Article Text

Download PDFPDF
Extended report
Economic considerations and patients' preferences affect treatment selection for patients with rheumatoid arthritis: a discrete choice experiment among European rheumatologists
  1. M Hifinger1,2,
  2. M Hiligsmann1,3,
  3. S Ramiro4,
  4. V Watson5,
  5. J L Severens6,
  6. B Fautrel7,
  7. T Uhlig8,
  8. R van Vollenhoven9,
  9. P Jacques10,
  10. J Detert11,
  11. J Canas da Silva12,
  12. C A Scirè13,
  13. F Berghea14,
  14. L Carmona15,
  15. M Péntek16,17,
  16. A Keat18,
  17. A Boonen1,2
  1. 1CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
  2. 2Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
  3. 3Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
  4. 4Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  5. 5Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
  6. 6Institute for Health Policy and Management, Erasmus Rotterdam University, Rotterdam, The Netherlands
  7. 7Department of Rheumatology, University Paris 6, GRC-UPMC08, Pierre Louis Institute of Epidemiology and Public Health—AP-HP, Pitie Salpetriere University Hospital, Paris, France
  8. 8National Advisory Unit for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo, Oslo, Norway
  9. 9Unit for Clinical Therapy Research Inflammatory Diseases, Karolinska Institute, Stockholm, Sweden
  10. 10Department of Rheumatology, University Hospital Ghent, Ghent, Belgium
  11. 11Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
  12. 12Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal
  13. 13Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
  14. 14Department of Rheumatology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
  15. 15Department of Rheumatology, Instituto de Salud Musculoesqueletica, Madrid, Spain
  16. 16Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
  17. 17Department of Rheumatology, Flór Ferenc Hospital, Kistarcsa, Hungary
  18. 18Arthritis Centre, Northwick Park Hospital, Harrow, UK
  1. Correspondence to Monika Hifinger, Department of Rheumatology, Maastricht University Medical Center, CAPHRI, Maastricht 6202 AZ, The Netherlands; monikahifinger{at}


Objective To compare the value that rheumatologists across Europe attach to patients' preferences and economic aspects when choosing treatments for patients with rheumatoid arthritis.

Methods In a discrete choice experiment, European rheumatologists chose between two hypothetical drug treatments for a patient with moderate disease activity. Treatments differed in five attributes: efficacy (improvement and achieved state on disease activity), safety (probability of serious adverse events), patient's preference (level of agreement), medication costs and cost-effectiveness (incremental cost-effectiveness ratio (ICER)). A Bayesian efficient design defined 14 choice sets, and a random parameter logit model was used to estimate relative preferences for rheumatologists across countries. Cluster analyses and latent class models were applied to understand preference patterns across countries and among individual rheumatologists.

Results Responses of 559 rheumatologists from 12 European countries were included in the analysis (49% females, mean age 48 years). In all countries, efficacy dominated treatment decisions followed by economic considerations and patients’ preferences. Across countries, rheumatologists avoided selecting a treatment that patients disliked. Latent class models revealed four respondent profiles: one traded off all attributes except safety, and the remaining three classes disregarded ICER. Among individual rheumatologists, 57% disregarded ICER and these were more likely from Italy, Romania, Portugal or France, whereas 43% disregarded uncommon/rare side effects and were more likely from Belgium, Germany, Hungary, the Netherlands, Norway, Spain, Sweden or UK.

Conclusions Overall, European rheumatologists are willing to trade between treatment efficacy, patients' treatment preferences and economic considerations. However, the degree of trade-off differs between countries and among individuals.

  • Rheumatoid Arthritis
  • Treatment
  • Patient perspective
  • Economic Evaluations
  • DMARDs (biologic)

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Hans WJ Bijlsma

  • Twitter Follow Carlo Scirè at @rthritis

  • Competing interests MH contributed during an unpaid extended maternity leave (2013–2016) agreed with Hexal AG, Germany.

  • Provenance and peer review Not commissioned; externally peer reviewed.