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Patient preferences and willingness-to-pay for a home or clinic based program of chronic heart failure management: findings from the Which? trial

Citation

Whitty, JA and Stewart, S and Carrington, MJ and Calderone, A and Marwick, T and Horowitz, JD and Krum, H and Davidson, PM and Macdonald, PS and Reid, C and Scuffham, PA, Patient preferences and willingness-to-pay for a home or clinic based program of chronic heart failure management: findings from the Which? trial, PLoS One, 8, (3) Article e58347. ISSN 1932-6203 (2013) [Refereed Article]


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DOI: doi:10.1371/journal.pone.0058347

Abstract

Background: Beyond examining their overall cost-effectiveness and mechanisms of effect, it is important to understand patient preferences for the delivery of different modes of chronic heart failure management programs (CHF-MPs). We elicited patient preferences around the characteristics and willingness-to-pay (WTP) for a clinic or home-based CHF-MP.

Methodology/Principle Findings: A Discrete Choice Experiment was completed by a sub-set of patients (n = 91) enrolled in the WHICH? trial comparing home versus clinic-based CHF-MP. Participants provided 5 choices between hypothetical clinic and home-based programs varying by frequency of nurse consultations, nurse continuity, patient costs, and availability of telephone or education support. Participants (aged 71&plusmin;13 yrs, 72.5% male, 25.3% NYHA class III/IV) displayed two distinct preference classes. A latent class model of the choice data indicated 56% of participants preferred clinic delivery, access to group CHF education classes, and lower cost programs (p < 0.05). The remainder preferred home-based CHF-MPs, monthly rather than weekly visits, and access to a phone advice service (p < 0.05). Continuity of nurse contact was consistently important. No significant association was observed between program preference and participant allocation in the parent trial. WTP was estimated from the model and a dichotomous bidding technique. For those preferring clinic, estimated WTP was ≈AU$9-20 per visit; however for those preferring home-based programs, WTP varied widely (AU$15-105).

Conclusions/Significance: Patient preferences for CHF-MPs were dichotomised between a home-based model which is more likely to suit older patients, those who live alone, and those with a lower household income; and a clinic-based model which is more likely to suit those who are more socially active and wealthier. To optimise the delivery of CHF-MPs, health care services should consider their patients' preferences when designing CHF-MPs.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, T (Professor Tom Marwick)
ID Code:85502
Year Published:2013
Web of Science® Times Cited:13
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-07-11
Last Modified:2014-12-17
Downloads:190 View Download Statistics

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