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Rheumatoid arthritis
Original article
Influence of disease activity on RA treatment choices in countries with restricted access to expensive, innovative drugs: a discrete choice experiment among rheumatologists
  1. Monika Hifinger1,2,
  2. Mickael Hiligsmann1,3,
  3. Sofia Ramiro4,
  4. Verity Watson5,
  5. Florian Berghea6,
  6. Márta Péntek7,8,
  7. Andrew Keat9,
  8. Johan L Severens10,
  9. Bruno Fautrel11 and
  10. Annelies Boonen1,2
  1. 1CAPHRI Research Institute,Maastricht University, Maastricht, The Netherlands
  2. 2Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
  3. 3Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
  4. 4Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  5. 5Health Economics Research Unit,University of Aberdeen, Aberdeen, UK
  6. 6Department of Rheumatology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
  7. 7Department of Health Econmics, Corvinus University of Budapest, Budapest, Hungary
  8. 8Department of Rheumatology, Flór Ferenc Hospital, Kistarcsa, Hungary
  9. 9Arthritis Centre,Northwick Park Hospital, Harrow, UK
  10. 10Institute for Health Policy and Management, Erasmus Rotterdam University, Rotterdam, The Netherlands
  11. 11Department of Rheumatology, Pierre et Marie Curie University, Paris, France
  1. Correspondence to Monika Hifinger; monikahifinger{at}gmx.de

Abstract

Objective To assess the influence of disease activity of patients with rheumatoid arthritis on treatment choices of rheumatologists in countries with restricted access to expensive, innovative drugs.

Methods Rheumatologists from Hungary, Romania and UK were invited to complete two consecutive discrete choice experiments with hypothetical drug treatments for two different patient profiles: high and moderate disease activity. Rheumatologists were asked to choose repeatedly between two unlabelled treatment options that differed in five attributes: efficacy (expected improvement and achieved disease activity state), safety (probability of serious adverse events), patient's preference (level of agreement), total medication costs and cost-effectiveness. A heteroscedastic discrete choice model using interaction terms between attribute levels and patient profiles (binary variable) was used to assess the preferences of rheumatologists towards each attribute and the influence of the patient profile.

Results Overall, 148 rheumatologists completed the survey (46% females, mean age 49 years, 49% academic). For both patient profiles, efficacy dominated the treatment choice over patient's preference, safety and economic aspects. However, for patients with high compared with moderate disease activity, the importance of drug efficacy significantly increased (from 48% for moderate to 57% for high disease activity), whereas the importance of patient's preference significantly decreased (from 15% to 11%). No significant differences were observed for economic and safety considerations.

Conclusion Rheumatologists were willing to give up some efficacy to account for patient's preference when choosing treatments for patients with moderate compared to high disease activity. Disease activity however did not influence importance of economic aspects in treatment choices.

  • physician's attitude
  • DMARDs (biologic)
  • patient perspective
  • economic evaluation
  • rheumatoid arthritis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2017-000453

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    Footnotes

    • Contributors MH contributed to conception and design of the study, performed the statistical analyses, contributed to the interpretation of results and drafted the manuscript. MH contributed to conception and design of the study, supervised the performance of the statistical analyses and contributed to data interpretation and manuscript writing. SR contributed to conception and design of the study, the interpretation of results and manuscript writing. VW contributed to conception and design of the study, statistical analyses and interpretation of results and reviewed the manuscript. FB, MP and AK contributed to conception and design of the study, were responsible for recruitment of rheumatologists as principle investigator in their country, contributed to the interpretation of results and reviewed the manuscript. JLS and BF contributed to conception and design of the study and reviewed the manuscript. AB supervised the study including conception and design, data analysis, interpretation and manuscript writing. All authors read, critically reviewed and approved the final version of the manuscript submitted for publication.

    • Competing interests MH contributed during an unpaid extended maternity leave (2013-2016) agreed with Hexal AG, Germany. Related to the topic of this study, all other co-authors have no disclosures to declare.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.