Patient preferences and HIV drugs What about uncertainty?

OBJECTIVES: Quantitative patient preferences are increasingly considered for healthcare policy decisions. The objective of this study is to develop a methodology to combine patient preferences with clinical evidence in a multi-criteria framework that takes into account uncertainty in both preferences and clinical evidence. The methodology will be illustrated with a case on antiretroviral treatments.

METHODS: Treatments under consideration are eight highly active antiretroviral therapies (HAART) recommended for treatment-naïve patients by the National Institute of Health. The treatments are compared on the probabilities of virologic failure, hypersensitivity reaction, bone damage, and kidney damage; and on the treatability of bone/kidney damage. Preferences from 147 patients were elicited with a discrete choice method in an earlier study. Preferences were assumed to be distributed with a multivariate normal distribution. Treatment performances as identified from clinical trials were assumed to be distributed with beta distributions. The probability distributions around preferences and clinical performances were combined with a Monte Carlo simulation method to estimate the joint probability distribution around each treatment-s patient-weighted utility.

RESULTS: The three treatments with the highest mean patient-weighted utility were dolutegravir+abacavir/lamivudine (-0.4, 95% CI: -1.3 to 0.5), raltegravir+tenofovir/emtricitabine (-0.5, 95% CI: -1.6 to 0.7) and darunavir/ritonavir+tenofovir/emtricitabine (-0.6, 95% CI: -2.0 to 0.8). There was considerable overlap between the probability distributions of patient-weighed utilities (probability of first rank reversal: 49%; probability of any rank reversal: >99%). When ignoring uncertainty around patient preferences, the probability of a first rank reversal dropped to 12%, and that of any rank reversal dropped to 88%.

CONCLUSIONS: A probabilistic multi-criteria methodology was developed that explicitly combines patient preferences and clinical evidence. The individual or joint impact of uncertainty in these on the treatments' patient-weighted utilities is assessed. Although limited by the small number of attributes, the illustrative case suggests the choice of HAART is highly sensitive to patient preferences.

Broekhuizen, H., Ijzerman, MJ., Hauber, A., & Groothuis-Oudshoorn, CGM. (2014). Patient preferences and HIV drugs: What about uncertainty? Value in Health, 17(7), A565. [PRM127]. https://doi.org/10.1016/j.jval.2014.08.1879