Patients’ preferences for anti-osteoporosis drug treatment: a cross-European discrete-choice experiment

OBJECTIVES: To estimate the preferences of osteoporotic patients for medication attributes, and analyse data from seven European countries.
METHODS: A discrete choice experiment was conducted in Belgium, France, Ireland, the Netherlands, Spain, Switzerland and United Kingdom. Patients were asked to choose repeatedly between two hypothetical unlabelled drug treatments (and an opt-out option) that varied with respect to four attributes: efficacy in reducing the risk of fracture, type of potential common side-effects, mode and frequency of administration. In those countries in which patients contribute to the cost of their treatment directly, a fifth attribute was added: out-of-pocket cost. A mixed logit panel model was used to estimate patients’ preferences.
RESULTS: In total 1,124 patients completed the experiment, with sample of between 98 and 257 patients per country. In all countries, patients preferred treatment with higher effectiveness and 6-monthly subcutaneous injection was always preferred over weekly oral tablets. In five countries, patients also preferred monthly oral tablet and yearly intravenous injections over weekly oral tablets. In the three countries where the out-of-pocket cost was included as an attribute, lower costs significantly contribute to the treatment preference. Between countries there were statistically significant differences for 13 out of 42 attribute/levels interactions.
CONCLUSIONS: We find statistically significant differences in patients’ preferences for anti-osteoporosis medications between countries, especially for the mode of administration. Our findings emphasize that international treatment recommendations should allow for local adaptation and that understanding individual preferences is important if we want to improve the quality clinical care for patients with osteoporosis.