Patient Preferences for Managing Insomnia: A Discrete Choice Experiment.

Publication Type:
Journal Article
Patient, 2018, 11, (5), pp. 503-514
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BACKGROUND: Despite the rapid development of effective treatments, both pharmacological and non-pharmacological, insomnia management remains suboptimal at the practice interface. Patient preferences play a critical role in influencing treatment outcomes. However, there is currently a mismatch between patient preferences and clinician recommendations, partly perpetuated by a limited understanding of the patients' decision-making process. OBJECTIVES: The aim of our study was to empirically quantify patient preferences for treatment attributes common to both pharmacological and non-pharmacological insomnia treatments. METHOD: An efficient dual-response discrete choice experiment was conducted to evaluate patient treatment preferences for managing insomnia. The sample included 205 patients with self-reported insomnia and an Insomnia Severity Index ≥ 14. Participants were presented with two unlabelled hypothetical scenarios with an opt-out option across 12 choice sets. Data were analyzed using a mixed multinomial logit model to investigate the influence of five attributes (i.e. time, onset of action, maintainability of improved sleep, length of treatment, and monthly cost) on treatment preferences. RESULTS: Treatments were preferentially viewed if they conferred long-term sleep benefits (p < 0.05); had an ongoing, as opposed to a predefined, duration of treatment course (p < 0.05); required some, as opposed to no, additional time commitment (p < 0.05); and had lower monthly out-of-pocket treatment costs (p < 0.001). However, treatment onset of action had no influence on preference. Age, help-seeking status, concession card status and fatigue severity significantly influenced treatment preference. CONCLUSION: Participants' prioritization of investing time in treatment and valuing the maintainability of therapeutic gains suggests a stronger inclination towards non-pharmacological treatment, defying current assumptions that patients prefer 'quick-fixes' for managing insomnia.
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