Objectives: The objectives were 1) to elicit relative preferences for attributes of antiretroviral therapies (ART) in people living with HIV (PLWH) and 2) to explore satisfaction and adherence with current ART. Patients and methods: We conducted a multicenter cross-sectional study, consecutively enrolling PLWH receiving an ART. The quantitative part estimated the strength of preference for different attributes using an online discrete choice experiment (DCE). DCE data were analyzed using a mixed logit regression model. Qualitative data were collected through individual interviews. A preliminary coding framework was developed which was then further refined and applied during thematic analysis of factors influencing satisfaction and adherence. Results: A total of 101 PLWH took part in the quantitative part and 31 in the qualitative part. Over 90% had an undetectable viral load. Quantitative data revealed a strong preference for a treatment with limited drug–drug interactions, diarrhea and long-term health problems ( P <0.0001), and that did not need to be taken on an empty stomach ( P <0.0001). Patients also preferred to avoid problems associated with treatment failure ( P <0.0001) or one that left them with a higher viral load after the first weeks of treatment ( P =0.044). Differences in CD4 cell count, and pills that must be taken with food were not significant drivers of treatment choice. The strength of these attributes was reflected in the qualitative data, highlighting the importance patients place on treatment efficacy, and also suggesting that some of these attributes may impact adherence. Many factors influencing adherence and satisfaction with treatment were identified, including pill size, worry about sexual transmission and impact on social life. Conclusion: Most of the attributes included in this survey were important to participants when choosing an ART, in particular those related to quality of life, and these should be taken into account in order to optimize adherence and satisfaction. Keywords: antiretroviral therapy, adherence, HIV infection, preference elicitation, satisfaction, ARV treatments
Abstract Objectives In the European context of falling reimbursement rates for some osteoarthritis (OA) treatments, we performed a study to determine whether the cost covered by patients influenced the decisions of their physicians' prescriptions for medication. Methods The study involved 106 general practitioners (GPs) and 82 rheumatologists. Preferences were elicited using a discrete choice experiment. Scenarios were generated including seven treatment attributes with associated different levels: pain relief, improvement in function, retardation of joint degradation, risk of moderate side effects, risk of serious side effects, cost borne by the patient and degree of patient acceptance of the treatment. Key findings OA treatment choices were significantly influenced by pain relief (β = 1.1533, P < 0.0001 for GPs and β = 0.5043, P = 0.0024 for rheumatologists), improvement in function (β = 1.2140 for GPs and β = 0.7192 for rheumatologists, P < 0.0001), annual cost to the patient (β = −0.0054 for GPs and β = −0.0038 for rheumatologists, P < 0.0001) and serious side effects (β = −0.5524 for GPs and β = −0.4268 for rheumatologists, P < 0.0001). The risk of moderate side effects only had an impact on GP decision making (β = 0.0282, P = 0.0028). All physicians were willing to make patients bear an extra annual cost of: (1) €225 among GPs and €189 among rheumatologists so that they could benefit from one unit improvement in function; and (2) €214 among GPs and €133 among rheumatologists so that they could benefit from a one unit improvement in pain relief. Conclusion When making decisions about which treatment to prescribe, physicians take into account the cost to patients. Changes in reimbursement rates for some OA treatments may lead to changes in prescribing practices.
Objective: This study compared the effectiveness of 4 main revisional bariatric surgery (RBS) sequences after sleeve gastrectomy (SG) and adjustable gastric banding (AGB), on the reimbursement of antidiabetic treatments in France. Background: Few large-scale prospective cohort studies have assessed the changes in antidiabetic treatments after RBS. Method: This nationwide observational population-based cohort study analyzed data from the French National Health Insurance Database. All patients who underwent primary SG and AGB in France between January 2012 and December 2014 were included and followed up until December 31, 2020. The changes in categories and costs of reimbursed antidiabetic treatments across different RBS sequences were assessed (presented as follows: bariatric surgery (BS)-RBS). Results: Among the 107,088 patients who underwent BS, 6396 underwent RBS, 2400 SG-GBP (SG converted to gastric bypass [GBP] during follow-up), 2277 AGB-SG, 1173 AGB-GBP, and 546 SG-SG. Pre-RBS insulin was used in 10 (2.9%), 4 (0.9%), 8 (2.4%), and 10 (2.6%) patients, respectively. Two years after RBS, the treatment discontinuation or decrease (the change of treatment to a lighter one category rates [eg, insulin to bi/tritherapy]) was 47%, 47%, 49%, and 34%, respectively. Four years after RBS, the median annual cost per patient compared with baseline was lower ( P < 0.01) for all sequences, except SG-SG ( P = 0.24). The most notable effect concerned AGB-GBP (median of more than 220 euros to 0). Conclusions: This study demonstrated the positive impact of RBS over a 4-year follow-up period on antidiabetic treatments reimbursement, through the reduction or discontinuation of treatments and a significant decrease in costs per patient.
