adverse event), patient preference (level of agreement with proposed treatment), medication costs and cost-effectiveness (incremental cost-effectiveness ratio (ICER)). Attributes and levels were selected based on literature data and expert consensus. An efficient experimental design was used to construct 14 treatment choices and a mixed logit model was used to estimate the relative importance of attributes.Results452 rheumatologists from 11 European countries contributed to the analysis (51% females, mean age 49 years). In all countries, drug-efficacy had the strongest influence on the rheumatologists' preferred drug choice. In addition, patient preferences were taken into account, especially when patients did not favour the drug. With regard to economic attributes of the drug, medication costs influenced the treatment choice more than ICER (table 1). However relative importance of ICER differed across countries (2-13%).ConclusionsThis study suggests that efficacy had the highest impact on treatment decisions. But for rheumatologists also patient preferences were relevant. Among the economic considerations, overall medication costs primarily influenced treatment decisions in RA, while ICER played a more limited role, especially in some countries.Disclosure of InterestM. Hifinger Employee of: Hexal AG, Holzkirchen, Germany (maternity leave), M. Hiligsmann: None declared, S. Ramiro: None declared, H. Severens: None declared, B. Fautrel: None declared, V. Watson: None declared, T. Uhlig: None declared, R. van Vollenhoven: None declared, P. Jacques: None declared, J. Detert: None declared, C. Scirè: None declared, J. Canas da Silva: None declared, F. Berghea: None declared, L. Carmona: None declared, M. Péntek: None declared, A. Boonen: None declared

No abstract

No abstract

No abstract

Background The patient's perspective is becoming increasingly important in clinical and policy decisions. Information about what patients prefer, and how they value various aspects of a health intervention can be useful when designing and evaluating health care programs and could help health professionals to improve disease management. Objectives To evaluate the preferences of European patients with, or at risk of, osteoporosis for medication attributes, and to establish how they trade between these attributes Methods A discrete choice experiment was conducted using a questionnaire in Belgium, France, Ireland, Spain, Switzerland and United Kingdom. Patients were asked to choose between two hypothetical unlabelled drug treatments (and an opt-out option) that vary in several attributes: efficacy in reducing the risk of fracture, type of potential common side-effects, mode and frequency of administration and out-of-pocket costs (only in countries with patients' contribution on the cost of treatment). An efficient design was used to construct the treatment option choice sets and a mixed logit model was used to estimate patients' preferences. Results A total of 1,124 patients completed the experiment, with at least 100 patients per country. As expected, in all countries, patients preferred treatment with higher effectiveness and lower cost was preferred in the three countries in which a cost-attribute was part of the experiment. In all countries, patients preferred 6-monthly subcutaneous injection over weekly oral tablets. In most countries, patients also preferred monthly oral tablet and yearly intravenous injections over weekly oral tablets. Patients disliked being at risk of gastro-intestinal disorders more than being at risk of skin reactions and flu-like symptoms. There were significant differences between countries for only some levels of attributes, and we found in all countries a significant variation in preferences across the sample for most attributes. Conclusions This study suggests that the preferences of patients for osteoporotic drug therapy did not substantially differ between six European countries. Only for levels of some attributes, significant differences were observed. The heterogeneity of preferences across each country highlights the potential importance of clinical decision-making taking individual preferences into account to improve osteoporosis care. Acknowledgements This study was funded by Amgen Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4055

ported data. The objective of this study was to estimate persistence to oral bisphosphonates (OBPs) in the Portuguese postmenopausal osteoporosis (PMO) population, exploring different methods. METHODS: This was an observational, prospective cohort study of women Ն50 years old with PMO who had not been prescribed PMO treatment within 6 months prior to recruitment from community pharmacies. Patients were classified as persistent if they refilled their prescription within a 30-day grace period after exhausting the time covered by their previous supply. For subgroup analysis, non-persistent patients were followed up by telephone. Sensitivity analysis included 6 different methods, in particular, increasing the grace period to 90 days and allowing a switch to other PMO medication. RESULTS: A total of 427 women (mean age 65 years) were included in the analysis. Persistence rates at 6 months of follow-up (interim analysis) varied from 27.6% (95%CI 23.4%-32.0%) to 52.6% (95%CI 47.3%-57.6%) using pharmacy records exclusively and additional patient report of BP acquisition in a different pharmacy (reported by 113 of 269 patients), respectively. Allowing a longer grace period (90 days) and switch to other PMO medications resulted in rates of 49.9% (95%CI 33.8%-64.0%) and 28.6% (95%CI 24.3%-33.0%), respectively. CONCLUSIONS: Results at 6 months showed a variation in persistence rate estimates depending on the method applied, with increased estimates when self-reported data and longer grace periods were used. Ongoing analysis will allow assessment of the impact of the different methods over longer follow-up periods.

48% had less than a year, 16% between two and three years, 18% more than three years, 13% more than four years, and 5% were temporarily caregivers. In our study, 85% of caregivers were a family member, while 15% a nurse or a non-related person. Regarding the compensation, 97% did not receive any salary or payment for being caregiver, the remaining 3% received between 265 and 530 USD per month. Conclusions: Our study demonstrated that the care for patients with MD is mainly assumed by family members. Our results agree with other studies in chronic conditions where only a small proportion of caregivers is paid. Caregivers should be considered for the health system.