Preferences for knee and hip osteoarthritis care. a discrete choice experiment

Abstract

Purpose: Despite the wide range of treatment options, healthcare for knee and hip osteoarthritis (KHOA) is often suboptimal. With the availability of a variety of healthcare settings (e.g. primary, intermediate, and secondary care), we need to gain insight into preferences for KHOA treatment. This study identified the preferences of patients and the heterogeneity in their preferences for current healthcare for KHOA. Additionally, we explored the differences between the preferences of patients, healthcare providers, and health insurance employees for healthcare for KHOA. Methods: A survey containing a discrete choice experiment (DCE) was conducted, in which KHOA patients, healthcare providers (orthopaedists and general practitioners (GPs)), and insurance employees had to choose between KHOA care alternatives that differed in six attributes: waiting time, out of pocket costs, travel distance, involved healthcare providers during consultation, length of consultation, and access to specialist equipment (see Figure 1 for an example). A (panel latent class) conditional logit model was used to determine the preference heterogeneity and the relative importance of the attributes. Results: A total of 648 patients (55.4% female, mean age of 61.7 years) completed the survey, of which 23.1% had a total joint replacement (TJR), and 76.9% had clinical OA according to the NICE guidelines and/or OA diagnosed by a clinician (self-reported). All six attributes played a significant role in patients’ choices (p<0.05). On average, low out of pocket costs was an important factor for patients. Moreover, a GP with an orthopaedist together during the consultation was preferred compared to a GP alone. Healthcare providers (n=76) and insurance employees (n=150) showed similar preferences. Figure 2 shows the relative importance of the attributes for these three groups. We identified four different classes of patients with varying preferences. Patients who were likely to belong to class 1 showed strong preferences to low out of pocket costs, an orthopaedist and GP together, and short waiting times. Patients without a total joint replacement were more likely to belong to this class than the reference class (class 4) (U=-0.60, 95%CI=-1.24; 0.05). The length of consultation did not significantly influence their preferences. Patients who were likely to belong to class 2 showed a strong preference for direct access to specialist equipment and an orthopaedist and GP together, but the waiting time did not significantly influence their preferences. Patients with a high probability to belong to this class had relatively more experience in healthcare with knee/hip complaints than the reference class (U=0.71, 95%CI= 0.05; 1.36). Patients who were likely to belong to class 3 strongly preferred an orthopaedist during consultation over a GP. Seeing a GP and an orthopaedist together during consultation did not add more value in their choices compared to an orthopaedist alone. In contrast, length of consultation and travel distance did not significantly influence their preference at all. Patients with a total joint replacement (U=0.84, 95%CI=0.25; 1.43) and low disease-specific quality of life (U=-0.61, 95%CI= -1.16; -0.06) were relatively more likely to belong to this class than the reference class. All attributes had a significant influence on the preferences of class 4, the reference group, except the length of consultation. Figure 3 shows the relative importance of the attributes for these four classes of patients. Conclusions: Our findings show that patients, healthcare providers, and insurance employees generally prefer similar attributes regarding healthcare for KHOA; they prefer low out of pocket costs and a consultation by a GP with an orthopedist together, while the length of consultation was less important. As we identified four subgroups of patients that have varying preferences for KHOA care, we suggest to tailor KHOA care according to the following characteristics of patients: 1) having a total joint replacement, 2) experience with healthcare for their complaints, and 3) disease-specific quality of life.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)