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Variation in Treatment Priorities for Chronic Hepatitis C: A Latent Class Analysis

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Abstract

Background

Data describing patients’ priorities, or main concerns, are essential to inform important decisions in healthcare, including treatment planning, diagnostic testing, and the development of programs to improve access and delivery of care. To date, the majority of studies performed does not account for variability in patients’ priorities, and as a consequence may not effectively inform end users. The objective of this study was to examine the value of segmentation analysis as a method to illustrate variability in priorities for treatment of chronic hepatitis C (HCV).

Methods

We elicited patients’ main concerns when considering antiviral therapy for HCV using a Best–Worst Scaling experiment (Case 1) with ten objects. Latent class analysis was used to estimate part-worth utilities and the probability that each respondent belongs to each segment.

Results

In the aggregate, subjects (N = 162) had three main concerns: (1) not being cured; (2) experiencing a lot of side effects; and (3) developing viral resistance to therapy. Segmentation into two groups demonstrated that both groups prioritized the likelihood of cure and coping with side effects, but that only one group (n = 78) was concerned about developing viral resistance to therapy, while subjects in the second group (n = 84) prioritized being able to keep up with their responsibilities. Further segmentation revealed distinct clusters of patients with unique priorities.

Conclusions

Patients’ priorities vary significantly. Preference studies should consider including methods to determine whether distinct clusters of priorities and/or concerns exist in order to accurately inform end users’ decision making.

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Acknowledgments and disclosures

The authors would like to thank Dorthe Welch and Lanette Errante for recruiting and interviewing the subjects for this study. We are, as always, indebted to the Veterans.

Author information

Authors and Affiliations

  1. VA Connecticut Health Care System, Yale University School of Medicine, 300 Cedar ST, TAC Bldg, RM #525, PO Box 208031, New Haven, CT, USA

    Liana Fraenkel, Joseph Lim & Guadalupe Garcia-Tsao

  2. Department of Human Development and Psychology, Cornell University, Ithaca, NY, USA

    Valerie Reyna

  3. Section of Digestive Diseases, University of California, San Francisco, San Francisco, CA, USA

    Alexander Monto

  4. Department of Health Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    John F. P. Bridges

Authors
  1. Liana Fraenkel
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  2. Joseph Lim
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  3. Guadalupe Garcia-Tsao
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  4. Valerie Reyna
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  5. Alexander Monto
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  6. John F. P. Bridges
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Corresponding author

Correspondence to Liana Fraenkel.

Ethics declarations

This study was approved by the Veterans Administration Central Institutional Review Board and has been performed in accordance with the ethical standards of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

Drs. Fraenkel, Monto, and Bridges have no declaration of personal interests. Dr. Lim has served as consultant for Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead, Janssen, and Merck, and has received research funding from Abbott, Achillion, Bristol-Myers Squibb, Gilead, and Janssen (paid to institution). Dr. Reyna has served on advisory groups, including committees of the National Academy of Sciences, Psychonomic Society, and other nonprofit organizations. She has been a paid consultant for Xerox. Dr. Garcia-Tsao has served as a consultant for Abbvie and Fibrogen, is Associate Editor for Hepatology, and serves on committees of the American Association for the Study of Liver Diseases.

Funding

This study was funded in full by the VA Health Services and Research Department (IIR 10-131).

Author contributions

Analyses were performed by Liana Fraenkel. All authors had a substantial role in the design of the study and writing the manuscript.

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Fraenkel, L., Lim, J., Garcia-Tsao, G. et al. Variation in Treatment Priorities for Chronic Hepatitis C: A Latent Class Analysis. Patient 9, 241–249 (2016). https://doi.org/10.1007/s40271-015-0147-7

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  • DOI: https://doi.org/10.1007/s40271-015-0147-7

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