Patients’ preferences for anti-osteoporosis drug treatment: a cross-European discrete-choice experiment

Mickaël Hiligsmann, Benedict G Dellaert, Carmen D Dirksen, Verity Watson, Sandrine Bours, Stefan Goemaere, Jean-Yves Reginster, Christian Roux, Bernie McGowan, Carmel Silke, Bryan Whelan, Adolfo Diez-Perez, Elisa Torres, Georgios Papadakis , Rene Rizzoli, Cyrus Cooper, Gill Pearson, Annelies Boonen

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)
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OBJECTIVES: To estimate the preferences of osteoporotic patients for medication attributes, and analyse data from seven European countries.
METHODS: A discrete choice experiment was conducted in Belgium, France, Ireland, the Netherlands, Spain, Switzerland and United Kingdom. Patients were asked to choose repeatedly between two hypothetical unlabelled drug treatments (and an opt-out option) that varied with respect to four attributes: efficacy in reducing the risk of fracture, type of potential common side-effects, mode and frequency of administration. In those countries in which patients contribute to the cost of their treatment directly, a fifth attribute was added: out-of-pocket cost. A mixed logit panel model was used to estimate patients’ preferences.
RESULTS: In total 1,124 patients completed the experiment, with sample of between 98 and 257 patients per country. In all countries, patients preferred treatment with higher effectiveness and 6-monthly subcutaneous injection was always preferred over weekly oral tablets. In five countries, patients also preferred monthly oral tablet and yearly intravenous injections over weekly oral tablets. In the three countries where the out-of-pocket cost was included as an attribute, lower costs significantly contribute to the treatment preference. Between countries there were statistically significant differences for 13 out of 42 attribute/levels interactions.
CONCLUSIONS: We find statistically significant differences in patients’ preferences for anti-osteoporosis medications between countries, especially for the mode of administration. Our findings emphasize that international treatment recommendations should allow for local adaptation and that understanding individual preferences is important if we want to improve the quality clinical care for patients with osteoporosis.
Original languageEnglish
Pages (from-to)1167-1176
Number of pages10
Issue number7
Early online date6 Apr 2017
Publication statusPublished - Jul 2017

Bibliographical note

We would like to thank all participating centres: the Unit for Osteoporosis and Metabolic Bone from Ghent University Hospital (Belgium); the University Center for Investigation in Bone and Articular Cartilage Metabolism in Liege (Belgium); the Fracture Clinic of the Maastricht University Medical Center (Netherlands); the Bone Unit of Paris Descartes University, Paris (France); The North Western Rheumatology Unit, Our Lady’s Hospital, Manorhamilton and the Sligo University Hospital (Ireland); the Musculoskeletal Research Unit and RETICEF from the Universitat Auto` noma de Barcelona (Spain); the Division of Bone Diseases from the Geneva University Hospitals (Switzerland); the MRC Lifecourse Epidemiology Unit from the University of Southampton (UK) for helping us in data collection; Ed Porquie, our patient partner; Wafa Ben Sedrine, Ivette Essers and Wilco Tilburgs for data entry; and all the patients for their participation.

This work was supported by Amgen. The funding agreement between Maastricht University and Amgen ensured the authors’ independence in designing the study (including selection of attributes and levels), interpreting the data, and writing and publishing the report. Other participating centres were compensated by Maastricht University for their participation in the study.


  • Cross-Country Comparison
  • discrete choice experiment
  • drug treatment
  • osteoperosis
  • patients
  • preferences


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