COPD-treating nurses' preferences for inhaler attributes - a discrete choice experiment.

OBJECTIVE: To assess nurses' preferences for various attributes of chronic obstructive pulmonary disease (COPD) inhalation devices in order to obtain information about the relative importance of the different attributes and their assigned levels. METHODS: Data from a web-based questionnaire among Danish nurses who treat patients with COPD (accomplished in the spring/summer of 2015) was used. A total of 222 nurses completed the questionnaire which was based on discrete choice experiment (DCE) methodology. The probability of choosing an alternative from a number of choices in a discrete choice game was estimated by means of the conditional logit model. RESULTS: The two most important attributes according to the COPD-treating nurses were "Indicator when empty" and "Inspiratory flow rate". In addition, the nurses considered the attribute "Obvious that dose is given" important. The three least-valued attributes were frequency of doses, whether the inhaler requires fine motor skills and whether it requires hand strength. CONCLUSION: Inhalation devices can be classified into five categories, where the soft mist inhaler (SMI) includes the three most important attributes among its characteristics. LIMITATIONS: The study sample size does not allow for subgroup analysis, which would have been valuable. The questionnaire design gives an indication of nurses' preferences and it is assumed that these are similar to real life choices, but the current study cannot conclude on the nurses' actual choices.

Is dabigatran considered a cost-effective alternative to warfarin treatment: a review of current economic evaluations worldwide.

OBJECTIVE: Dabigatran was the first of a new generation of anticoagulation drugs for the indication of non-valvular atrial fibrillation (AF) to be approved. Evidence show that dabigatran 150 mg twice daily significantly reduces the risk of stroke and systemic embolism (RR = 0.65; p < 0.001) and shows a comparable rate of major bleedings (RR = 0.93; p = 0.32), whereas dabigatran 110 mg twice daily was associated with a comparable rate of stroke and systemic embolism (RR = 0.90; p = 0.30) and a significantly lower rate of major bleedings compared to warfarin treatment (RR = 0.80; p = 0.003). The purpose is to review current economic evaluations of these alternatives for healthcare professionals to include these findings in their decision-making. METHODS: A systematic literature search identified 43 economic evaluations, of which 10 were included and evaluated according to the Consensus Health Economic Criteria list (CHEC-list) and the Oxford model. RESULTS: Six economic evaluations concluded that dabigatran was a cost-effective alternative to warfarin. One evaluation concluded the same except when quality in warfarin treatment was excellent, with a mean time in therapeutic range (TTR) > 73%. Three evaluations concluded that dabigatran was a cost-effective alternative to warfarin in patient sub-groups; TTR ≤ 64%, congestive heart failure, hypertension, age ≥ 75, diabetes mellitus, prior stroke or transient ischemic attack (CHADS2 score) ≥3, or a CHADS2 score = 2 unless international normalized ratio (INR) control was excellent, and with high risk of stroke or in a low-quality warfarin treatment. Dabigatran 110 mg twice daily was in general dominated by dabigatran 150 mg twice daily. LIMITATIONS: The evaluations were not fully homogeneous, as some did not include loss of productivity, costs of dyspepsia, and annual costs of dabigatran patient management. CONCLUSIONS: In the majority of the economic evaluations, dabigatran is a cost-effective alternative to warfarin treatment. In some evaluations dabigatran is only cost-effective in sub-groups, such as patients with a low TTR-value in warfarin treatment and a CHADS2 score ≥2.