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

PubMedID: 23505491

Whitty JA, Stewart S, Carrington MJ, Calderone A, Marwick T, Horowitz JD, Krum H, Davidson PM, Macdonald PS, Reid C, 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. 2013;8(3):e58347.
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/PRINCIPAL 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±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.