Patients', healthcare providers', and insurance company employees' preferences for knee and hip osteoarthritis care: a discrete choice experiment

Abstract

Objective: To determine patients', healthcare providers', and insurance company employees' preferences for knee and hip osteoarthritis (KHOA) care. Design: In a discrete choice experiment, patients with KHOA or a joint replacement, healthcare providers, and insurance company employees were repetitively asked to choose between KHOA care alternatives that differed in six attributes: waiting times, out of pocket costs, travel distance, involved healthcare providers, duration of consultation, and access to specialist equipment. A (panel latent class) conditional logit model was used to determine preference heterogeneity and relative importance of the attributes. Results: Patients (n ¼ 648) and healthcare providers (n ¼ 76) valued low out of pocket costs most, while insurance company employees (n ¼ 150) found a joint consultation by general practitioner (GP) and orthopaedist most important. Patients found the duration of consultation less important than healthcare providers and insurance company employees did. Patients without a joint replacement were likely to prefer healthcare with low out of pocket costs. Patients with a joint replacement and/or low diseasespecific quality of life were likely to prefer healthcare from an orthopaedist. Patients who already received healthcare for knee/hip problems were likely to prefer a joint consultation by GP and orthopaedist, and direct access to specialist equipment. Conclusions: Patients, healthcare providers, and insurance company employees highly prefer a joint consultation by GP and orthopaedist with low out of pocket costs. Within patients, there is substantial preference heterogeneity. These results can be used by policy makers and healthcare providers to choose the most optimal combination of KHOA care aligned to patients' preferences.

The Impact of Unexpected Billing in Spine Surgery and How the Price Calculator Can Improve Patient Care

“…12,13 A discrete choice model found evaluating patient and provider priorities found that both populations valued low out-of-pocket costs the most when deciding where to obtain/administer care for knee or hip osteoarthritis. 14 Dekhne et al 1 reviewed a database of 216,263 collective arthroscopic meniscal repair, lumbar discectomy, total knee arthroplasty, and total hip arthroplasty patients and demonstrated that 1 in 6 patients are at risk for a surprise bill despite seeking care at an in-network facility. Patients undergoing lumbar discectomy were particularly susceptible, whereby 24.5% received a surprise bill, most commonly from an intraoperative neuromonitoring company.…”

Management of hand osteoarthritis: from an US evidence-based medicine guideline to a European patient-centric approach

“…A previous ESCEO DCE of patients with hip and knee osteoarthritis showed that the most important treatment attributes were impact on disease progression followed by the ability to improve walking and reduce pain [ 23 ]. In another US DCE study, including hip and knee osteoarthritis patients, healthcare providers and insurance company employees, the most important attribute was out of pocket costs [ 24 ] (though it should be noted that this was not included as an attribute in the ESCEO study and might be related to the US healthcare distribution system). Another DCE in the US included patients with osteoarthritis and chronic low back pain and found a preference for daily oral medication over longer term intravenous therapy [ 25 ].…”

Preference Variation: Where Does Health Risk Attitude Come Into the Equation?

“…An overview of the case studies and their DCE designs can be found in Table 1. [30][31][32] Attributes and levels were selected based on literature reviews, focus groups, and interviews; these are presented in Table 2. The first case study concerned the treatment preferences of patients with multiple sclerosis (MS) in The Netherlands, France, and the UK.…”

“…The third study concerned care for hip and knee osteoarthritis (HKOA) in The Netherlands. 32 Respondents aged 45 years and older with knee or hip osteoarthritis were recruited online, also via Dynata (N = 648). In contrast to the other 2 studies, none of the attributes were explicitly described to respondents as being related to risks.…”

“…Given the varying study contexts, inclusion criteria, and study designs, the 3 studies had different types of respondents (see Table 1 [30][31][32] for an overview of the case studies). The studies consisted of 753, 378, and 648 respondents, respectively.…”