OBJECTIVES: A quantitative patient preference study using a discrete choice experiment (DCE) was applied to understand Tricuspid Regurgitation (TR) patient perspectives on treatment options.

METHODS: A list of DCE survey attributes and levels was identified from a targeted literature review. FDA, physician, patient, and manufacturer input was gathered to assess attribute relevance.

Five attributes were chosen with two to four levels. A D-efficient main-effects experimental design systematically chose three blocks of eight paired comparisons leading patients to randomly view eight scenarios presenting a choice between two treatment profiles.

A mixed logit (MXL) regression model analyzed the DCE choice data to estimate patient treatment preferences. The MXL accounts for the panel nature of the data and unobserved preference heterogeneity by assuming that there is a preference weights distribution of each attribute due to respondents’ differences.

The relative attribute importance (RAI) was calculated for the MXL and the RAI provided a ranking for the attributes with higher ranked attributes more important to the decision-making process.

RESULTS: The DCE approach was successful because it showed statistically significant differences in preferences between attributes. A more invasive procedure with more risk of re-intervention at a 5% (p=0.006), or 10% (p=0.002) level was less preferred than a less invasive procedure with 0% risk of re-intervention. An increased number of medication in 2 years (p=0.009) was less preferred than no medication. Moderate (p=<0.001) or severe (p<0.001) shortness of breath was less preferred than no/mild shortness of breath. Swelling every morning (p=0.001) was less preferred than no swelling.

Shortness of breath was a dominant, most important attribute, contributing to 66% of treatment decision making. All other attributes had overlapping RAI confidence intervals and contributed somewhat equally to patients’ treatment decisions.

CONCLUSIONS: A DCE survey is a robust and effective tool in understanding TR patients’ priorities when considering treatment.