BRINGING TACROLIMUS MONITORING HOME: A DISCRETE CHOICE EXPERIMENT OF PATIENT PREFERENCES IN ORGAN TRANSPLANTATION
Author(s)
Pauline Breuer, MSc1, Lucas Goossens, PhD1, Dennis Hesselink, MD, PhD2, Olivier Manintveld, MD, PhD2, Marinus Hazenbroek, MD2, Jan IJzermans, MD, PhD3, Esther de Bekker-Grob, PhD1.
1Erasmus School of Health Policy and Management, Rotterdam, Netherlands, 2Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands, 3Erasmus MC Transplant Institute, Rotterdam, Netherlands.
1Erasmus School of Health Policy and Management, Rotterdam, Netherlands, 2Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands, 3Erasmus MC Transplant Institute, Rotterdam, Netherlands.
OBJECTIVES: Therapeutic drug monitoring (TDM) of tacrolimus is essential in transplant care, but requires frequent hospital visits, creating a burden for both patients and healthcare systems. Home-based TDM using dried blood spot sampling, combined with algorithm-supported dosing, may improve accessibility and efficiency. However, patient preferences for such monitoring approaches remain unclear. This study aimed to quantify patient preferences for characteristics (i.e., attributes) of home-based tacrolimus TDM, to assess trade-offs between key features, and explore preference heterogeneity across patient subgroups.
METHODS: A prospective, single-center discrete choice experiment (DCE) was conducted among adult pre- and post-transplant patients receiving tacrolimus care. Attributes and attribute levels for the DCE were identified through expert consultation. Attributes included mode of communication, number of hospital visits avoided, risk of nephrotoxicity, information received from blood samples, sampling location, and frequency. A Bayesian efficient experimental design with blocking was applied. Participants completed 12 choice tasks, each presenting two hypothetical TDM strategies alongside hospital-based venous sampling. Data were analyzed using mixed logit and latent class models within a random utility framework to estimate preference weights, relative attribute importance, and preference heterogeneity.
RESULTS: Preference patterns were consistent across attributes, with clinical safety and convenience features influencing choice behavior. Higher risk of nephrotoxicity and higher sampling frequency were negatively associated with uptake of home-based TDM, whereas a greater number of hospital visits avoided and more convenient sampling arrangements were positively associated with uptake. Differences in preference across patient subgroups indicated heterogeneity in decision-making.
CONCLUSIONS: This study highlights patient preferences for home-based tacrolimus TDM and the trade-offs they are willing to make between convenience, clinical safety, and monitoring features. The findings can inform the design and implementation of patient-centered TDM strategies, facilitate shared decision-making, and support policy development for innovative transplant monitoring approaches.
METHODS: A prospective, single-center discrete choice experiment (DCE) was conducted among adult pre- and post-transplant patients receiving tacrolimus care. Attributes and attribute levels for the DCE were identified through expert consultation. Attributes included mode of communication, number of hospital visits avoided, risk of nephrotoxicity, information received from blood samples, sampling location, and frequency. A Bayesian efficient experimental design with blocking was applied. Participants completed 12 choice tasks, each presenting two hypothetical TDM strategies alongside hospital-based venous sampling. Data were analyzed using mixed logit and latent class models within a random utility framework to estimate preference weights, relative attribute importance, and preference heterogeneity.
RESULTS: Preference patterns were consistent across attributes, with clinical safety and convenience features influencing choice behavior. Higher risk of nephrotoxicity and higher sampling frequency were negatively associated with uptake of home-based TDM, whereas a greater number of hospital visits avoided and more convenient sampling arrangements were positively associated with uptake. Differences in preference across patient subgroups indicated heterogeneity in decision-making.
CONCLUSIONS: This study highlights patient preferences for home-based tacrolimus TDM and the trade-offs they are willing to make between convenience, clinical safety, and monitoring features. The findings can inform the design and implementation of patient-centered TDM strategies, facilitate shared decision-making, and support policy development for innovative transplant monitoring approaches.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA357
Topic
Health Technology Assessment, Patient-Centered Research
Disease
Personalized & Precision Medicine