Discrete Choice Experiment Survey Research Articles

Implementing artificial intelligence in breast cancer screening: Women's preferences.

Artificial intelligence (AI) could improve accuracy and efficiency of breast cancer screening. However, many women distrust AI in health care, potentially jeopardizing breast cancer screening participation rates. The aim was to quantify community preferences for models of AI implementation within breast cancer screening. An online discrete choice experiment survey of people eligible for breast cancer screening aged 40 to 74 years in Australia. Respondents answered 10 questions where they chose between two screening options created by an experimental design. Each screening option described the role of AI (supplementing current practice, replacing one radiologist, replacing both radiologists, or triaging), and the AI accuracy, ownership, representativeness, privacy, and waiting time. Analysis included conditional and latent class models, willingness-to-pay, and predicted screening uptake. The 802 participants preferred screening where AI was more accurate, Australian owned, more representative and had shorter waiting time for results (all p<.001). There were strong preferences (p<.001) against AI alone or as triage. Three patterns of preferences emerged: positive about AI if accuracy improves (40% of sample), strongly against AI (42%), and concerned about AI (18%). Participants were willing to accept AI replacing one human reader if their results were available 10 days faster than current practice but would need results 21 days faster for AI as triage. Implementing AI inconsistent with community preferences could reduce participation by up to 22%.

Do the Age of Children and Parental Status Matter in Valuing the Child Health Utility 9D (CHU9D)?

This study aims to test whether preferences for children's health states differ (a) when considering those aged 2-4 years compared with older children and (b) by parental status; we also aim to provide a value set that can be used for 2-4 years old. Health states were described using the Child Health Utility 9D (CHU9D). A discrete choice experiment (DCE) survey was administered between September 2023 and March 2024 to a representative sample of the Australian general adult population which included a 20% quota of parents of 0-18-year-old children. Participants were randomly allocated to two study arms considering the health of a 2-4-year-old or a 10-year-old child. A conditional logit model was used to obtain the latent values from the choice responses. The differences in latent values between the two ages and between parental status were analyzed using relative attribute importance (RAI), poolability test, and pooled model with interaction terms. Visual Analogue Scale (VAS) responses were used to anchor the latent values onto a 0-1 utility scale. In all, 3112 participants were included. Results suggested that the preferences between the two age perspectives were similar, with only 1 out of 36 interaction terms being significant. Preferences of parents of children aged 0-18 years differed from those who were not, as indicated by three significant interaction terms and failure in poolability testing, having smaller disutility for severe health states in the Pain, Tired, and Joining in Activities dimensions. In the valuation of CHU9D health states, asking respondents to consider a 2-4-year-old compared with a 10-year-old did not influence adults' preferences; however, the preferences of respondents who were parents of 0-18-year-olds at that time differed from those who were not. Two CHU9D value sets are reported for children 2 years and older, one derived from the general adult population and the other from parents.

Estimating a preference-based index for patients with myasthenia gravis from the MGQoL-6D measure

ObjectiveMyasthenia gravis is a chronic neuromuscular disease that causes weakness. It’s uncertain whether generic health instruments can adequately capture its impact. This study aimed to develop a scoring system to generate utility values for all health states defined by the myasthenia gravis quality of life 6-dimension (MGQoL-6D) classification in Chinese patients with myasthenia gravis (MG).MethodsThe data used in this study were obtained from a web-based cross-sectional study conducted in China. Patients with MG were invited to complete an online discrete choice experiment (DCE) survey. Each participant completed 10 randomly assigned choice pairs from a set of 40 choice pairs, with each pair comprising two health states and a duration attribute. Conditional logistic regression analysis was employed to analyse the data, which included responses from 300 patients.ResultsUtility decrements estimated by conditional logit regression were generally monotonic, with the largest decrements observed for emotion (− 0.419), social activity (− 0.323), and hobbies and fun activities (− 0.323). The MGQoL-6D utility scores ranged between − 0.559 and 1.ConclusionThis study established utility weights for the MGQoL-6D that can facilitate cost-utility analyses related to MG-related health interventions and technologies.

Preferences for couple-based smoking cessation interventions among couples who smoke: online discrete choice experiment.

The purpose of this study was to elicit smoking couples' preferences for the 'format' and 'content' of couple-based interventions and partner support from both partners' perspectives, using an online discrete choice experiment (DCE) survey. An online DCE study was conducted during online interviews with 56 smoking couples (N = 112). Conditional logistic regression models were constructed to determine optimal profiles of couple-based treatment. Six attributes of couple-based smoking cessation interventions were identified as statistically significant: smokers and their partners preferred interventions that were designed for both partners, interactive, and tailored; they also valued positive support, open discussions with their partners, and having their partners involved in the quitting process. Smokers preferred to receive empathy, love, and trust from their partners rather than information, advice, and services. Income level and race interacted with the preferences for certain attributes. Differences in convenience, method of delivery, topics, duration, and frequency of treatment, willingness to provide support, frequency of partner support, and couple types were not significant. This study highlights the significance of incorporating partner involvement and support in smoking cessation interventions. The findings can provide direction for developing efficient couple-based interventions that consider the preferences of both smokers and partners.

Patient preferences for key organizational features of primary cardiovascular care in Quebec: a discrete choice experiment

BackgroundCardiovascular diseases and their risk factors are leading causes of morbidity and mortality worldwide, and are among the top reasons for primary care visits. Little is known about patient preferences for primary care in the context of chronic conditions. This study aimed to investigate the effect of key organizational features identified by patients and providers on patients’ choice of a preferred primary care practice to receive cardiovascular care.MethodsA discrete choice experiment survey was completed by a weighted online sample of 501 Quebec residents having or being at risk of cardiovascular disease. Respondents completed one of two blocks of nine choice sets by indicating, among three hypothetical primary care practice alternatives in each choice set, their preferred and second-most preferred options. Alternatives were differentiated on the basis of five key attributes identified as priorities in an earlier Delphi study: listening to and respecting care preferences; providing personalized information; 24-to- 48-h accessibility in the event of a problem; continuity of care; and up-to-date clinical skills. Each attribute could be assigned a best, moderate, or worst level. Choices were analyzed using generalized multinomial logit modeling. Marginal effects and choice probabilities for policy-relevant scenarios were estimated.ResultsAll five attributes significantly influenced choices of primary care practice. The marginal effects of worst attribute levels were of much greater magnitude than those of best levels for all attributes. Improving short-term accessibility from worst to moderate level had the largest average incremental effect on the probability of patients choosing a practice. Best continuity of care was more valued by older patients and those in poorer general health, but had nonsignificant impact unless it was coupled with enhanced short-term accessibility.ConclusionsA balanced approach across the key organizational features covered seems more advantageous for primary care practices than focusing solely on achieving excellence in any single attribute. The interactions between patient preferences for short-term accessibility and continuity of care should be taken into account when planning and implementing organizational change in primary care. Whether these preferences are generalizable to other jurisdictions and subsets of primary care patients deserves further exploration.

Quantifying Patient Preferences for Risk Tolerance With Novel Dual Biologic Therapies for Inflammatory Bowel Disease.

Quantifying Patient Preferences for Risk Tolerance With Novel Dual Biologic Therapies for Inflammatory Bowel Disease.

Quantifying patient preferences for treatments for refractory chronic spontaneous urticaria.

Quantifying patient preferences for treatments for refractory chronic spontaneous urticaria.

Discrete choice experiment on the preferences for continuing medical education training programs among primary health care physicians in China

BackgroundImproving primary health care (PHC) physician’s capacity has been identified as an important area in the healthcare reform. The continuing medical education (CME) training programs are conducive to enhancing competence of PHC physicians. But few studies have explored PHC physicians’ needs and preferences for CME training programs. This study aimed to explore the preferences for CME training programs from the perspective of PHC physicians, and to understand the willingness, tendency, and needs in CME.MethodsA Discrete Choice Experiment (DCE) was developed based on literature review and semi-structured interviews with 4 general practitioners to identify key attributes of CME programs. The DCE survey was administered to 360 PHC physicians in Jiangsu Province, China, in August 2023, to elicit preferences for: training frequency, training time, training duration, training location, training content of basic medical services, and training content of basic public health services. A total of 281 valid responses were included after the quality control test, which involved checking completion time and consistency in repeated choice tasks. DCE data were analyzed using Mixed Logit, and Latent Class Models to explore preference heterogeneity and class membership.ResultsPHC physicians showed strong preference for CME training programs that were conducted during working hours on weekdays, once a year, at a local meeting place and training on health management of patients with multiple chronic diseases. Latent class analysis identified 2 preference classes, with half (51.2%) of the respondents focused only on training frequency and time while the rest considered training logistic arrangement as well as training content. These preferences could be explained by some observed characteristics of PHC physicians such as age and professional level.ConclusionsOverall, PHC physicians valued the convenience of participation in CME training programs and training on health management of patients with multiple chronic disease. Our findings can be used to inform the design of CME training programs for PHC physicians in China.

Patient preferences for CDK4/6 inhibitor treatments in HR+/HER2− early breast cancer: a discrete choice survey study

PurposeAdding CDK4/6 inhibitors (CDK4/6is) to endocrine therapy (ET) for HR+/HER2− early breast cancer (EBC) demonstrated statistically significant invasive disease-free survival (iDFS) benefits in monarchE (node positive, high risk, stage II/III) and NATALEE (select N0 and all macroscopic N1, stage II/III). This study evaluated patient preferences for EBC treatment attributes and how these may translate for CDK4/6i selection.MethodsA web-based discrete choice experiment survey was conducted among US-based adult women with self-reported stage II/III HR+/HER2− EBC. Eight attributes were included, informed by 14 qualitative interviews (to identify most relevant attributes), expert clinical input, and differentiating features between CDK4/6is: efficacy (5-year iDFS), adverse events (venous thromboembolic event [VTE], diarrhea, fatigue), number of blood tests, number of electrocardiograms (EKGs), treatment duration, and schedule. Participants selected scenarios that best reflected their preferences from 10 choice cards, each displaying a pair of hypothetical treatment profiles. A conditional logit regression model was used to estimate preference weights and relative importance (RI) of attributes.ResultsA total of 409 women participated. Patient preferences, from high to low RI, were higher efficacy, lower diarrhea risk, lower fatigue risk, shorter treatment duration, and lower VTE risk. Number of blood tests, number of EKGs, and treatment schedule were less important. Utility scores were higher for reconstructed treatment profiles that resembled ribociclib.ConclusionThis study demonstrated that patients prefer adjuvant treatment with higher efficacy and lower risk of adverse events. These data will aid shared decision-making when discussing the addition of CDK4/6is to adjuvant ET for eligible patients with HR+/HER2− EBC.

Health valuation protocol for dual discrete choice experiment (dual-DCE) surveys to estimate the effects of different scenarios and attributes on main effects

IntroductionA typical health preference study conducts a single discrete choice experiment (DCE). For example, a health valuation study may elicit preferences on an individual’s health-related quality of life along five...

Measuring Effectiveness Based on Patient Experience (Instead of QALYs) in US Value Assessments.

A key challenge in value assessment is how to summarize effectiveness, particularly the impact of interventions on patient health-related quality of life (HRQoL). One approach is to quantify the gains in HRQoL and life expectancy together as quality-adjusted life years (QALYs); however, this approach has faced various criticisms regarding its potential discriminatory aspects toward persons with disabilities, older adults, and the most vulnerable individuals in society. Instead of QALYs, we provide an alternative approach that summarizes HRQoL gains from the perspective of its stakeholders (e.g., patients, parents, and caregivers) using an "experience" scale. On an experience scale, a positive value signifies an experience better than having no experience at all, while a negative value indicates an experience worse than having no experience. To illustrate the merits of this approach, we examine US preferences on the relief of child health problems, namely a discrete choice experiment (DCE) with kaizen tasks and alternatives described using the EQ-5D-Y-3L. Using this approach, we demonstrate the differences in perspectives between parents (N = 179), mothers (N = 99), and fathers (N = 80) of children younger than 18 years of age, as well as the feasibility of this patient-centered approach using a brief DCE survey of less than 100 respondents each (and without QALYs). Specifically, we found that mothers place a higher value on the child's feelings than fathers. The results also suggest other differences between the perspectives of mothers and fathers, but these differences were not statistically significant (p-values < .05). We put forth that future value assessments may summarize gains in HRQoL on a patient experience scale (i.e., experience scale from the patient perspective) to inform decision-making.

P-332. A Discrete Choice Experiment to Evaluate Healthcare Personnel Preferences Regarding Risk-Tailored Policies for Contact Precautions for Patients with Methicillin-Resistant Staphylococcus aureus in Hospitals

Abstract Background The risk of MRSA transmission differs by healthcare personnel (HCP) role and care activity. An alternative to an “all or none” approach to contact precautions for patients with MRSA carriage is a “risk-tailored” approach – using gloves and gowns only for certain high-risk activities, locations, or roles. A discrete choice experiment is a proven method to assess HCP perspectives on varied implementation strategies. Methods We distributed a discrete choice experiment survey to HCPs at medical centers in three cities. Respondents were presented with eight choice sets, each consisting of two hypothetical policy options for glove and gown use to prevent MRSA transmission (Fig 1). In each comparison, respondents selected their preferred policy option. Using mixed logit modeling we calculated the utility derived from each policy component, the probability of uptake for the most favored policies, and heterogeneity in preferences based on HCP role. Results 384 HCP completed the survey: 138 from New York, 128 from Pittsburgh, and 118 from Baltimore. Respondents’ occupations were physicians or advanced practice providers (93, 24%), nurses (87, 23%), environmental services (56, 15%), respiratory therapists (55, 14%), occupational or physical therapists (44, 11%), and “other” (46, 11%). 237 (54%) respondents reported wearing gloves and gowns ‘all the time’ when required. Respondents preferred policy with the highest utility score was to use gloves and gown for all HCPs roles (utility, 0.17; 95% CI, 0.12 to 0.23), in high-risk settings (utility, 0.12; 95% CI 0.07-0.18), when touching the patient (utility, 0.11; 95% CI 0.06-0.17) (Fig 2). Sixty-three percent (95% CI 60-66%) of respondents would support a risk-tailored approach over an approach where contact precautions are used by all HCP in all settings and for all activities. The support for this policy varied by HCP role (p&amp;lt; 0.02), with the strongest probability of support from physicians and advanced practice providers (77%, 95% CI 72-82%) and the least support from environmental services (45%, 95% CI 37-53%) (Fig 3). Conclusion This discrete choice survey demonstrates that most HCP prefer a risk-tailored approach to contact precautions when caring for patients with MRSA. Disclosures Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor Graham M. Snyder, MD, SM, Infectious Diseases Connect: Advisor/Consultant Nathan N. O'Hara, PhD MHA, Arbutus Medical Inc.: Stocks/Bonds (Private Company)

A discrete choice experiment to elicit preferences for a chronic disease screening programme in Queensland, Australia: designing the choice sets for the final survey

Background Chronic diseases are a significant health concern in Australia. Understanding community preferences for health screening services is vital for enhancing service delivery. We conducted a study to determine community preferences for health screening services for chronic diseases in Australia using a discrete choice experiment (DCE). This paper aims to present the development of the final DCE design using priors estimated from a survey. Methods A DCE was conducted in Australia. An online survey was administered to a general Australian population over 18. The final attribute list of five attributes with three levels each was designed. A D-efficient design with 30 pair-wise choice tasks was developed using a fractional factorial design. A pre-test was conducted to assess comprehension and understanding of the online DCE survey. The pilot survey aimed to compute priors (i.e. coefficients) associated with attributes. A multinomial logit model was used to analyse the pilot DCE data. Results The survey included 30 choice tasks in three blocks, with 119 participants responding. The best DCE design was selected based on D-error, with a lower D-error indicating the most efficient design. The pilot survey results indicated a strong preference for highly accurate screening tests, with coefficients for 85% and 95% accuracy being positive. Coefficients estimated from the pilot survey were used as priors to design the DCE choice tasks for the main survey. The final DCE design showed a notable improvement in the attribute level overlap compared to the design used for the pilot survey. Conclusions A rigorous approach was taken to develop a DCE survey that could effectively determine the preferences of the community for health screening services. The resulting DCE design consisted of 30 choice tasks presented in pairs and was deemed efficient enough to gather comprehensive information in the final survey.

What are parents' preferences for Human Papillomavirus vaccination promotion messages and communication? Application of a discrete choice experiment to a French Caribbean setting

IntroductionHuman Papillomavirus (HPV) vaccine uptake in the French Caribbean has remained below 25% since introduction in 2007, which is well behind national and international targets. Using a discrete choice experiment (DCE), we explored parental preferences around HPV vaccination and optimized communication content in a sample of parents of middle-school pupils in Guadeloupe.MethodsWe conducted a cross-sectional survey in public and private middle age schools in Guadeloupe in June 2023 using an online questionnaire. Across a series of nine hypothetical scenarios, participants were asked to decide to vaccinate or not and how certain they were about this choice. Scenarios differed by five attributes (diseases characteristics, vaccine safety, health professionals or institutions promoting vaccination, social conformity and optimal vaccination age). We used random effect logit and linear regression models to estimate the effects of attribute levels on vaccine acceptance and vaccine eagerness.ResultsA total of 389 parents out of the 23,184 pupils’ parents completed the DCE survey. The attributes with a significant effect size on theoretical vaccine acceptance were "social conformity" and "optimal vaccination age”. Overall, the odds of scenarios stating high vaccine coverage in adolescents were at least 1.8 (95% CI: 1.2—2.6) times more likely to yield theoretical vaccine acceptance compared to a low vaccine uptake reference. The odds of providing scientific explanation along with age yielded theoretical vaccination acceptance respectively up to 3.2 times higher (95% CI: 1.7 to 6.1) in parents reporting an un vaccinated child and not intention to vaccinate. For vaccine eagerness, we observe significant positive effects of communication content overall when stating high vaccination uptake in adolescents or scientific evidence along with age or mentioning cancer prevention. Parents always refusing vaccination remained unsensitive to communication contents.Discussion and conclusionThese original DCE results highlighted the need for tailoring specific HPV vaccination promotion communication in a French Caribbean setting. Contextual features such as sexuality concerns as regard to age and peers’ adhesion to vaccination have to be thoroughly considered. The nationwide HPV vaccination campaign in middle schools should adapt communication in order to raise HPV vaccine uptake in the French Caribbean.

Patient Preferences for HR+/HER2− Early Breast Cancer Adjuvant Treatment: A Multicountry Discrete Choice Experiment

Introduction: More adjuvant treatment options are becoming available for hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) early breast cancer (EBC) based on results of clinical trials. This study quantified the importance of different attributes of EBC adjuvant therapies to patients and the benefit-risk tradeoffs patients were willing to make. Methods: Women with HR+/HER2− EBC completed an online discrete choice experiment (DCE) survey; the design was informed by clinical data, qualitative interviews (n = 40), and pre-testing interviews (n = 40). Participants (pts) made 10 choices between pairs of hypothetical treatments described by varying levels of 6 attributes. DCE data were analyzed using a correlated mixed logit model. Relative attribute importance scores captured the impact of each attribute across clinically relevant ranges. Benefit-risk tradeoffs were captured as the minimum improvements in 5-year invasive disease-free survival (iDFS) that pts would require to tolerate increases in therapy-associated adverse event (AE) risks. Results: A total of 866 patients from the USA, France, Spain, Canada, the UK, Germany, South Korea, and Australia completed the DCE (mean age: 57.7 years; 76% postmenopausal; 29% stage I disease, 55% stage II, 16% stage III). Improved 5-year iDFS (75.4–82.7% range; associated with combination regimens [CRs] vs. endocrine therapy [ET] alone) contributed the most to treatment preferences (clinically relevant relative attribute importance: 38.4%), followed by reduced risks of venous thromboembolic events (VTEs) (20.4%), neutropenia (20.3%), and diarrhea (15.0%). Treatment type + duration (3.7%) and fatigue (2.3%) were less important. Pts required the largest improvement in 5-year iDFS (3.9%) to tolerate increased risks of VTE (0.7%–2.5%) or neutropenia (5.6%–46%); willingness to accept tradeoffs depended on the AE. Preference heterogeneity was observed across subgroups, but 5-year iDFS improvement was consistently the most impactful on treatment choice in all subgroups. Conclusion: A multicountry sample of patients most valued adjuvant therapies with higher 5-year iDFS and may therefore prefer CRs over ET alone. The value of CRs depends on their specific safety profiles, and shared decision-making should consider this to select treatment options that align with individual preferences. Introduction: More adjuvant treatment options are becoming available for hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) early breast cancer (EBC) based on results of clinical trials. This study quantified the importance of different attributes of EBC adjuvant therapies to patients and the benefit-risk tradeoffs patients were willing to make. Methods: Women with HR+/HER2− EBC completed an online discrete choice experiment (DCE) survey; the design was informed by clinical data, qualitative interviews (n = 40), and pre-testing interviews (n = 40). Participants (pts) made 10 choices between pairs of hypothetical treatments described by varying levels of 6 attributes. DCE data were analyzed using a correlated mixed logit model. Relative attribute importance scores captured the impact of each attribute across clinically relevant ranges. Benefit-risk tradeoffs were captured as the minimum improvements in 5-year invasive disease-free survival (iDFS) that pts would require to tolerate increases in therapy-associated adverse event (AE) risks. Results: A total of 866 patients from the USA, France, Spain, Canada, the UK, Germany, South Korea, and Australia completed the DCE (mean age: 57.7 years; 76% postmenopausal; 29% stage I disease, 55% stage II, 16% stage III). Improved 5-year iDFS (75.4–82.7% range; associated with combination regimens [CRs] vs. endocrine therapy [ET] alone) contributed the most to treatment preferences (clinically relevant relative attribute importance: 38.4%), followed by reduced risks of venous thromboembolic events (VTEs) (20.4%), neutropenia (20.3%), and diarrhea (15.0%). Treatment type + duration (3.7%) and fatigue (2.3%) were less important. Pts required the largest improvement in 5-year iDFS (3.9%) to tolerate increased risks of VTE (0.7%–2.5%) or neutropenia (5.6%–46%); willingness to accept tradeoffs depended on the AE. Preference heterogeneity was observed across subgroups, but 5-year iDFS improvement was consistently the most impactful on treatment choice in all subgroups. Conclusion: A multicountry sample of patients most valued adjuvant therapies with higher 5-year iDFS and may therefore prefer CRs over ET alone. The value of CRs depends on their specific safety profiles, and shared decision-making should consider this to select treatment options that align with individual preferences.

Patient Preferences for Episodic Migraine Medications: A Discrete Choice Experiment of Self-Injectable Versus Oral Treatments Targeting Calcitonin Gene-Related Peptide Pathway.

To understand the trade-offs that patients with episodic migraine are willing to make between attributes of self-injectable calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) and oral small-molecule calcitonin gene-related peptide receptor antagonists (gepants). This was an online discrete choice experiment survey among adults with episodic migraine (≥4 and <15 migraine headache days and <15headache days per month over 3 months) in the United States. Hypothetical treatments were characterized by five attributes: chance of ≥50% migraine reduction, impact on daily activities, onset of treatment effect, reduction in number of acute medications, and treatment administration. The attributes were selected based on insights gained from a previously conducted literature review and focus group study and aligned with the primary and secondary outcome measures in the double-blind Phase IV head-to-head clinical trial of a CGRP mAb versus gepant. 601 patients (mean age: 44.8 years) completed the survey. Treatment preferences differed significantly between patients. However, for all patients, the most important driver of treatment preferences was the chance of a ≥50% reduction in monthly migraine headache days (relative attribute importance: 38.3%), followed by the impact on daily activities (23.5%), the onset of treatment effect (19.5%), the reduction in need for acute medication (15.4%), and finally the route of administration (3.4%). Patients were willing to consider a one-week delayed onset of treatment effect or one-day increased need for acute medication for a higher chance (by 2.06% and 2.65% respectively) of a ≥50% reduction in monthly migraine headache days. Patients would trade a reduction of migraine's impact on daily activities from "extreme" to "moderate" or "minimal" with a lower chance (17.09%, 12.06% respectively) of halving the number of monthly migraine headache days. A ≥50% reduction in monthly migraine headache days was the most important treatment attribute for which participants were willing to trade against other attributes. The variation in treatment preferences between patients emphasizes the importance to align decision-making with individual patients' preferences.

Value of Innovative Multiple Myeloma Treatments from Patient and Healthcare Provider Perspectives: Evidence from a Discrete Choice Experiment.

Although innovation generally provides measurable improvements in disease characteristics and patient survival, some benefits can remain unclear. This study aimed to investigate patient and healthcare provider (HCP) preferences for the innovative attributes of multiple myeloma (MM) treatments. A cross-sectional, web-based, discrete choice experiment (DCE) survey was conducted among 200 patients with MM and 30 HCPs of patients with MM in the USA. A literature review, followed by interviews with patients with MM and HCPs, was undertaken to select five attributes (progression-free survival [PFS], chance of severe side effects, how patients live with MM treatments, scientific innovation, and monthly out-of-pocket [OOP] cost) and their levels. A Bayesian efficient design was used to generate DCE choice sets. Each choice set comprised two hypothetical MM treatment alternatives described by the selected attributes and their levels. Each patient and HCP was asked to choose a preferred alternative from each of the 11 choice sets. Mixed logit and latent class models were developed to estimate patient and HCP preferences for the treatment attributes. Overall, patients and HCPs preferred increased PFS, less chance of severe side effects, a treatment that offered life without treatment, scientific innovation, and lower OOP cost. From patients' perspectives, PFS had the highest conditional relative importance (44.7%), followed by how patients live with MM treatments (21.6%) and scientific innovation (16.0%). In addition to PFS, patients and HCPs also valued innovative MM treatments that allowed them to live without treatments and/or offered scientific innovation. These attributes should be considered when evaluating MM treatments.

Patterns of HIV Treatment Preferences Among People With Diverse Demographic, Social, and Behavioral Characteristics Who Are Living With HIV in the United States.

New dosage form and frequency options may improve HIV treatment outcomes and reduce disparities in access and use. People with HIV in the United States completed a demographic and discrete choice experiment survey of preference for 13 hypothetical HIV treatment options: daily and weekly oral tablets; 1-, 3-, or 6-monthly injections by self or a health care provider (HCP); yearly implant; or combinations. Best-Worst Scaling and a latent class model were used to analyze overall preference choices and for groups of individuals with similar patterns of preferences; the model also predicted uptake of products. Among the diverse 829 respondents, weekly oral tablets and 6-monthly injections by an HCP were significantly more favored than daily oral tablets. Convenience of the treatment and being tired of taking pills were the top drivers of preference responses. Latent class analysis identified 4 groups of respondents with distinct preference patterns; approximately two-thirds belonged to groups strongly preferring products other than daily oral tablets. The modelled uptake of a weekly pill, yearly implant, 6-monthly HCP injection, oral daily pill, and 3-monthly HCP injections were 24%, 24%, 24%, 18%, and 11%, respectively. Patterns of HIV medication preference can inform development of new forms of HIV therapy products because the majority of patients do not prefer the currently most available treatment option of daily oral tablets. Looking beyond population-level preferences and into similar groups of people with HIV increases the ability to develop patient-centered products to fill gaps in care and increase treatment effectiveness.

Patient Preferences for Features Associated With Leadless Versus Conventional Transvenous Cardiac Pacemakers.

Regulatory approval of the first dual-chamber leadless pacemaker system provides patients an alternative to conventional transvenous pacemakers. The study objective was to quantify the preferences of patients for pacemaker features. Patients with a de novo (ie, initial) pacemaker indication were recruited from 7 US sites to complete a Web-based discrete-choice experiment survey between May 11, 2022, and May 24, 2023. Patients chose between pairs of experimentally designed, hypothetical pacemakers that varied according to type (removable leadless, nonremovable leadless, or conventional transvenous); battery life (5, 8, 12, or 15 years); time since regulatory approval (2 or 10 years); discomfort for 6 months (none or discomfort); and complication risk and infection risk (1%, 5%, or 10%/20% for each). Patients' choice data were analyzed using random-parameter logit models and latent-class analysis. Among 117 participants, the mean (SD) age was 67.3 (14.6) years, 94% were white, and 42% were female. On average, patients' survey responses revealed a preference for removable leadless pacemakers (β, 0.340; SE, 0.096) over both nonremovable leadless pacemakers (β, -0.310; SE, 0.131; P=0.001) and conventional transvenous pacemakers (β, -0.030; SE, 0.119; P=0.031). However, latent-class analysis revealed 2 distinct preference classes. One class preferred leadless pacemakers (50.5%), and the other class preferred conventional transvenous pacemakers (49.5%). The conventional pacemaker class prioritized pacemakers with 10 rather than 2 years since regulatory approval (P<0.001), whereas the leadless pacemaker class was insensitive to years since regulatory approval (P=0.83). Complication risks and infection risks were found to be the most influential. All else equal, patients would accept maximum risks of complications or infections ranging about 5% to 18% to receive their preferred pacemaker type. Latent-class analysis revealed strong patient preferences for the type of pacemaker, with a nearly equal split between recent leadless pacemaker technology and conventional transvenous pacemakers. These findings can inform shared decision-making between health care providers and patients. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05327101.

Identifying pragmatic solutions to reduce cigarette smoking prevalence in Indigenous North Americans: A sequential exploratory mixed-methods study protocol.

American Indians and Alaska Natives (AI/AN) have the highest prevalence of cigarette smoking of any race or ethnicity in the United States. Efforts to address smoking prevalence in this population have not historically targeted maintenance of smoking cessation, or behaviors associated with pregnancy. Recent longitudinal cohort studies have identified maintenance of cessation and pregnancy as potential opportunities to address smoking in AI/AN people. To promote success in achieving sustained smoking cessation in AI/AN people, we propose a community engaged sequential exploratory mixed-methods study focused on identifying pragmatic elements of cessation interventions. A discovery sample of 45 AI/AN people will be included in the qualitative study in one of two arms consisting of small groups or one-on-one interviews to develop elements of cessation interventions for evaluation in a discrete choice experiment survey. These one-on-one interviews will characterize the key drivers of smoking relapse and unique experiences of smoking during pregnancy. An additional, independent small group will consist of counselors who engage in smoking cessation counseling. A larger-scale survey will be administered to an AI/AN cohort from Olmsted County, Minnesota (n = 898). Elements of successful interventions will be used to inform a smoking cessation intervention pilot study. Community stakeholders have informed the methods outlined in this protocol, and there is a longitudinal engagement plan for the duration of study. We outline the methods to understand optimal strategies to promote sustained cigarette smoking cessation and cessation during pregnancy in AI/AN people. This study is critical to inform a pilot intervention aimed at reducing smoking prevalence in AI/AN people.