Co-Design of a Discrete Choice Experiment for Revascularization Decisions in Complex Coronary Heart Disease: Importance of Patient Perspectives
Author(s)
Todd Wison, BSc, MSc, PhD1, Maria Dalton, MSc1, Nirav Bhagat, BSc, MSc1, Bryan Har, MPH, MD1, Doyin Abatan, BSc.1, Glen Hazlewood, PhD1, Maria Santana, PhD1, Gary Semeniuk, BComm1, Ayotunde Kayode, MSc.1, Sukhwant Parmar, N/A1, Winnie Pearson, N/A1, Aishah Matar Mohamed Mobarak Alhmoudi, MD1, Nishant Sharma, MD1, Stephen Wilton, MSc, MD1, Michelle Graham, MD2, Matthew James, MD, PhD1, Tolulope Sajobi, PhD1;
1University of Calgary, Calgary, AB, Canada, 2University of Alberta, Edmonton, AB, Canada
1University of Calgary, Calgary, AB, Canada, 2University of Alberta, Edmonton, AB, Canada
OBJECTIVES: The selection of the optimal treatment strategy remains one of the most challenging decisions in the management of coronary artery disease (CAD). Current clinical practice guidelines recommend revascularization for multivessel CAD for most patients. However, understanding patient preferences based on trade-offs in potential benefits and harms of the treatment options for multivessel CAD is limited. This study aims to characterize patient preferences towards revascularization and optimal medical therapy for individuals with multivessel CAD using discrete choice experiment design (DCE).
METHODS: An iterative, DCE design process was utilized, co-developed with patient advisors to select attributes based on a literature review and input from cardiologists. A total of 400 patient participants will be recruited from two Alberta coronary catheterization units. Eligible participants are individuals with multivessel disease, able to provide written informed consent, and communicate in English. Hierarchical Bayes models will be used to model the relative importances of the treatment attributes and latent class analysis will be used to explore preference heterogeneity. We will also estimate the marginal rate of substitution to measure patient’s willingness to accept a trade-off among different attributes.
RESULTS: We identified six attributes for inclusion in the DCE: treatment approach, one-year risks of death, heart attack, stroke, kidney damage resulting in chronic kidney disease, and quality of life. The pilot study included 19 participants, and recruitment is underway for the full DCE, with 166 questionnaires completed to date. We anticipate recruitment and preliminary analysis will be complete in Spring 2025.
CONCLUSIONS: To our knowledge, this is the first study to use a discrete choice experiment (DCE) to assess and quantify the preferences of patients with multivessel coronary artery disease towards revascularization and optimal medical therapy in Alberta, Canada. Understanding treatment preferences for individuals with multivessel disease CAD can support patient-physician shared-decision making for optimal CAD management.
METHODS: An iterative, DCE design process was utilized, co-developed with patient advisors to select attributes based on a literature review and input from cardiologists. A total of 400 patient participants will be recruited from two Alberta coronary catheterization units. Eligible participants are individuals with multivessel disease, able to provide written informed consent, and communicate in English. Hierarchical Bayes models will be used to model the relative importances of the treatment attributes and latent class analysis will be used to explore preference heterogeneity. We will also estimate the marginal rate of substitution to measure patient’s willingness to accept a trade-off among different attributes.
RESULTS: We identified six attributes for inclusion in the DCE: treatment approach, one-year risks of death, heart attack, stroke, kidney damage resulting in chronic kidney disease, and quality of life. The pilot study included 19 participants, and recruitment is underway for the full DCE, with 166 questionnaires completed to date. We anticipate recruitment and preliminary analysis will be complete in Spring 2025.
CONCLUSIONS: To our knowledge, this is the first study to use a discrete choice experiment (DCE) to assess and quantify the preferences of patients with multivessel coronary artery disease towards revascularization and optimal medical therapy in Alberta, Canada. Understanding treatment preferences for individuals with multivessel disease CAD can support patient-physician shared-decision making for optimal CAD management.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD17
Topic
Health Service Delivery & Process of Care
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)