Discrete Choice Experiment to Evaluate Factors That Influence Preferences for Antibiotic Prophylaxis in Pediatric Oncology

PLOS ONE, Dec 2019

Background Bacterial and fungal infections in pediatric oncology patients cause morbidity and mortality. The clinical utility of antimicrobial prophylaxis in children is uncertain and the personal utility of these agents is disputed. Objectives were to use a discrete choice experiment to: (1) describe the importance of attributes to parents and healthcare providers when deciding between use and non-use of antibacterial and antifungal prophylaxis; and (2) estimate willingness-to-pay for prophylactic strategies. Methods Attributes were chances of infection, death and side effects, route of administration and cost of pharmacotherapy. Respondents were randomized to a discrete choice experiment outlining hypothetical treatment options to prevent antibacterial or antifungal infections. Each respondent was presented 16 choice tasks and was asked to choose between two unlabeled treatment options and an opt-out alternative (no prophylaxis). Results 102 parents and 60 healthcare providers participated. For the antibacterial discrete choice experiment, frequency of administration was significantly associated with utility for parents but not for healthcare providers. Increasing chances of infection, death, side effects and cost were all significantly associated with decreased utility for parents and healthcare providers in both the antibacterial and antifungal discrete choice experiment. Parental willingness-to-pay was higher than healthcare providers for both strategies. Conclusion Chances of infection, death, side effects and costs were all significantly associated with utility. Parents have higher willingness-to-pay for these strategies compared with healthcare providers. This knowledge can help to develop prophylaxis programs.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0047470&type=printable

Discrete Choice Experiment to Evaluate Factors That Influence Preferences for Antibiotic Prophylaxis in Pediatric Oncology

et al. (2012) Discrete Choice Experiment to Evaluate Factors That Influence Preferences for Antibiotic Prophylaxis in Pediatric Oncology. PLoS ONE 7(10): e47470. doi:10.1371/journal.pone.0047470 Discrete Choice Experiment to Evaluate Factors That Influence Preferences for Antibiotic Prophylaxis in Pediatric Oncology Dean A. Regier 0 Caroline Diorio 0 Marie-Chantal Ethier 0 Amanda Alli 0 Sarah Alexander 0 Katherine M. Boydell 0 Adam Gassas 0 Jonathan Taylor 0 Charis Kellow 0 Denise Mills 0 Lillian Sung 0 Ann M. Moormann, University of Massachusetts Medical School, United States of America 0 1 Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Agency , Vancouver, British Columbia , Canada , 2 Program in Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario , Canada , 3 Division of Haematology/Oncology, The Hospital for Sick Children , Toronto, Ontario , Canada , 4 Community Health Systems Resource Group, The Hospital for Sick Children , Toronto, Ontario , Canada , 5 Program in Health Research Methodology, McMaster University , Hamilton, Ontario , Canada Background: Bacterial and fungal infections in pediatric oncology patients cause morbidity and mortality. The clinical utility of antimicrobial prophylaxis in children is uncertain and the personal utility of these agents is disputed. Objectives were to use a discrete choice experiment to: (1) describe the importance of attributes to parents and healthcare providers when deciding between use and non-use of antibacterial and antifungal prophylaxis; and (2) estimate willingness-to-pay for prophylactic strategies. Methods: Attributes were chances of infection, death and side effects, route of administration and cost of pharmacotherapy. Respondents were randomized to a discrete choice experiment outlining hypothetical treatment options to prevent antibacterial or antifungal infections. Each respondent was presented 16 choice tasks and was asked to choose between two unlabeled treatment options and an opt-out alternative (no prophylaxis). Results: 102 parents and 60 healthcare providers participated. For the antibacterial discrete choice experiment, frequency of administration was significantly associated with utility for parents but not for healthcare providers. Increasing chances of infection, death, side effects and cost were all significantly associated with decreased utility for parents and healthcare providers in both the antibacterial and antifungal discrete choice experiment. Parental willingness-to-pay was higher than healthcare providers for both strategies. Conclusion: Chances of infection, death, side effects and costs were all significantly associated with utility. Parents have higher willingness-to-pay for these strategies compared with healthcare providers. This knowledge can help to develop prophylaxis programs. - Funding: LS is supported by a New Investigator Award from the Canadian Institutes of Health Research (Grant no. 87719). This research is supported by the Pediatric Oncology Group of Ontario Research Unit. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Bacterial and fungal infections continue to be common causes of mortality for children receiving intensive chemotherapy. [1] Infections also cause morbidity, limit the ability to deliver anticancer therapy, decrease quality of life, and are associated with substantial costs. [2] A meta-analysis of randomized trials of prophylactic antibacterial medication in neutropenic adult oncology patients showed a significantly decreased risk of death in patients receiving prophylaxis. [3] Similarly, a meta-analysis of randomized controlled trials demonstrated that antifungal prophylaxis significantly decreased all-cause mortality in patients (mainly adults) receiving chemotherapy. [4] The evidence is much more limited in children with cancer and we have previously shown substantial variation in practices related to antibacterial and antifungal prophylaxis within North American and Germany for children with acute myeloid leukemia [5]. Preferences toward antibiotic prophylaxis may, in part, explain such variability in practice. One method for measuring preferences in the face of multiple trade-offs in health care is the discrete choice experiment (DCE) methodology. [6] The conceptual basis of DCE begins with the assumption that health care goods can be described by their characteristics (called attributes) and that individuals derive value (utility) from these attributes. [7] In the present example, the decision to accept routine antibiotic prophylaxis may be influenced by several factors such as the risks of invasive infection, infectious death and drug toxicity, and the requirement to give the medication intravenously or orally. In addition, costs may play a role in deci (...truncated)


This is a preview of a remote PDF: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0047470&type=printable

Dean A. Regier, Caroline Diorio, Marie-Chantal Ethier, Amanda Alli, Sarah Alexander, Katherine M. Boydell, Adam Gassas, Jonathan Taylor, Charis Kellow, Denise Mills, Lillian Sung. Discrete Choice Experiment to Evaluate Factors That Influence Preferences for Antibiotic Prophylaxis in Pediatric Oncology, PLOS ONE, 2012, Volume 7, Issue 10, DOI: 10.1371/journal.pone.0047470