TY - JOUR
T1 - Understanding Treatment Preferences for Patients with Tricuspid Regurgitation
AU - Iyer, Vijay
AU - Faza, Nadeen N.
AU - Pfeiffer, Michael
AU - Kozak, Mark
AU - Peterson, Brandon
AU - Wyler von Ballmoos, Mortiz
AU - Mollenkopf, Sarah
AU - Mancilla, Melissa
AU - Latibeaudiere-Gardner, Diandra
AU - Reardon, Michael J.
N1 - Funding Information:
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The external authors and study sponsors participated in study design, data collection, data analysis, data interpretation, and development of the manuscript and gave approval to submit for publication. Dr. Iyer has had a consulting relationship with Edwards Lifesciences, Medtronic, Abbott, and Boston Scientific. Dr. Wyler von Ballmoos has had a consulting relationship with Medtronic and Boston Scientific. Both Ms. Mollenkopf and Ms. Mancilla are employees of Edwards Lifesciences. Ms. Latibeaudiere-Gardner is an employee of ICON PLC, a consultancy contracted by Edwards Lifesciences. Dr. Reardon has a consulting relationship with Edwards Lifesciences and Medtronic. Financial support for this study was provided Edwards Lifesciences by a contract with ICON Clinical Research Limited. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The following authors are employed by the sponsor: Melissa Mancilla and Sarah Mollenkopf. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Edwards Lifesciences provided financial support for this research.
Publisher Copyright:
© The Author(s) 2024.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Background. Tricuspid regurgitation (TR) is a high-prevalence disease associated with poor quality of life and mortality. This quantitative patient preference study aims to identify TR patients’ perspectives on risk-benefit tradeoffs. Methods. A discrete-choice experiment was developed to explore TR treatment risk-benefit tradeoffs. Attributes (levels) tested were treatment (procedure, medical management), reintervention risk (0%, 1%, 5%, 10%), medications over 2 y (none, reduce, same, increase), shortness of breath (none/mild, moderate, severe), and swelling (never, 3× per week, daily). A mixed logit regression model estimated preferences and calculated predicted probabilities. Relative attribute importance was calculated. Subgroup analyses were performed. Results. An online survey was completed by 150 TR patients. Shortness of breath was the most important attribute and accounted for 65.8% of treatment decision making. The average patients’ predicted probability of preferring a “procedure-like” profile over a “medical management-like” profile was 99.7%. This decreased to 78.9% for a level change from severe to moderate in shortness of breath in the “medical management-like” profile. Subgroup analysis confirmed that patients older than 64 y had a stronger preference to avoid severe shortness of breath compared with younger patients (P < 0.02), as did severe or worse TR patients relative to moderate. New York Heart Association class I/II patients more strongly preferred to avoid procedural reintervention risk relative to class III/IV patients (P < 0.03). Conclusion. TR patients are willing to accept higher procedural reintervention risk if shortness of breath is alleviated. This risk tolerance is higher for older and more symptomatic patients. These results emphasize the appropriateness of developing TR therapies and the importance of addressing symptom burden. This study provides quantitative patient preference data from clinically confirmed tricuspid regurgitation (TR) patients to understand their treatment preferences. Using a targeted literature search and patient, physician, and Food and Drug Administration feedback, a cross-sectional survey with a discrete-choice experiment that focused on 5 of the most important attributes to TR patients was developed and administered online. TR patients are willing to accept higher procedural reintervention risk if shortness of breath is alleviated, and this risk tolerance is higher for older and more symptomatic patients.
AB - Background. Tricuspid regurgitation (TR) is a high-prevalence disease associated with poor quality of life and mortality. This quantitative patient preference study aims to identify TR patients’ perspectives on risk-benefit tradeoffs. Methods. A discrete-choice experiment was developed to explore TR treatment risk-benefit tradeoffs. Attributes (levels) tested were treatment (procedure, medical management), reintervention risk (0%, 1%, 5%, 10%), medications over 2 y (none, reduce, same, increase), shortness of breath (none/mild, moderate, severe), and swelling (never, 3× per week, daily). A mixed logit regression model estimated preferences and calculated predicted probabilities. Relative attribute importance was calculated. Subgroup analyses were performed. Results. An online survey was completed by 150 TR patients. Shortness of breath was the most important attribute and accounted for 65.8% of treatment decision making. The average patients’ predicted probability of preferring a “procedure-like” profile over a “medical management-like” profile was 99.7%. This decreased to 78.9% for a level change from severe to moderate in shortness of breath in the “medical management-like” profile. Subgroup analysis confirmed that patients older than 64 y had a stronger preference to avoid severe shortness of breath compared with younger patients (P < 0.02), as did severe or worse TR patients relative to moderate. New York Heart Association class I/II patients more strongly preferred to avoid procedural reintervention risk relative to class III/IV patients (P < 0.03). Conclusion. TR patients are willing to accept higher procedural reintervention risk if shortness of breath is alleviated. This risk tolerance is higher for older and more symptomatic patients. These results emphasize the appropriateness of developing TR therapies and the importance of addressing symptom burden. This study provides quantitative patient preference data from clinically confirmed tricuspid regurgitation (TR) patients to understand their treatment preferences. Using a targeted literature search and patient, physician, and Food and Drug Administration feedback, a cross-sectional survey with a discrete-choice experiment that focused on 5 of the most important attributes to TR patients was developed and administered online. TR patients are willing to accept higher procedural reintervention risk if shortness of breath is alleviated, and this risk tolerance is higher for older and more symptomatic patients.
KW - discrete choice experiment
KW - patient preference
KW - treatment
KW - tricuspid regurgitation
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U2 - 10.1177/23814683231225667
DO - 10.1177/23814683231225667
M3 - Article
AN - SCOPUS:85182632305
SN - 2381-4683
VL - 9
JO - MDM Policy and Practice
JF - MDM Policy and Practice
IS - 1
ER -