Discrete Choice Experiment to Evaluate Factors That Influence Preferences for Antibiotic Prophylaxis in Pediatric Oncology

Abstract

BackgroundBacterial and fungal infections in pediatric oncology patients cause morbidity and mortality. The clinical utility of antimicrobial prophylaxis in children is uncertain and the personal utility of these agents is disputed. Objectives were to use a discrete choice experiment to: (1) describe the importance of attributes to parents and healthcare providers when deciding between use and non-use of antibacterial and antifungal prophylaxis; and (2) estimate willingness-to-pay for prophylactic strategies.MethodsAttributes were chances of infection, death and side effects, route of administration and cost of pharmacotherapy. Respondents were randomized to a discrete choice experiment outlining hypothetical treatment options to prevent antibacterial or antifungal infections. Each respondent was presented 16 choice tasks and was asked to choose between two unlabeled treatment options and an opt-out alternative (no prophylaxis).Results102 parents and 60 healthcare providers participated. For the antibacterial discrete choice experiment, frequency of administration was significantly associated with utility for parents but not for healthcare providers. Increasing chances of infection, death, side effects and cost were all significantly associated with decreased utility for parents and healthcare providers in both the antibacterial and antifungal discrete choice experiment. Parental willingness-to-pay was higher than healthcare providers for both strategies.ConclusionChances of infection, death, side effects and costs were all significantly associated with utility. Parents have higher willingness-to-pay for these strategies compared with healthcare providers. This knowledge can help to develop prophylaxis programs.

Patients’ Preferences for Outcome, Process and Cost Attributes in Cancer Treatment: A Systematic Review of Discrete Choice Experiments

“…An overview of the study characteristics is provided in Table 1 . Within the investigated timeframe of this review (January 2010–April 2016), most studies were published in 2012 (25%) [ 31 – 37 ]. The majority of studies were conducted in North America ( n = 13) [ 33 , 34 , 38 – 47 ] with at least one study each year since 2010; 2014 was a peak year, with five published studies.…”

“…While all studies gathered preferences of patients, five also included carers’ preferences or those of healthcare providers [ 32 , 36 , 37 , 50 , 55 ]. A majority of the 25 studies (89%) targeted adult patients [ 31 , 32 , 34 – 36 , 38 – 58 ], and only two included children or their parents [ 33 , 37 ]. Furthermore, two studies focused their research on follow-up after therapy [ 49 , 58 ] and one study on psychological care during the treatment process [ 32 ].…”

“…A total of 32% of the studies showed inconsistency in attribute labelling [ 33 , 37 – 39 , 48 , 55 ], meaning that terms used for the results of analysis were different from those used within choice tasks and survey description (e.g. ‘severity of dehydration’ in the analysis in comparison with ‘need to seek additional treatment for dehydration’ in the choice task reference).…”

“…One study offered the possibility of choosing between an online or paper questionnaire [ 58 ]. Only five of the studies conducted face-to-face interviews (19%) [ 33 , 36 , 37 , 48 , 57 ], of which one was computer-assisted [ 48 ].…”

Levofloxacin prophylaxis in hospitalized children with leukemia: A cost‐utility analysis

“…Previous studies have shown a positive attitude of parents of children with cancer and health care providers toward antibiotic prophylaxis. A previous discrete choice experiment conducted with parents and pediatric cancer care providers revealed a marginal willingness‐to‐pay threshold for antibiotic prophylaxis of $40 per 1% reduction in risk of infection 58 . Combining this result with the effectiveness of levofloxacin prophylaxis would result in a willingness‐to‐pay threshold of approximately $864.…”