List of publications, posters and presentations

Orme ME, Miners A, Sabin C, Fisher M, Alfred S, Rogatto F, Reilly G, Perard R. A Discrete Choice Experiment to Evaluate HIV Patient Preference for Simplified Treatment Regimens: Results from the UK Survey (P4)


Background: The development of effective single-tablet regimens for anti-retroviral therapy has led to the prospect of simplified treatment for HIV patients. The aim of this study was to conduct a discrete choice experiment (DCE) to estimate the relative strength of patient preference for simplified treatment regimens. Methods: A prospective web survey was set up to collect data from HIV patients in the UK. A steering committee consisting of clinicians, nurses, pharmacists, patient group representatives and academics, guided the initial survey design. HIV patient organisations provided feedback on the pilot survey. The DCE consisted of 12 hypothetical choices of two drug scenarios with different attributes (number of tablets (1 to 4), mealtime dosing, increased risk of heart attack or insomnia (yes/no), and monthly cost to the healthcare system (£500, £600, £750, £1000)). For each scenario, patients chose the option they preferred and the response patterns were analysed in STATA v13 using generalised multinomial logit models. Willingness to pay (WTP) in GBP was used as a metric to quantify the strength of preference for each attribute. Results: Of 316 responses, 278 (88%) qualified for inclusion in the analysis. 72.6% of the respondents were men who have sex with men and 14.7% were female, mean age was 44 (range 21-66) years. The time since diagnosis was 8 (0-30) years with a 5 (0-27) years median duration of treatment. Patients had a statistically significant preference for the avoidance of insomnia and heart attack and for a reduced number of tablets. The strongest preference was for the avoidance of insomnia, followed by having a single tablet regimen, the avoidance of heart attack and avoiding mealtime dosing. Translating preferences to WTP provided the table below

Avoid CV Avoid insomnia Tablets Avoid mealtime dosing
1 2 3 Base: 4+
WTP £ 527 731 623 72 -131 -564 404
95% Confidence Interval 381 527 455 0 -212 286
674 935 792 143 -51 522

The ordering of preferences (and WTP for each attribute) varied by patient, and was particularly affected by the patient’s current regimen. For example, those on two or more tablets per day had a stronger preference for avoiding mealtime dosing than patients already on single tablet regimens. Conclusions: UK HIV patients have a strong preference for avoiding treatment regimens associated with insomnia, then prefer single tablet regimens and the avoidance of an increased risk of a heart attack. Avoiding mealtime dosing was a lower priority.

Presented at the 21st Annual Conference of the British HIV Association, 21-24 April 2015, Brighton, UK.

Citation: BHIVA 2015