Patient preferences for treatment of low back pain – a discrete choice experiment

Mirja Elisabeth Kløjgaard, Claus Manniche, Line Bjørnskov Pedersen, Mickael Bech, Rikke Søgaard

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Background

Back pain imposes a substantial economic and social burden, and treatment decisions are distorted by conflicting evidence. Thus, it is important to include patient preferences in decision making and policy making.
Objective

To contribute to the understanding of patient preferences in relation to the choice of treatment for low back pain.
Methods

A discrete choice experiment was conducted with consecutive patients referred to a regional spine center. The respondents (n = 348) were invited to respond to a choice of two hypothetical treatment options and an opt-out option. The treatment attributes included the treatment modality, the risk of relapse, the reduction in pain, and the expected increase in the ability to perform activities of daily living. In addition, the wait time to achieve the treatment effect was used as a payment vehicle. Mixed logit models were created to perform analysis. Subgroup analysis, dividing respondents into sociodemographic and disease-related categories, further explored the willingness to wait.
Results

Respondents assigned positive utilities to positive treatment outcomes and disutility to higher risks and longer waits for effects of treatment and to surgical interventions. The model captured significant heterogeneity within the sample for the outcomes of pain reduction and the ability to pursue activities of daily living and for the treatment modality. The subgroup analysis revealed differences in the willingness to wait, especially with regard to treatment modality, the level of pain experienced at the time of data collection, and the respondents’ preferences for surgery.
Conclusions

The majority of the respondents prefer nonsurgical interventions, but patients are willing to wait for more ideal outcomes and preferred interventions. The results show that health care professionals have a very important task in communicating clearly about the expected results of treatment and the basis of their treatment decisions, as patients' preferences are highly individual.
OriginalsprogEngelsk
TidsskriftValue in Health
Vol/bind17
Udgave nummer4
Sider (fra-til)390-396
ISSN1098-3015
StatusUdgivet - 2014

Fingeraftryk

Patient Preference
Low Back Pain
Policy Making
Risk Reduction Behavior
Logistic Models
Delivery of Health Care

Citer dette

Kløjgaard, Mirja Elisabeth ; Manniche, Claus ; Pedersen, Line Bjørnskov ; Bech, Mickael ; Søgaard, Rikke. / Patient preferences for treatment of low back pain – a discrete choice experiment. I: Value in Health. 2014 ; Bind 17, Nr. 4. s. 390-396.
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Patient preferences for treatment of low back pain – a discrete choice experiment. / Kløjgaard, Mirja Elisabeth; Manniche, Claus; Pedersen, Line Bjørnskov; Bech, Mickael; Søgaard, Rikke.

I: Value in Health, Bind 17, Nr. 4, 2014, s. 390-396.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Patient preferences for treatment of low back pain – a discrete choice experiment

AU - Kløjgaard, Mirja Elisabeth

AU - Manniche, Claus

AU - Pedersen, Line Bjørnskov

AU - Bech, Mickael

AU - Søgaard, Rikke

PY - 2014

Y1 - 2014

N2 - BackgroundBack pain imposes a substantial economic and social burden, and treatment decisions are distorted by conflicting evidence. Thus, it is important to include patient preferences in decision making and policy making.ObjectiveTo contribute to the understanding of patient preferences in relation to the choice of treatment for low back pain.MethodsA discrete choice experiment was conducted with consecutive patients referred to a regional spine center. The respondents (n = 348) were invited to respond to a choice of two hypothetical treatment options and an opt-out option. The treatment attributes included the treatment modality, the risk of relapse, the reduction in pain, and the expected increase in the ability to perform activities of daily living. In addition, the wait time to achieve the treatment effect was used as a payment vehicle. Mixed logit models were created to perform analysis. Subgroup analysis, dividing respondents into sociodemographic and disease-related categories, further explored the willingness to wait.ResultsRespondents assigned positive utilities to positive treatment outcomes and disutility to higher risks and longer waits for effects of treatment and to surgical interventions. The model captured significant heterogeneity within the sample for the outcomes of pain reduction and the ability to pursue activities of daily living and for the treatment modality. The subgroup analysis revealed differences in the willingness to wait, especially with regard to treatment modality, the level of pain experienced at the time of data collection, and the respondents’ preferences for surgery.ConclusionsThe majority of the respondents prefer nonsurgical interventions, but patients are willing to wait for more ideal outcomes and preferred interventions. The results show that health care professionals have a very important task in communicating clearly about the expected results of treatment and the basis of their treatment decisions, as patients' preferences are highly individual.

AB - BackgroundBack pain imposes a substantial economic and social burden, and treatment decisions are distorted by conflicting evidence. Thus, it is important to include patient preferences in decision making and policy making.ObjectiveTo contribute to the understanding of patient preferences in relation to the choice of treatment for low back pain.MethodsA discrete choice experiment was conducted with consecutive patients referred to a regional spine center. The respondents (n = 348) were invited to respond to a choice of two hypothetical treatment options and an opt-out option. The treatment attributes included the treatment modality, the risk of relapse, the reduction in pain, and the expected increase in the ability to perform activities of daily living. In addition, the wait time to achieve the treatment effect was used as a payment vehicle. Mixed logit models were created to perform analysis. Subgroup analysis, dividing respondents into sociodemographic and disease-related categories, further explored the willingness to wait.ResultsRespondents assigned positive utilities to positive treatment outcomes and disutility to higher risks and longer waits for effects of treatment and to surgical interventions. The model captured significant heterogeneity within the sample for the outcomes of pain reduction and the ability to pursue activities of daily living and for the treatment modality. The subgroup analysis revealed differences in the willingness to wait, especially with regard to treatment modality, the level of pain experienced at the time of data collection, and the respondents’ preferences for surgery.ConclusionsThe majority of the respondents prefer nonsurgical interventions, but patients are willing to wait for more ideal outcomes and preferred interventions. The results show that health care professionals have a very important task in communicating clearly about the expected results of treatment and the basis of their treatment decisions, as patients' preferences are highly individual.

KW - Low Back Pain

KW - Patient preferences

M3 - Journal article

VL - 17

SP - 390

EP - 396

JO - Value in Health

JF - Value in Health

SN - 1098-3015

IS - 4

ER -