Patient preferences for osteoarthritis pain and chronic low back pain treatments in the United States: a discrete-choice experiment

Abstract

Objective: To quantify preferences for attributes of potential analgesic treatments for moderate-to-severe pain associated with osteoarthritis (OA) and/or chronic low back pain (CLBP) as relevant to injectable nerve growth factor (NGF)einhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids. Methods: We used a discrete-choice experiment (DCE) to elicit preferences for attributes of OA and CLBP pharmaceutical treatments, and a best-worst scaling (BWS) exercise to further characterize the relative importance of treatment-related side-effect risks. The survey was completed online by 602 US residents with self-reported chronic, moderate-to-severe OA pain and/or CLBP who had tried, had contraindications for, or were unwilling to take currently available pharmaceutical therapies. In the DCE, respondents repeatedly chose between two hypothetical treatments defined by six attributes (symptom control; treatment-related risks of (1) severe joint problems, (2) heart attack, and (3) physical dependence; mode/frequency of administration; and cost). In the BWS exercise, respondents evaluated ten side-effect risks. Random-parameters logit models were estimated; conditional relative attribute importance, maximum acceptable risks, and willingness to pay were calculated. Results: The most important DCE attributes were improving symptom control (scaled conditional relative importance, 10.00) and reducing risk of physical dependence (6.99). The three most important BWS attributes were, in rank order, risks of stroke, physical dependence, and heart attack. Respondents were willing to accept a > 4% treatment-related risk of severe joint problems for even modest symptom improvement. Conclusion: A pharmaceutical treatment with a risk of severe joint problems was viewed as an acceptable alternative to other treatments with comparable efficacy but risks associated with NSAIDs or opioids.

Assessment of the satisfaction with public health insurance programs by patients with chronic diseases in China: a structural equation modeling approach

“…However, it is very hard for patients to comprehend the concept of the cost-effectiveness of medical technologies. As shown in patient-centered surveys [49][50][51], effectiveness and cost were often treated as independent attributes of medical technologies. Consequently, patients' perceived clinical and economic values of health insurance were considered in our study.…”

Patients’ Preferences Regarding Osteoarthritis Medications: An Adaptive Choice-Based Conjoint Analysis Study

“…9,10 Other studies found that patients were more concerned about the risk of side effects. [11][12][13] Costs and mode of administration have also been shown to be predictors of preferences in some studies. [14][15][16][17] Therefore, eliciting patients´ preferences for OA treatment may enable therapists to better develop and implement patient-oriented treatment.…”

Evaluation of Factors Relevant to Pain Control Among Patients After Surgical Treatment

“…Our findings contrast with research on chronic pain, for which patients often rank avoidance of adverse effects as one of the most important factors when devising pain control regimens. 6 , 7 , 17 For example, in a DCE of patients with chronic osteoarthritis, the highest-ranking attribute was symptom control, followed by risk of addiction. 17 Meanwhile, our study of acute pain control found that the potential for adverse effects was less important than pain relief or risk of addiction.…”

“… 6 , 7 , 17 For example, in a DCE of patients with chronic osteoarthritis, the highest-ranking attribute was symptom control, followed by risk of addiction. 17 Meanwhile, our study of acute pain control found that the potential for adverse effects was less important than pain relief or risk of addiction. Furthermore, unlike patients with chronic pain, who may use opioids after finding other treatment modalities ineffective, patients with acute postoperative pain are often prescribed opioids despite the availability of effective, yet less addictive medications.…”