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Evaluating Patient Preferences of Maintenance Therapy for the Treatment of Chronic Obstructive Pulmonary Disease: A Discrete Choice Experiment in the UK, USA and Germany

Authors Lewis HB, Schroeder M, Gunsoy NB, Janssen EM, Llewellyn S, Doll HA, Jones PW, Ismaila AS

Received 4 July 2019

Accepted for publication 21 February 2020

Published 18 March 2020 Volume 2020:15 Pages 595—604


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Hannah B Lewis,1 Melanie Schroeder,2 Necdet B Gunsoy,3 Ellen M Janssen,4 Samuel Llewellyn,5 Helen A Doll,1 Paul W Jones,6 Afisi S Ismaila7,8

1Patient Centred Outcomes, ICON plc., London, UK; 2Value Evidence and Outcomes, GlaxoSmithKline plc., Brentford, UK; 3Value Evidence and Outcomes, GlaxoSmithKline plc., Uxbridge, UK; 4Patient Centred Outcomes, ICON plc., Gaithersburg, MD, USA; 5Patient Centred Outcomes, ICON plc., Abingdon, UK; 6Respiratory Therapy Area, GlaxoSmithKline plc., Brentford, UK; 7Value Evidence and Outcomes, GlaxoSmithKline plc., Collegeville, PA, USA; 8Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

Correspondence: Afisi S Ismaila
Value Evidence and Outcomes, GlaxoSmithKline plc., 1250 South Collegeville Road, Collegeville, PA 19426-0989, USA
Tel +1 919 932 0430

Introduction: With increasing availability of different treatments for chronic obstructive pulmonary disease (COPD), we sought to understand patient preferences for COPD treatment in the UK, USA, and Germany using a discrete choice experiment (DCE).
Methods: Qualitative research identified six attributes associated with COPD maintenance treatments: ease of inhaler use, exacerbation frequency, frequency of inhaler use, number of different inhalers used, side effect frequency, and out-of-pocket costs. A DCE using these attributes, with three levels each, was designed and tested through cognitive interviews and piloting. It comprised 18 choice sets, selected using a D-efficient experimental design. Demographics and disease history were collected and the final DCE survey was completed online by participants recruited from panels in the UK, USA and Germany. Responses were analyzed using mixed logit models, with results expressed as odds ratios (ORs).
Results: Overall, 450 participants (150 per country) completed the DCE; most (UK and Germany, 97.3%; USA, 98.0%) were included in the final analysis. Based on relative attribute importance, avoidance of side effects was found to be most important (UK: OR 11.65; USA: OR 7.17; Germany: OR 11.45; all p< 0.0001), followed by the likelihood of fewer exacerbations (UK: OR 2.22; USA: OR 1.63; Germany: OR 2.54; all p< 0.0001) and increased ease of use (UK: OR 1.84; USA: OR 1.84; Germany: OR 1.60; all p< 0.0001). Number of inhalers, out-of-pocket costs, and frequency of inhaler use were found to be less important. Preferences were relatively consistent across the three countries. All participants required a reduction in exacerbations to accept more frequent inhaler use or use of more inhalers.
Conclusion: When selecting COPD treatment, individuals assigned the highest value to the avoidance of side effects, experiencing fewer exacerbations, and ease of inhaler use. Ensuring that patients’ preferences are considered may encourage treatment compliance.

Keywords: discrete choice experiment, DCE, symptomatic chronic obstructive pulmonary disease, COPD, stated-preference methods

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