Open Access Open Badges Research article

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

Mickaël Hiligsmann1*, Benedict G Dellaert2, Carmen D Dirksen3, Trudy van der Weijden4, Stefan Goemaere5, Jean-Yves Reginster6, Verity Watson7 and Annelies Boonen8

Author Affiliations

1 Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands

2 Department of Business Economics, Erasmus Rotterdam University, Rotterdam, the Netherlands

3 Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, the Netherlands

4 Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands

5 Department of Rheumatology and Endocrinology, Ghent University Hospital, Gent, Belgium

6 Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium

7 Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK

8 Department of Internal Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands

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Arthritis Research & Therapy 2014, 16:R36  doi:10.1186/ar4465

Published: 31 January 2014



The patient’s perspective is becoming increasingly important in clinical and policy decisions. In this study, we aimed to evaluate the preferences of patients with, or at risk of, osteoporosis for medication attributes, and to establish how patients trade between these attributes.


A discrete choice experiment survey was designed and patients were asked to choose between two hypothetical unlabelled drug treatments (and an opt-out option) that vary in five attributes: efficacy in reducing the risk of fracture, type of potential common side-effects, mode and frequency of administration and out-of-pocket costs. An efficient experimental design was used to construct the treatment option choice sets and a mixed logit panel data model was used to estimate patients’ preferences and trade-offs between attributes.


A total of 257 patients with, or at risk of, osteoporosis completed the experiment. As expected, patients preferred treatment with higher effectiveness and lower cost. They also preferred either an oral monthly tablet or 6-month subcutaneous injection above weekly oral tablets, 3-month subcutaneous, 3-month intravenous or yearly intravenous injections. Patients disliked being at risk of gastro-intestinal disorders more than being at risk of skin reactions and flu-like symptoms. There was significant variation in preferences across the sample for all attributes except subcutaneous injection.


This study revealed that osteoporotic patients preferred 6-month subcutaneous injection and oral monthly tablet, and disliked gastro-intestinal disorders. Moreover, patients were willing to pay a personal contribution or to trade treatment efficacy for better levels of other attributes. Preferences for treatment attributes varied across patients and this highlights the importance of clinical decision-making taking individual preferences into account to improve osteoporosis care.