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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Environmental and resource economics 13 (1999), S. 219-234 
    ISSN: 1573-1502
    Keywords: contingent valuation survey ; loss aversion ; willingness-to-accept ; willingness-to-pay
    Source: Springer Online Journal Archives 1860-2000
    Topics: Energy, Environment Protection, Nuclear Power Engineering , Economics
    Notes: Abstract This paper examines the three major explanations for the disparity between willingness-to-pay (WTP) and willingness-to-accept (WTA) observed in contingent value surveys and laboratory experiments: a belief that the results must be biased in some fashion, Hanemann's (1991) substitutes hypothesis, and the loss aversion model proposed by Tversky and Kahneman (1991). Starting from the assumption that individuals make utility maximizing choices, we develop structural equations that yield parametric tests of the hypotheses within a single, non-experimental framework. The approach is flexible enough to incorporate a variety of functional form and distributional assumptions and can be applied to either data from either open-ended bids or dichotomous choice questions. The usefulness of the approach is demonstrated using data from a survey that asked both WTP and WTA questions. The results provide weak support for loss aversion.
    Type of Medium: Electronic Resource
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  • 2
    Publication Date: 2019-11-13
    Description: Introduction: Evaluation of patients' psychosocial burden related to their cancer and its treatment is important for shared decision making by patients and their healthcare team. We aimed to better understand the impact of age on this burden as reported by patients with chronic lymphocytic leukemia (CLL), diffuse large B-cell lymphoma (DLBCL), and follicular lymphoma (FL) using data from a large US patient advocacy survey. Methods: We developed a survey to understand patients' perceptions of disease burden and impact on physical and emotional health. The survey was designed through consultation with medical experts, patient advocacy organizations and research team members. Concept elicitation and cognitive pretesting were conducted with patients to inform the survey content. The survey was administered electronically to patients with CLL, DLBCL, or FL who had received either initial or subsequent treatment within the past year. The survey consisted of categorical Likert options that quantified the impact of disease on physical function, sleep, cognition, work, emotional health and quality of life (QoL). The survey data were analyzed descriptively by patients' reported age: 60 years or older versus less than 60 years. Results: The survey was completed by 424 patients who were associated with The Leukemia & Lymphoma Society and/or the Lymphoma Research Foundation (309 patients with CLL, 59 patients with DLBCL and 69 patients with FL). Respondents had a mean age of 66 years (range: 22-95 with five patients electing not to report their age), 79% were 60 years or older, and 51% were female. A greater proportion of younger patients (
    Print ISSN: 0006-4971
    Electronic ISSN: 1528-0020
    Topics: Biology , Medicine
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  • 3
    Publication Date: 2018-11-29
    Description: OBJECTIVES: Several agents have recently been approved for relapsed/refractory multiple myeloma (RRMM), providing patients and providers with more treatment options. The existing literature on patient preferences for MM treatments is limited. This study aims to quantify these preferences using a discrete-choice experiment (DCE) survey coupled with a best-worst scaling (BWS) exercise to elicit treatment priorities and unmet needs. METHODS: The survey design utilized both a DCE and a BWS exercise that included attributes and levels that overlapped between the two types of patient preference questions (DCE and BWS) to provide multiple sources of information on treatment preferences. The attributes for the DCE and BWS exercise were informed by patient focus groups. The final DCE included six attributes with varying levels: progression-free survival (PFS, 6-24 months); risk of heart failure (0%-5%); peripheral neuropathy (none, mild-to-moderate, severe); risk of low blood counts, combining thrombocytopenia and neutropenia (0%-70%); gastrointestinal (GI) problems (none, nausea and vomiting, diarrhea, constipation); and mode and frequency of administration (daily and weekly pill, weekly injection, intravenous [IV] infusion 4 hours per week, IV 1 hour twice a week). The BWS exercise included 18 items (the modes and frequency of administration included in the DCE, additional treatment convenience items, mild and serious adverse events, and treatment side-effects). The final survey was administered online to patients recruited from the Multiple Myeloma Research Foundation CoMMpass study (NCT01454297). For the DCE data, latent-class analysis was used to identify patient subgroups with systematically different preferences. The relative strength of preference for each attribute level (i.e., relative preference weights) was estimated for all subgroups and was used to calculate the relative importance of attributes. For each item in the BWS exercise, a relative score was calculated by subtracting the number of times a feature was chosen as least bothersome from the number of times it was chosen as most bothersome, then dividing by the total number of times appeared in the design. RESULTS: The final sample consisted of 94 patient respondents with RRMM. Patients had an average age of 65 years, and 59% were male. The latent-class analysis identified two subgroups of respondents with systematically different preferences (Figure 1). Both subgroups expressed a willingness to trade PFS for less treatment toxicity. Members of subgroup 1 placed the greatest relative importance on toxicities (nerve damage, risk of low blood counts, GI problems). A change in nerve damage from none to severe was the most important attribute to subgroup 1, approximately 1.8 times more important than the relative importance of a change in the risk of low blood counts from 0% to 70%, and 2.7 times more than the relative importance of a change in PFS from 6 months to 1 year. Members of the second subgroup considered PFS the most important attribute, followed by nerve damage and mode of administration. Subgroup 2 considered the relative importance of a change in PFS from 6 months to 2 years to be more than two times as important as the relative importance of changes in all other attributes. In the BWS exercise, respondents evaluated kidney complications and low white blood cell count as the most bothersome medicine characteristics, while taking pills once a week for 3 weeks per month or pill taken daily were the least bothersome (most favorable) characteristics. CONCLUSIONS: Patients with RRMM place importance on PFS and nerve toxicity when considering treatment features and modes of administration. Results from the preference study indicate that there are subgroups of patients with systematically different treatment preferences. Understanding how different patients value treatment attributes may help decision makers improve the quality of patient-centered care. Figure 1. Figure 1. Disclosures Mansfield: Takeda Pharmaceuticals International Co: Consultancy; Genentech: Consultancy. Chari:Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Array Biopharma: Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bristol Myers Squibb: Consultancy; Pharmacyclics: Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Adaptive Biotechnology: Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees; The Binding Site: Consultancy. Cole:Cancer Support Community myeloma advisory board: Membership on an entity's Board of Directors or advisory committees; University of Michigan: Employment. Kaufman:Karyopharm: Other: data monitoring committee; Roche: Consultancy; BMS: Consultancy; Janssen: Consultancy; Abbvie: Consultancy. Siegel:BMS: Consultancy, Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Takeda: Consultancy, Honoraria, Speakers Bureau; Karyopharm: Consultancy, Honoraria; Merck: Consultancy, Honoraria, Speakers Bureau; Amgen: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Speakers Bureau; Celgene: Consultancy, Honoraria, Research Funding, Speakers Bureau. Zonder:Takeda: Honoraria; Alnylam: Honoraria; Celgene: Consultancy, Honoraria; Janssen: Honoraria; Coelum: Honoraria; BMS: Research Funding; Pharmacyclics: Other: DSMC. Mange:Takeda Pharmaceutical Company: Consultancy. Dalal:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA: Employment, Equity Ownership. Mikhael:Onyx, Celgene, Sanofi, AbbVie: Research Funding.
    Print ISSN: 0006-4971
    Electronic ISSN: 1528-0020
    Topics: Biology , Medicine
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  • 4
    Publication Date: 2018-11-29
    Description: OBJECTIVES: In recent years, there has been an increase in the number of treatments with different administration modes for patients with CLL, DLBCL, and FL, providing patients with options that were previously unavailable. However, there is a dearth of quantitative evidence for how patients make decisions when choosing treatments and on patients' opinions regarding the burden of disease, treatment, and satisfaction with processes involved in treatment. We developed a survey to understand patient experiences, preferences, and factors that contribute to decision making. This study aims to quantify patient-reported information via standard survey items with categorical Likert options that measure aspects of satisfaction with patients' most recent treatment. Additionally, patient preferences for various modes of treatment administration will be measured through direct assessment. METHODS: To design the survey, a rigorous approach consisting of consultation with medical experts, patient advocacy organizations, and research team members was undertaken. Additionally, concept elicitation and cognitive pretesting with patients yielded important attributes to measure, including satisfaction with and preference for various aspects of treatment, treatment schedule and burden, travel time, work productivity and caregiver impact. A particular focus was given to the impact of disease and treatment on health-related quality of life. Specific topics in this category included impact on energy levels, sleep, concentration, emotional health, personal relationships, anxiety and uncertainty, and optimism about future health status. RESULTS: The draft survey questionnaire was developed and pretested in semistructured interviews with patients (n = 14). Four patients with CLL, 5 patients with DLBCL, and 6 patients with FL were interviewed. Eight patients were male and 6 were female, and mean patient age was 59 (range: 33-74). Interview results suggested that patients experience a significant time burden related to the treatment of their disease. All survey items (including those addressing preferences for treatments based on duration and level of satisfaction with various time and resource dependent treatment characteristics) were refined during the interviews. The final survey is currently being administered online to patients who are associated with The Leukemia & Lymphoma Society and The Lymphoma Research Foundation. We anticipate surveying 500 patients, with results ready for the 2018 American Society of Hematology Annual Meeting. CONCLUSIONS: Evaluations of patient satisfaction, preferences, and priorities are increasingly important as patients are enabled to take more active roles in decision-making for their treatment pathways. Our present study will yield necessary data on important treatment attributes among patients with CLL, DLBCL, and FL. A large-scale evaluation of patient satisfaction and preferences can be used for education of the clinical and broader medical community in a landscape that includes several new therapies. Disclosures Price: Genentech: Consultancy. Ravelo:Genentech: Employment. Weiss:Genentech: Research Funding. Torney:Genentech: Research Funding. Gonzalez:Genentech: Research Funding. Sae-Hau:Genentech: Research Funding. Mansfield:Takeda Pharmaceuticals International Co: Consultancy; Genentech: Consultancy. Comenencia-Ortiz:Genentech: Employment. Cunanan:Genentech: Consultancy. Masaquel:Roche: Equity Ownership; Genentech: Employment, Equity Ownership. Dawson:Genentech: Employment.
    Print ISSN: 0006-4971
    Electronic ISSN: 1528-0020
    Topics: Biology , Medicine
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  • 5
    Publication Date: 2016-12-02
    Description: Background: Over 15,000 new cases of CLL are diagnosed each year in the U.S. Different treatment options exist, which vary in efficacy, side effects, and mode of administration. Little is known about the value patients place upon the different attributes of available CLL treatments. Objectives: To estimate patient preferences for CLL treatments and investigate the relationship between treatment preferences and cost. Methods: Patients with a self-reported physician diagnosis of CLL were recruited through a patient advocacy group to complete an online discrete-choice experiment (DCE) survey. The survey included 8 DCE questions in which respondents chose between pairs of hypothetical treatments for CLL. Each hypothetical treatment was defined by 5 attributes with several predefined levels; the attributes were progression-free survival (PFS; 10-60 months), diarrhea (none to severe), chance of severe infection (0-30%), chance of organ damage (0-8%), and mode and schedule of administration (pill versus intravenous administration). Treatment duration was not addressed independently and treatment cost was not included in the DCE. Random-parameters logit (RPL) was used to analyze the data and estimate patient preference weights for each attribute level in the survey. An importance score and minimum acceptable benefit score were calculated using results from the RPL model. Later, a cost attribute was added that included 2 hypothetical treatment profiles (Treatment A: 26 months of PFS, no diarrhea, 15% chance of serious infection, 8% chance of organ damage, IV once a month for 6 months, and lower cost; Treatment B: 60 months of PFS, mild/moderate diarrhea, 30% chance of serious infection, no chance of organ damage, daily pill for 60 months, and higher cost). Results from the RPL model were used to predict the share of respondents who would choose each treatment based on the DCE questions when cost was not a consideration, as compared with respondents' choices when cost was included. Results: 384 respondents recruited through LLS: 53% were female, 94% were white, and the mean age was 65 years. 57% had Medicare insurance, 53% of respondents had received financial aid and 40% reported difficulty in paying out-of-pocket costs for their medicines. In the DCE results, the attribute levels were ordered as expected, with respondents preferring better outcomes to worse. Within each attribute, all levels were statistically significantly different from each other (P ≤ 0.05). Attributes in the order of importance to patients as determined by DCE were PFS, chance of infection, chance of organ damage and the occurrence and severity of diarrhea. Mode of administration was the least important attribute. Although PFS had the highest importance score, the risk of adverse events was also highly important to patients; significant additional PFS was needed to offset patients' acceptance of worsening adverse events. For example, an increase in the chance of infection from 0% to 30% required an offset of 36 months of additional PFS. An increase in the chance of organ damage from 0% to 8% required an additional 26 months of PFS by the respondents. A tradeoff of 22 additional months in PFS is needed for a change from no diarrhea to severe diarrhea. Using results from the RPL model, it was predicted that 91% of respondents would choose Treatment B when cost is excluded from the treatment profile description. This was mainly driven by the better PFS attribute of Treatment B. When a modest cost difference was introduced ($75 more per month for treatment B), half of the patients chose treatment A. When this difference became larger ($400 more per month), the change in patient preference was even more pronounced; 74% chose option A. Conclusions: The most important attribute in the survey was PFS, however patients also indicated that increases in the risk of adverse events would require significant increase in PFS to offset that risk. Patients with CLL are sensitive to treatment costs and many reported difficulty in paying for their medications. Given the choice of treatments available to patients and the high cost of some treatments, physicians may want to explore their patients' preferences for different treatment features, including benefit-risk tradeoffs and out-of-pocket cost when selecting the best treatment strategies for patients. Disclosures Mansfield: RTI Health Solutions: Other: Research for this abstract was performed in the course of my employment at Research Triangle Institute d/b/a RTI Health Solutions, pursuant to a contract between my employer and the study sponsor, Genentech. RTI was compensated by the sponsor.. Masaquel:Roche: Equity Ownership; Genentech: Employment. Sutphin:RTI Health Solutions: Other: Research for this abstract was performed in the course of my employment at Research Triangle Institute d/b/a RTI Health Solutions, pursuant to a contract between my employer and the study sponsor, Genentech. RTI was compensated by the sponsor.. Li:Genentech: Employment; Roche: Equity Ownership. Reyes:Genentech: Employment; Roche: Equity Ownership.
    Print ISSN: 0006-4971
    Electronic ISSN: 1528-0020
    Topics: Biology , Medicine
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  • 6
    Publication Date: 2014-03-01
    Print ISSN: 0921-8009
    Electronic ISSN: 1873-6106
    Topics: Energy, Environment Protection, Nuclear Power Engineering , Economics
    Published by Elsevier
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  • 7
  • 8
    Publication Date: 1998-11-01
    Print ISSN: 0095-0696
    Electronic ISSN: 1096-0449
    Topics: Energy, Environment Protection, Nuclear Power Engineering , Economics
    Published by Elsevier
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