Patient Preference for Antiepileptic Drugs Treatment in China: Evidence From the Discrete Choice Experiment

Abstract

Objective: Explore Chinese patients' risk-benefit preferences and willingness-to-pay (WTP) for antiepileptic drugs (AEDs) treatment through the discrete choice experiment (DCE).Method: Six attributes including the efficacy of AEDs, adverse reactions (digestive system, neuropsychic systems, and the effects on the fetus), dosing frequency and drug costs (to estimate patient WTP) were included in the DCE questionnaire based on results collected from literature reviews, expert consultation, and patient survey. The alternative-specific conditional logit model was used to analyze patient preference and WTP for each attribute and its level and to assess the sociodemographic impact and clinical characteristics.Results: A total of 151 valid questionnaires were collected. The result shows that five out of the six attributes are significant, except the dosing frequency. Among the six attributes, the efficacy of AEDs (10.0; 95% CI 8.9–11.1) is mostly concerned by patients, followed by the effects of AEDs on the fetus (8.9; 95% CI 7.7–10.1), duration of side effects in the neuropsychic system (4.9; 95% CI 3.7–6.0) and adverse reactions of the digestive system (3.2; 95% CI 1.5–4.2). The patients surveyed are willing to spend ¥ 1,246 (95% CI, ¥ 632- ¥ 1,861) per month to ensure 100% seizure control, and ¥ 1,112 (95% CI, ¥ 586–¥ 1,658) to reduce the risk of the drug affecting the fetus to 3%. Besides, it was found that personal characteristics including the intention for conception and AEDs treatment regimens have statistical significance.Conclusion: Improving the drug's efficacy and reducing its side effects are predominant considerations for patients with epilepsy in China, especially for those who are concerned about the seizure control and the drug effect on the fetus. This finding is useful to physicians and can encourage shared decision-making between the patients and their doctors in the clinic.

Healthcare preferences of the general Chinese population in the hierarchical medical system: A discrete choice experiment

“…Moreover, "Care provider" and "Cost" have little impact on respondents' choices. preferences of Chinese residents with chronic diseases (37)(38)(39)(40), no study categorized the diseases into three separate types at the same time and analyzed them in two models. Particularly, medical insurance reimbursement as an attribute is also a crucial novel addition in this study.…”

“…This study is the first quantitative analysis of Chinese residents' healthcare preferences under different types of diseases. Although some scholars have analyzed the healthcare preferences of Chinese residents with chronic diseases ( 37 – 40 ), no study categorized the diseases into three separate types at the same time and analyzed them in two models. Particularly, medical insurance reimbursement as an attribute is also a crucial novel addition in this study.…”

Relative importance of clinical outcomes and safety risks of antiseizure medication monotherapy for patients and physicians: Discrete choice experiment eliciting preferences in real‐world study "VOTE"

“…In addition, few studies have assessed preferences for diagnostics in epilepsy, 18 and previous studies of preferences for ASM treatment are relatively rare. [3][4][5][6][7][8] Efficacy (chance of becoming seizure-free) was considered the most important treatment attribute by these patients. The second most important attribute was avoiding negative effect on cognition in terms of trouble thinking clearly.…”

“…However, improving the chance of becoming seizure-free from 25% to 60%, a change in utility of approximately 2.4, yields double the effect on utility than does eliminating severe tiredness in Chinese patients, found that efficacy was the most important aspect of ASM treatment, although reducing side effects was also a major concern. 6 In addition, a DCE survey that elicited patient preferences toward pharmacogenetic testing before carbamazepine treatment showed that patients were willing to accept a less effective ASM if that treatment had less risk of harm. 7 The patient population in this study was diverse in terms of demographics, epilepsy characteristics, and treatment history.…”

“…2 Although adverse events (AEs) associated with ASMs affect many patients with epilepsy, few studies have evaluated patients' preferences regarding the clinical outcomes and safety risks associated with ASMs. [3][4][5][6][7][8] The importance of understanding patient needs and preferences is increasingly recognized. [9][10][11][12] There has been a shift toward patient-centered health care, shared decisionmaking, and involvement of the patient perspective in regulatory decision-making.…”