Estimating Patients’ Preferences to Inform Treatment (ESPRIT)
In the United States, HIV treatment costs exceed $16 billion annually. Antiretroviral medications (ARVs), which have transformed HIV infection from a nearly universally fatal illness to a life-long manageable disease, account for the largest share of these costs. The changing landscape of HIV therapeutics in the context of patent expirations and new co-formulations, and the changing insurance landscape as a result of the Affordable Care Act (ACA), have led to a rapid increase in the number and characteristics of treatment options and increasingly complex tradeoffs between diverse patient-relevant characteristics of ARVs, including pill burden, food requirements, side effects, long-term toxicities, and out-of-pocket costs. Because these characteristics are associated with HIV medication adherence, they have important implications for treatment efficacy. However, how patients value these characteristics is unknown. The proposed study aims to characterize patients’ HIV treatment preferences using Discrete Choice Experiment (DCE) methodology, and identify systematic variation in preferences with insurance coverage. Using in-depth interviews (IDIs) with HIV care providers and focus group discussions (FGDs) and DCE surveys with patients at Duke University and the University of South Carolina, we will elicit preferences for diverse attributes of HIV medications such as out-of-pocket costs, number of pills per day, food requirements, and side effects. The results will provide the basis for policy simulations and a decision tool that can facilitate joint decision making by patients and physicians.
Key Duke Staff: Nathan Thielman (co-PI), Jan Ostermann (co-PI), Amy Hobbie, Andrew Weinhold
Funder: Robert Wood Johnson Foundation, Grant 73056 Project period: 10/1/2015 – 5/31/2017