Do patients and physicians have similar preferences for chronic hepatitis B treatment outcomes in Turkey?
Introduction: We aimed to quantify patients? and physicians' preferences for therapeutic trade-offs involving the efficacy, side-effect risks, and evidence uncertainty in chronic hepatitis B (CHB) treatments.
Materials and Methods: Physicians who treat CHB patients and adult patients with a self-reported physician diagnosis of CHB completed a web-enabled, discrete-choice experiment survey in Turkey. Both patients and physicians answered 12 treatment-choice questions. Each question required evaluating a pair of hypothetical CHB medication profiles defined by the years the medicine has been studied (weight of evidence), probability that the patient's viral load remains undetectable for five years with possible reversal of disease progression (efficacy), five-year treatment-related risks of a fracture and renal insufficiency, and monthly medication cost. Logit models were used to estimate preference weights for all attribute levels and the profile preference scores for three current CHB treatments. A choice format conjoint analysis was used.
Results: 159 physicians and 117 patients completed the survey. Patients and physicians had discordant views on the relative importance of CHB treatment attributes. Patients ranked weight of evidence and efficacy as the most important attributes, while physicians ranked efficacy and risk of renal insufficiency as the most important attributes. Both groups preferred a CHB medication profile characterized by potent efficacy and low side-effect risk versus a medication profile characterized by a potent efficacy and moderate side-effect risk profile (p> 0.05). Both medication profiles were preferred over a CHB medication with poor efficacy and low side-effect risk profile (p> 0.05 for patients and p< 0.05 for physicians).
Conclusion: This is the first study to quantify patients' and physicians' preferences for CHB treatments in Turkey. Discordance between physicians' and patients' preferences can be explained by asymmetric knowledge and information regarding the importance of weight of evidence and efficacy versus side-effect risks. This fact highlights the need for reflection of physician and patient perspectives on regulatory and reimbursement decisions.