Abstract
Objectives:
To elicit and value patient preferences for the processes and outcomes of surgical management of stress urinary incontinence in women.
Design: A discrete choice experiment survey to elicit preferences for type of anaesthesia, post-op time, treatment success, adverse events, impact on daily activities and cost. An experimental design generated 40 choice tasks, and each respondent completed one block of 10 and two validity tests. Analysis was by multinomial logistical regression.
Setting: N=21 UK hospitals
Participants: N=325 adult women who were a sub-sample of those randomised to the SIMS clinical trial.
Outcomes: Patient preferences; valuation obtained using willingness to pay
Results:
N=227/325 (70%) returned a questionnaire, and 94% of those completed all choice tasks. Respondents preferred general anaesthesia, shorter recovery times, improved stress urinary incontinence symptoms and avoidance of adverse events. Women were willing to pay, mean (95% CI), £76(£33 to £119) per day of reduction in recovery time following surgery. They valued increases in Patient Global Impression of Improvement, ranging from £8,173 (£5,459
to £10,887) for “improved” to £11,706 (£8,267 to £15,144) for “very much improved”, compared to no improvement. This was offset by negative values attached to complications ranging between £-8,022 (£-10,661 to £-5,383) and £-10,632 (£-14,077 to £-7,187) for the avoidance of various complications. Avoidance of daily activities had a negative impact on preferences, with willingness to pay ranging from £-967 (£-2,199 to £266) for rarely avoiding
activities to £-5,338 (£-7258 to £-3417) for frequently avoiding daily activities compared to no avoidance.
Conclusion: This discrete choice experiment demonstrates that patients place considerable value on improvement in stress urinary incontinence symptoms and avoidance of treatment complications. These trade-offs should be considered within shared decision making. The willingness to pay values from this study can be used in future cost-benefit analyses.
To elicit and value patient preferences for the processes and outcomes of surgical management of stress urinary incontinence in women.
Design: A discrete choice experiment survey to elicit preferences for type of anaesthesia, post-op time, treatment success, adverse events, impact on daily activities and cost. An experimental design generated 40 choice tasks, and each respondent completed one block of 10 and two validity tests. Analysis was by multinomial logistical regression.
Setting: N=21 UK hospitals
Participants: N=325 adult women who were a sub-sample of those randomised to the SIMS clinical trial.
Outcomes: Patient preferences; valuation obtained using willingness to pay
Results:
N=227/325 (70%) returned a questionnaire, and 94% of those completed all choice tasks. Respondents preferred general anaesthesia, shorter recovery times, improved stress urinary incontinence symptoms and avoidance of adverse events. Women were willing to pay, mean (95% CI), £76(£33 to £119) per day of reduction in recovery time following surgery. They valued increases in Patient Global Impression of Improvement, ranging from £8,173 (£5,459
to £10,887) for “improved” to £11,706 (£8,267 to £15,144) for “very much improved”, compared to no improvement. This was offset by negative values attached to complications ranging between £-8,022 (£-10,661 to £-5,383) and £-10,632 (£-14,077 to £-7,187) for the avoidance of various complications. Avoidance of daily activities had a negative impact on preferences, with willingness to pay ranging from £-967 (£-2,199 to £266) for rarely avoiding
activities to £-5,338 (£-7258 to £-3417) for frequently avoiding daily activities compared to no avoidance.
Conclusion: This discrete choice experiment demonstrates that patients place considerable value on improvement in stress urinary incontinence symptoms and avoidance of treatment complications. These trade-offs should be considered within shared decision making. The willingness to pay values from this study can be used in future cost-benefit analyses.
| Original language | English |
|---|---|
| Journal | BMJ Open |
| Publication status | Accepted/In press - 28 Apr 2023 |
Keywords
- Surgery
- Urinary Incontinence
- Health policy
- Health Economics
- Patient preference
