Background Economic considerations and patient preferences are increasingly important when choosing treatments. It is not known to what extent rheumatologists across Europe account for these factors when changing drug therapies in patients with active rheumatoid arthritis (RA).
Objectives To evaluate the extent to which rheumatologists across Europe consider costs, cost-effectiveness and patient preferences in addition to efficacy and safety in treatment decisions in RA.
Methods In a discrete choice experiment, rheumatologists were asked to choose iteratively between two unlabelled drug treatment options for a hypothetical RA patient with moderate disease activity who failed two synthetic DMARDs. The treatment options were characterized by five attributes further specified by three levels; efficacy (level of improvement and achieved state on DAS28), safety (probability of a serious adverse event), patient preference (level of agreement with proposed treatment), medication costs and cost-effectiveness (incremental cost-effectiveness ratio (ICER)). Attributes and levels were selected based on literature data and expert consensus. An efficient experimental design was used to construct 14 treatment choices and a mixed logit model was used to estimate the relative importance of attributes.
Results 452 rheumatologists from 11 European countries contributed to the analysis (51% females, mean age 49 years). In all countries, drug-efficacy had the strongest influence on the rheumatologists' preferred drug choice. In addition, patient preferences were taken into account, especially when patients did not favour the drug. With regard to economic attributes of the drug, medication costs influenced the treatment choice more than ICER (table 1). However relative importance of ICER differed across countries (2-13%).
Conclusions This study suggests that efficacy had the highest impact on treatment decisions. But for rheumatologists also patient preferences were relevant. Among the economic considerations, overall medication costs primarily influenced treatment decisions in RA, while ICER played a more limited role, especially in some countries.
Disclosure of Interest M. Hifinger Employee of: Hexal AG, Holzkirchen, Germany (maternity leave), M. Hiligsmann: None declared, S. Ramiro: None declared, H. Severens: None declared, B. Fautrel: None declared, V. Watson: None declared, T. Uhlig: None declared, R. van Vollenhoven: None declared, P. Jacques: None declared, J. Detert: None declared, C. Scirè: None declared, J. Canas da Silva: None declared, F. Berghea: None declared, L. Carmona: None declared, M. Péntek: None declared, A. Boonen: None declared