Semra Özdemir

Multiple sclerosis patients—benefit-risk preferences: Serious adverse event risks versus treatment efficacy

Objective:The aim of this study is to estimate the willingness of multiple sclerosis (MS) patients to accept life-threatening adverse event risks in exchange for improvements in their MS related health outcomes.Methods:MS patients completed a survey questionnaire that included a series of choice-format conjoint tradeoff tasks. Patients chose hypothetical treatments from pairs of treatment alternatives with varying levels of clinical efficacy and associated risks.Results:Among the 651 patients who completed the survey, delay in years to disability progression was the most important factor in treatment preferences. In return for decreases in relapse rates from 4 to 1 and increases in delay in progression from 3 to 5 years, patients were willing to accept a 0.38% annual risk of death or disability from PML, a 0.39% annual risk of death from liver failure or a 0.48% annual risk of death from leukemia.Conclusions:Medical interventions carry risks of adverse outcomes that must be evaluated against their clinical benefits. Most MS patients indicated they are willing to accept risks in exchange for clinical efficacy. Patient preferences for potential benefits and risks can assist in decision-making.

Hypothetical bias, cheap talk, and stated willingness to pay for health care

Subjects with rheumatoid arthritis (RA) enrolled in an online panel were asked to evaluate pairs of treatment alternatives with different attributes. Half of the sample saw a cheap-talk text. Preference parameters were estimated using random-parameters logit models to account for unobserved taste heterogeneity. The models also were estimated in willingness-to-pay (WTP) space instead of conventional utility space. Cheap talk not only affected the coefficient on the cost attribute, but also preferences for other attributes. WTP estimates were generally lower in cheap talk sample, except for the most important attribute and a 2-level attribute. Subjects who were presented with cheap talk discriminated between the adjoning attribute levels better than the subjects in the control sample.

Using Conjoint Analysis to Estimate Healthy‐Year Equivalents for Acute Conditions: An Application to Vasomotor Symptoms

OBJECTIVE Conventional standard gamble and time trade-off methods may be inappropriate for eliciting preferences for some health states because both require subjects to make trade-offs between a morbid health state and death. Thus, the objective of this study is to demonstrate the use of conjoint analysis to obtain time trade-off estimates of healthy-year equivalents (HYEs) for clinically relevant durations and severities of acute, self-limiting, or nonfatal conditions such as vasomotor symptoms. METHODS A self-administered, web-enabled, graded-pairs conjoint-analysis survey was developed to elicit womens preferences for reducing the frequency and severity of vasomotor symptoms (daytime hot flushes and night sweats). Observed trade-offs between symptom duration and symptom relief were used to calculate HYEs for different severities and durations of vasomotor symptoms. RESULTS A total of 523 women with a mean age of 52 years completed the survey. For these women, an improvement from severe to moderate vasomotor symptoms yields a gain of 4.44 HYEs, and an improvement from moderate to mild vasomotor symptoms over 1 year yields a gain of 4.62 HYEs over a period of 7 years. HYE gains for symptom relief are larger for younger women than for older women. CONCLUSIONS Conjoint analysis is a feasible method for estimating HYEs for acute, self-limiting, or nonfatal conditions. This approach may provide an alternative utility-elicitation method when conventional standard gamble and time trade-off methods are inappropriate to the decision context.

Who pays attention in stated-choice surveys?

Responses of inattentive or inconsistent subjects in stated-choice (SC) surveys can lead to imprecise or biased estimates. Several SC studies have investigated inconsistency and most of these studies dropped subjects who were inconsistent. However, none of these studies reported who is more likely to fail consistency tests. We investigated the effect of the personal characteristics and task complexity on preference inconsistency in eight different SC surveys. We found that white, higher-income and better-educated female subjects were less likely to fail consistency tests. Understanding the characteristics of subjects who are inattentive to the choice task may help in designing and pre-testing instruments that work effectively for a wider range of subjects.

Effects of simplifying choice tasks on estimates of taste heterogeneity in stated-choice surveys

Researchers usually employ orthogonal arrays or D-optimal designs with little or no attribute overlap in stated-choice surveys. The challenge is to balance statistical efficiency and respondent burden to minimize the overall error in the survey responses. This study examined whether simplifying the choice task, by using a design with more overlap, provides advantages over standard minimum-overlap methods. We administered two designs for eliciting HIV test preferences to split samples. Surveys were undertaken at four HIV testing locations in San Francisco, California. Personal characteristics had different effects on willingness to pay for the two treatments, and gains in statistical efficiency in the minimal-overlap version more than compensated for possible imprecision from increased measurement error.

Giving Patients a Meaningful Voice in United States Regulatory Decision Making: The Role for Health Preference Research

Weighing the benefits and risks of new health technologies requires assessing the available scientific evidence but also making societal value judgments about the relative importance of those benefits and risks [1]. Such judgments traditionally have been delegated to physicians. Increasingly, however, patients are claiming a greater role in such assessments. This paper discusses the increasing concern of the US FDA in strengthening patient engagement by conducting health preference research (HPR) on patients’ risk tolerance.

Estimating willingness to pay: do health and environmental researchers have different methodological standards?

Health and environmental economists have been employing Stated-Preference (SP) methods such as conjoint analysis or contingent valuation to estimate the monetary value of public health interventions and environmental goods and services. However, the quality of data and the validity of results are sensitive to a number of decisions researchers make. The aim of this study is to compare the degree of the current consensus among active researchers in the rapidly evolving area of SP methods in health and environmental valuation. We surveyed researchers who have published manuscripts on SP methods in the last 10 years. Researchers were presented with hypothetical SP studies with different attributes. They were first asked which study they would recommend to use to inform policy decisions, and then asked which study has better-quality. Our results show that good-practice SP methods vary among study features and among researchers with different amounts and kinds of research experience. Although health researchers had specific preferences on which study features were better, their quality judgements were not very consistent with their judgements about the acceptability of studies for policy analysis. On the other hand, environmental researchers had similar preferences over the study attributes for the two types of questions.

PAR16 CAN OSTEOARTHRITIS PATIENTS EVALUATE TRADEOFFS BETWEEN NSAID RISKS AND BENEFITS

CLUSIONS: Five methods of measuring BLISS attainment using four pre-specified threshold levels of pain were able to statistically discriminate between treatment groups. This method may potentially provide an approach, to defining which patients not only improve but also achieve a good state of health, at low and very low levels of pain intensity. BLISS -10 is a therapeutically attainable very low symptom state at which clinically important, statistically significant between group differences are detectable, and therefore may provide a benchmark against which therapeutic interventions can be assessed. However, the value to patients, of this and other low and very low intensity pain states, requires further elaboration.