OBJECTIVES : Physician preference items (PPIs) are high-cost medical devices on which clinicians express firm preferences with respect to a particular manufacturer and a specific product. We aimed at understanding what are the most important factors and their relative importance in the choice of new PPIs (i.e. hip or knee prosthesis) adoption by orthopedic clinicians in Italy.

METHODS : Based on a literature review and clinical experts’ opinions, we identified a number of key factors (e.g., HTA recommendation) and their corresponding levels (e.g., positive HTA recommendation). We administered an online survey to hospital orthopedists using discrete choice experiment (DCE) and case 1 best-worst scaling (BWS) techniques. BWS data were analysed through descriptive statistics (i.e. best-minus-worst score) and conditional logit model. DCE data were analysed through a mixed logit model, and a willingness-to-pay (WTP) was estimated. All analyses were conducted using Stata 16.

RESULTS : 108 orthopedists were enrolled in the survey. In BWS, the most important factor was ‘clinical evidence’, followed by ‘quality of products’, ‘previous experience’ and ‘HTA recommendations’, while the least important were ‘relationship with the sales representative’ and ‘cost’. DCE results suggested that orthopedists prefer high-quality products with robust clinical evidence, positive HTA recommendation and affordable cost, and for which they have a consolidated experience of use and a good relationship with the sales representative. The WTP for a high-quality product was estimated at €1,766, and for a good relationship at €2,985.

CONCLUSIONS : This is the first study aimed at analysing the multidimensionality of clinician's decision-making process in selecting new PPIs in orthopedics in Italy. Despite clinical evidence and quality of products are declared as two of the most important dimensions in BWS, when other factors populate a hypothetical DCE scenario, physicians are not willing to accept them at any cost (e.g. high quality product but very bad support from the producer).