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Treatment Preferences in Germany Differ Among Apheresis Patients with Severe Hypercholesterolemia

Author

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  • Axel C. Mühlbacher

    (Hochschule Neubrandenburg
    Gesellschaft für empirische Beratung GmbH (GEB))

  • Andrew Sadler

    (Hochschule Neubrandenburg
    Gesellschaft für empirische Beratung GmbH (GEB))

  • Franz-Werner Dippel

    (Sanofi Deutschland GmbH, Evidenzbasierte Medizin/HEOR)

  • Christin Juhnke

    (Hochschule Neubrandenburg
    Gesellschaft für empirische Beratung GmbH (GEB))

Abstract

Background Severe hypercholesterolemia is a major risk factor of death in patients with coronary heart disease. New adjunctive drug therapies (proprotein convertase subtilisin/kexin type 9 [PCSK9] inhibitors) have gained approval in Europe and the USA. Objective In this empirical study, we documented preferences regarding adjuvant drug therapy in apheresis-treated patients with severe familial hypercholesterolemia. Methods We conducted a systematic literature search to identify patient-relevant outcomes in patients with severe hypercholesterolemia currently undergoing apheresis. Data were used to generate a semi-structured qualitative interview that enabled seven patient-relevant characteristics with three levels each to be identified. For the discrete choice experiment, an experimental design (7 × 3) was generated using NGene Software that consisted of 96 choices divided into eight blocks. The survey was conducted between November 2015 and April 2016 using computer-assisted personal interviews. Results The survey was completed by 348 patients (64.9% male). The random parameter logit estimation showed predominance for the attribute ‘reduction of LDL-C (low-density lipoprotein cholesterol) level’. ‘Risk of myopathy’ and ‘frequency of apheresis’ dominated next. Within the random parameter logit estimation, all coefficients were significant (P ≤ 0.01). The latent class analysis identified three patient groups. The first group (126 patients) found ‘reduction of LDL-C level in blood’ to be most important. This group focused solely on this treatment outcome independently of apheresis frequency or additional injections. The second group (106 patients) focused on three attributes: ‘frequency of apheresis’, ‘risk of myopathy’, and ‘reduction of LDL-C level in blood’. Respondents clearly considered a high frequency of apheresis to have a negative impact. The third group (116 patients) demonstrated the highest preference for apheresis. These patients have adjusted to apheresis for > 10 years. Conclusion Regarding patient preference, clinical efficacy seems to dominate. Hence, ‘reduction of LDC-C in blood’ was ranked highest above patient-relevant modes of administration and adverse effects. In the patient groups identified, reduction of apheresis was important for only a subsegment (30%) of patients. Another 30% wanted effective LDL-C reduction by whatever means necessary. Most strikingly, another 30% preferred higher frequencies of apheresis.

Suggested Citation

  • Axel C. Mühlbacher & Andrew Sadler & Franz-Werner Dippel & Christin Juhnke, 2018. "Treatment Preferences in Germany Differ Among Apheresis Patients with Severe Hypercholesterolemia," PharmacoEconomics, Springer, vol. 36(4), pages 477-493, April.
    • Handle: RePEc:spr:pharme:v:36:y:2018:i:4:d:10.1007_s40273-018-0614-9
    DOI: 10.1007/s40273-018-0614-9
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    References listed on IDEAS

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    3. Junyi Shen, 2009. "Latent class model or mixed logit model? A comparison by transport mode choice data," Applied Economics, Taylor & Francis Journals, vol. 41(22), pages 2915-2924.
    4. David Cutler & Jonathan Skinner & Ariel Dora Stern & David Wennberg, 2013. "Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending," NBER Working Papers 19320, National Bureau of Economic Research, Inc.
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