Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, United Kingdom.
J Med Econ. 2020 Aug;23(8):803-811. doi: 10.1080/13696998.2020.1735398. Epub 2020 Apr 2.
To elicit patients' preferences for HIV treatment of the rural population in Colombia. A discrete choice experiment (DCE), conducted in a HIV clinic in Bogotá, was used to examine the trade-off between five HIV treatment attributes: effect on life expectancy, effect on physical activity, risk of moderate side-effects, accessibility to clinic, and economic costs to access controls. Attributes selection was based on literature review, expert consultation and a focus group with six patients. An efficient experimental design was used to define two versions of the questionnaire with each of 12 choice sets and a dominance task was added to check reliability. A mixed logit model was then used to analyse the data and sub-group analyses were conducted on the basis of age, gender, education, and sexual preference. A total of 129 HIV patients were included for analysis. For all treatment attributes, significant differences between at least two levels were observed, meaning that all attributes were significant predictors of choice. Patients valued the effect on physical activity (conditional relative importance of 27.5%) and the effect on life expectancy (26.0%) the most. Sub-group analyses regard age and education showed significant differences: younger patients and high educated patients valued the effect on physical activity the most important, whereas older patients mostly valued the effect on life expectancy and low educated patients mostly valued the accessibility to clinic. One potential limitation is selection bias, as only patients from one HIV clinic were reached. Additionally, questionnaires were partly administered in the waiting rooms, which potentially led to noise in the data. This study suggests that all HIV treatment characteristics included in this DCE were important and that HIV patients from rural Colombia valued short-term efficacy (i.e. effect on physical activity) and long-term efficacy (i.e. effect on life expectancy) the most.
为了了解哥伦比亚农村地区艾滋病毒感染者对治疗方案的偏好。本研究采用离散选择实验（DCE），在波哥大的一家艾滋病诊所进行，以检验五种艾滋病治疗属性之间的权衡：对预期寿命的影响、对身体活动的影响、中度副作用风险、就诊的可及性以及获得控制的经济成本。属性选择基于文献综述、专家咨询和六名患者的焦点小组。采用有效的实验设计来定义两个问卷版本，每个版本都有 12 个选择集，并添加了一个优势任务来检查可靠性。然后使用混合 logit 模型来分析数据，并根据年龄、性别、教育程度和性偏好进行亚组分析。共纳入 129 名艾滋病毒感染者进行分析。对于所有治疗属性，至少两个水平之间存在显著差异，这意味着所有属性都是选择的重要预测因素。患者最看重身体活动的效果（条件相对重要性为 27.5%）和预期寿命的效果（26.0%）。年龄和教育程度的亚组分析显示出显著差异：年轻患者和高学历患者最看重身体活动的效果，而老年患者最看重预期寿命的效果，低学历患者最看重就诊的可及性。一个潜在的限制是选择偏差，因为只接触到了一家艾滋病诊所的患者。此外，部分问卷在候诊室发放，这可能导致数据存在噪音。本研究表明，本 DCE 中纳入的所有艾滋病治疗特征都很重要，来自哥伦比亚农村地区的艾滋病患者最看重短期疗效（即对身体活动的影响）和长期疗效（即对预期寿命的影响）。
