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)