A discrete choice experiment to assess patients’ preferences for HIV treatment in the rural population in Colombia

Abstract

Aim: To elicit patients' preferences for HIV treatment of the rural population in Colombia. Methods: A discrete choice experiment (DCE), conducted in a HIV clinic in Bogot a, was used to examine the trade-off between five HIV treatment attributes: effect on life expectancy, effect on physical activity, risk of moderate side-effects, accessibility to clinic, and economic costs to access controls. Attributes selection was based on literature review, expert consultation and a focus group with six patients. An efficient experimental design was used to define two versions of the questionnaire with each of 12 choice sets and a dominance task was added to check reliability. A mixed logit model was then used to analyse the data and subgroup analyses were conducted on the basis of age, gender, education, and sexual preference. Results: A total of 129 HIV patients were included for analysis. For all treatment attributes, significant differences between at least two levels were observed, meaning that all attributes were significant predictors of choice. Patients valued the effect on physical activity (conditional relative importance of 27.5%) and the effect on life expectancy (26.0%) the most. Subgroup analyses regard age and education showed significant differences: younger patients and high educated patients valued the effect on physical activity the most important, whereas older patients mostly valued the effect on life expectancy and low educated patients mostly valued the accessibility to clinic. Limitations: One potential limitation is selection bias, as only patients from one HIV clinic were reached. Additionally, questionnaires were partly administered in the waiting rooms, which potentially led to noise in the data. Conclusions: This study suggests that all HIV treatment characteristics included in this DCE were important and that HIV patients from rural Colombia valued short-term efficacy (i.e. effect on physical activity) and long-term efficacy (i.e. effect on life expectancy) the most.

Patients’ preferences for antiretroviral therapy service provision: a systematic review

“…Our data comprised of seven studies from the African region [ 34 – 40 ], 10 in the Americas [ 23 , 41 – 49 ], five in Europe [ 50 – 54 ], and one in both the Americas and Europe (USA and Germany) [ 55 ]. Sixteen studies were quantitative [ 23 , 34 , 36 , 38 , 40 , 41 , 43 , 44 , 46 – 48 , 51 – 55 ] and three were qualitative [ 35 , 39 , 42 ]. Four articles reported both qualitative and quantitative findings [ 37 , 45 , 49 , 50 ].…”

“…Patients’ preferences were elicited with DCE/conjoint analysis method in 12 studies [ 23 , 34 , 36 – 38 , 40 , 43 , 46 , 48 , 50 , 52 , 54 ]; rating exercise [ 47 , 51 ], ranking exercise [ 49 ] and adaptive conjoint analysis [ 41 , 55 ] in two studies each; and pair-wise comparison [ 45 ], and Best–Worst Scaling 1 [ 44 ] in one study each (Table 2 ).…”

“…Similarly, the impact of each attribute on patient preference regarding ART in each included study was shown by ranking and/or rating the preference (utility) values; and relative importance score, mean, or odds ratio was used depending on the reported data. The relative importance, expressed as a percentage of each of the attributes in influencing treatment decisions, was calculated for each participant by dividing the range of each attribute (utility of highest level minus utility of lowest level) by the sum of the ranges of all attributes, and multiplying it by 100 [ 23 – 25 ]. If a study reported the utility coefficients in a continuous scale of measurement, then the coefficients for discrete levels of each attribute were calculated in reference to a baseline category with the lowest utility value in the same attribute.…”

Understanding patients’ preferences for HIV treatment among rural and urban Colombian patients

“…In this issue of the Journal of Medical Economics (August 2020), Goossens et al 8 and Sijstermans et al 9 reported on DCEs conducted to assess patients' preferences for HIV treatment in rural and urban Colombia. Five attributes were derived from literature review and a focus group with patients: "effect on life expectancy," "effect on physical activity," "risk of moderate side effects," "accessibility to clinic" and "economic cost to access controls".…”

“…Next to rural versus urban differences, it is important to consider the different modes of administration of ART, which could be delivered orally as well as via injection. The studies of Goossens et al 8 and Sijstermans et al 9 did not include mode of administration, which means that more research is needed to identify potential differences in preferences between modes of administration. Recently, in the Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) and Assessment of ibrutinib plus rituximab in front-line CLL (FLAIR) trials, monthly ART injection was shown to be noninferior to continuing current daily threedrug oral ART 14 .…”