Fr Johnson

Treatment preferences and medication adherence of people with Type 2 diabetes using oral glucose-lowering agents

Aims  Medication non‐adherence is particularly common in patients with Type 2 diabetes. We constructed a discrete‐choice experiment to examine the relative importance of oral glucose‐lowering medication features and to estimate the likely effect of effectiveness and side effects on medication adherence in patients with Type 2 diabetes in the UK and the USA.

Benefits, Risk, and Uncertainty: Preferences of Antiretroviral-Naïve African Americans for HIV Treatments

While African Americans in the United States are disproportionately affected by HIV, they are less likely to take antiretroviral therapies. Different first-line antiretroviral therapies are associated with short-term and long-term adverse event (AE) risks. We estimated the willingness of antiretroviral-naïve, HIV-positive African Americans to accept risks of acute AEs with known outcomes and long-term AEs with uncertain outcomes in exchange for virologic suppression. We estimated the relative importance of short-term and long-term AE risks. Two hundred thirty-five subjects were recruited through eight clinics in the United States. One hundred fifty-eight subjects met study inclusion criteria. One hundred fifty-three subjects completed a series of choice-format conjoint trade-off tasks. In each task, subjects were asked to choose between two hypothetical treatments with varying levels of virologic failure, risks of hypersensitivity reaction, decreases in bone mineral density (BMD), and renal impairment, and outcome uncertainty associated with the risks of decreased BMD and renal impairment. Attributes were expressed as probabilities of occurrence. We calculated the relative importance of each AE and the level of risk subjects would accept to reduce the risk of virologic failure. Subjects indicated that short-term AEs with relatively certain outcomes are preferred to long-term AEs with uncertain outcomes. Subjects were strongly averse to the risk of decreased BMD that could not be treated successfully or when the outcome was uncertain and to the risk of renal impairment that could not be treated successfully. Subjects were willing to accept increased risks of AEs in exchange for lower risk of virologic failure.

How do physicians weigh benefits and risks associated with treatments in patients with osteoarthritis in the United Kingdom

Objective. To quantify the relative importance that UK physicians attach to the benefits and risks of current drugs when making treatment decisions for patients with osteoarthritis (OA). Methods. Physicians treating at least 10 patients with OA per month completed an online discrete-choice experiment survey and answered 12 treatment-choice questions comparing medication profiles. Medication profiles were defined by 4 benefits (reduction in ambulatory pain, resting pain, stiffness, and difficulty doing daily activities) and 3 treatment-related risks [bleeding ulcer, stroke, and myocardial infarction (MI)]. Each physician made medication choices for 3 of 9 hypothetical patients (varied by age, history of MI, hypertension, and history of gastrointestinal bleeding). Importance weights were estimated using a random-parameters logit model. Treatment-related risks physicians were willing to accept in exchange for various reductions in ambulatory and resting pain also were calculated. Results. The final sample was 475. A reduction in ambulatory pain from 75 mm to 25 mm (1.6 units) was 1.1 times as important as an increase in MI risk from 0% to 1.5% (1.5 units). The greatest importance was for eliminating a 3% treatment-related risk of MI or stroke. On average, physicians were willing to accept an increase in bleeding ulcer risk of 0.7% (95% CI 0.4%–1.7%) for a reduction in ambulatory pain of 75 mm to 50 mm. Conclusion. When presented with well-known benefits and risks of OA treatments, physicians placed greater importance on the risks than on the analgesic properties of the drug. This has implications for the reporting of the results of clinical research to physicians.

Physicians’ stated trade-off preferences for chronic hepatitis B treatment outcomes in Germany, France, Spain, Turkey, and Italy:

Objective To quantify physicians’ preferences among possible outcomes associated with chronic hepatitis B treatments and to determine which outcomes are most important to physicians in making treatment decisions. Methods Physicians in five countries who treat chronic hepatitis B patients completed a web-enabled, choice-format, conjoint-analysis survey. The survey presented physicians with four treatment-choice questions for three different patient types. Each treatment-choice question included a pair of hypothetical medication profiles. Medication outcomes included how long the medication has been studied (weight of evidence); the probability that a patient’s viral load remains undetectable for 5 years, with a possible histological improvement or reversal of disease progression (long-term efficacy); the 5-year treatment-related risk of fracture; the 5-year treatment-related risk of renal dysfunction; and patient cost. Treatment-choice questions were derived from a predetermined experimental design with known statistical properties. For each country, the random-parameters logit was used to estimate preference weights for all outcome levels and the mean relative importance of each outcome. Results Long-term efficacy and risk of renal dysfunction were the most important outcomes for the 788 physicians completing the survey, whereas weight of evidence was the least important. However, physicians perceived significant differences in weight of evidence timeframes. Physicians in Germany and France ranked efficacy above side-effect risk, whereas physicians in Spain, Italy, and Turkey ranked side-effect risk above efficacy in importance. Conclusion Physician preferences among treatment profiles indicate systematic differences in the relative importance of treatment outcomes. Physicians require higher efficacy for treatments with higher side-effect risk but somewhat less efficacy for treatments with longer evidence.

PMS50 PATIENTS' STATED HEALTH-OUTCOME PREFERENCES FOR CONFOUNDED PATIENT-REPORTED OUTCOME DOMAINS FOR OSTEOARTHRITIS

• Discrete-choice experiment (choice-format conjoint survey method) – Elicits patient tradeoffs among alternatives with varying levels of different endpoints – Repeated choices over treatment profi les with varying severity of outcomes provide reliable information for quantifying preferences1-4 • Patients evaluated 10 pairs of hypothetical OA treatments – Treatments defi ned using 7 endpoints (Table 1)

PHYSICIANS' STATED PREFERENCES OVER BENEFITS AND RISKS ASSOCIATED WITH NSAID USE IN PATIENTS WITH OSTEOARTHRITIS IN UNITED KINGDOM

PMS68 PHYSICIANS’ STATED PREFERENCES OVER BENEFITS AND RISKS ASSOCIATED WITH NSAID USE IN PATIENTS WITH OSTEOARTHRITIS IN UNITED KINGDOM Bridges JF, Taylor SD, Arden N, Hauber AB, Johnson FR, Watson D, Mavros P, Pellissier JM, Peloso P, Sen S, Mohamed A, Gonzalez JM Johns Hopkins University, Baltimore, MD, USA; Merck & Co., Inc., Whitehouse Station, NJ, USA; University of Southampton, Southampton, UK, UK; RTI Health Solutions, Research Triangle Park, NC, USA; MRL, Whitehouse Station, NJ, USA BACKGROUND: Treatments for symptom control in osteoarthritis (OA) confer varying degrees of benefi ts alongside medication-related risks. Physicians’ preferences over benefi ts and risks of NSAIDS are an important aspect of understanding clinical practice. OBJECTIVES: To estimate physicians’ preferences over benefi ts and risks associated with NSAID use in the management of OA and examine differences in preferences between general practitioners (GPs) and specialists. METHODS: Participating physicians treated at least 10 OA patients per-month. Each physician was randomized to receive one of four blocks of discrete-choice questions; each block consisting of 12 paired choice tasks comparing treatment profi les. Treatment profi les were defi ned by four benefi ts (ambulatory pain, resting pain, stiffness, diffi culty doing daily activities) and four medication-related risks (bleeding ulcer, stroke, heart attack, hypertension), each varying across four clinically meaningful levels. Elicitation of preferences was facilitated using standardized patient profi les systematically varying by age, co-morbid conditions and clinically relevant risks of NSAIDs. Preference weights were estimated using mixed-effects logistic regression and were standardized on a 0–10 (low-high) importance scale. RESULTS: 477 physicians participated (61% GPs, 39% specialists). Reductions in ambulatory pain and diffi culty doing daily activities were the most important effi cacy variables (6.45; 95%CI:4.8–8.2) followed by eliminating resting pain (3.18; 95%CI:1.9–4.5) and stiffness (2.79; 95%CI:1.5–4.1). Ambulatory pain was twice as important as resting pain or stiffness (P < 0.05). Risk of heart attack was the most important medication-related risk outcome (10.00; 95%CI:7.6–12.4) followed by stroke (9.42; 95%CI:7.2–11.6), ulcer risk (4.62; 95%CI:3.5–5.7) and hypertension (3.25; 95%CI:3.2–3.4). There were no statistically signifi cant differences in preferences between GPs and specialists. CONCLUSIONS: Ambulatory pain and the incremental risk of heart attack were the most important NSAID-related attributes that infl uence physicians’ treatment choices. Preferences did not vary between GPs and specialists. The fi ndings confi rm that benefi t-risk tradeoffs are important aspects in treament selection for OA management.

PR4 LINEAR SCORING RULES FOR PATIENT REPORTED OUTCOMES AND PATIENT PREFERENCES

PR2 DEVELOPMENT AND PSYCHOMETRIC PROPERTIES OF A PEDIATRIC PERCEIVED COGNITIVE FUNCTION ITEM BANK (PEDSPCF) Lai JS, Zelko F, Butt Z, Cella D, Magasi S, Goldman S Northwestern University, Chicago, IL, USA, Children’s Memorial Hospital, Chicago, Chicago, IL, USA OBJECTIVES: Cognitive difficulties are common among children with neurological diseases. A brief-yet-precise screening tool is needed to facilitate timely referral for neuropsychological testing in this population. Based on our prior research with clinicians, a standardized, self-report measure would be efficient and useful for this purpose. This paper reports the development and psychometric properties of a pediatric perceived cognitive function item bank (pedsPCF). METHODS: The pedsPCF consists of 45 items, developed via children/parent/clinician/teacher interview and literature review, and were qualitatively evaluated by children/parents and clinicians. The calibration sample includes data from 1,497 children: 49% aged 7–12; 45% 13– 17; 6% 18–21. Of them, 56% were males, 16% repeated grades in school, 39% received some forms of special education, 30% were given medication for attention difficulties, and 27% had at least one of the following diagnoses: epilepsy, traumatic brain injury, cerebral palsy or brain tumor. Data were randomly divided into two datasets to be used for exploratory factor analysis (EFA, n 747) and confirmatory factor analysis, specifically, bi-factor analysis (n 750). The clinical usefulness of the pedsPCF was evaluated by determining whether scores could discriminate between different sub-groups. RESULTS: One item was deleted due to its low Spearman rho and item-scale correlation. Results from the EFA suggested a single factor among the remaining 44 items based on a scree plot. Furthermore, all items had significant loadings ( 0.3) on the first factor after PROMAX rotation. Bi-factor analysis supported sufficient unidimensionality with satisfactory fit indices (CFI 0.923; TLI 0.992; RMSEA 0.112) and all items had significantly higher loadings onto the general factor versus local factors. T-tests showed that the pedsPCF significantly differentiated samples defined by medication use, repeated grades, special education status, and neurological diagnosis, all p 0.0001. CONCLUSIONS: The initial psychometric properties of pedsPCF are promising. Recruitment for the clinical validation study is in progress.

PDB56 PREFERENCES FOR ORAL ANTIDIABETIC AGENTS AMONG PEOPLE WITH TYPE 2 DIABETES

of life as an outcome due to adherence or compliance. Search terms included were “Diabetes Mellitus Type 2, Compliance, Medication Adherence” and various combinations of these terms. There was no specific criterion to include or exclude studies. All studies which fit into the purpose for literature review were analyzed. Patient education was found to be an intervention that enhances the quality of life. Use of different drug and drug delivery methods than conventional drugs were also found to improve quality of life. Age, gender, and treatment problems associated with insulin are risk factors for discontinuation and non-adherence to medications. Older patients were found to be adherent than younger patients. Forgetting to follow regimen, disruption of routine and adverse effects were some barriers reported in the literature. The main strategies for medication adherence were found to be individualized daily routines, reminder devices such as a day of the week, pillbox, and use of a special place. There are not many studies done to date to evaluate the quality of life as an outcome due to adherence and compliance. Further research in this area will help better the understanding of relationship between quality of life as an outcome due to adherence or compliance.

NE3 THE IMPORTANCE OF MODIFYING THE COURSE OF ALZHEIMER'S DISEASE: OLDER AMERICANS' RISK-BENEFIT PREFERENCES FOR NEW TREATMENTS

matched samples of employees with osteoarthritis (OA) and nonFM controls. METHODS: Samples were selected from a U.S. claims database of privately insured beneficiaries. Employees in the FM sample had ≥2 fibromyalgia diagnoses in 1999–2005 (with ≥1 in 2002–2005) and were continuously enrolled in 2005. Controls and employees with OA had no FM claims and were matched to the study sample on age, gender, and region. Costs are reported for 2005 experience. Nonparametric Wilcoxon tests were used to determine statistically significant differences in skewed variables including costs. Chi-square tests were used to test for differences in for categorical variables. RESULTS: Mean age in the FM sample was 50.1 years and 51.6% were female. Compared to control and OA samples, employees with FM had higher rates of depression, anxiety, chronic fatigue syndrome, and many pain diagnoses. The FM sample used more medical care overall, especially emergency department visits, specialty physician visits, and prescriptions. Direct (medical and prescription drug) costs in the FM sample were significantly higher than control sample costs (

Patient preference methods: A patient-centered evaluation paradigm

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