WHAT IS THE IMPACT OF DESCRIBING TREATMENTS AS 'NEW'?

Purpose:

Using an example of a new drug for rheumatoid arthritis which offers comparable effectiveness and side-effect point estimates to older drugs, we explore preferences for treatments labelled ‘new’. We then examine the persistence of preferences once ambiguity in the evidence base due to it being new is introduced.

Method:

We randomized a representative sample of the Canadian general population to one of three discrete choice experiment (DCE) designs which sought choices between hypothetical treatments for rheumatoid arthritis based on different levels of 7 attributes: route and frequency of administration, chance of benefit, serious and minor side-effects and life expectancy, and uncertainty in benefit and side-effect estimates. The DCEs differed in whether the treatment was 1) described as new (recently available) or older (available 5 or 10 years), 2) whether a qualitative description describing the confidence in the evidence was included instead, or 3) both the length of time available and confidence in evidence was provided. We collected characteristics of respondents including the self-reported Innovativeness scale, Subjective Numeracy Scale, and Health Risk Attitude scale.

Result:

2837 people responded to the survey. Overall, all 6 consistent attributes (route and frequency of administration, chance of benefit, serious and minor side-effects and life expectancy) influenced preferences for treatment. An overall significant preference for less ambiguity (more confidence) in benefit and side-effect estimates was observed, but there was no preference for a treatment labelled ‘new’ or ‘old’. However, in a subgroup analysis, early adopters (n=173) had a significant preference for ‘newer’ treatments relative to old treatments (B=0.157, p=0.045), preferences comparable in magnitude to preferences for reducing the risk of (rare) serious side-effects in this group. While early adopters valued reducing ambiguity in the evidence base consistently with later adopters, when the newness of the drug was combined with ambiguity in the evidence base, preferences for ‘new’ treatments diminished.

Conclusion:

Preferences for innovation in health care appear to exist for some potential groups of patients. However, when presented with the implications of new treatments, namely increased ambiguity in the evidence base, these preferences diminished. When communicating with patients, physicians should either avoid describing whether treatments are ‘new’, or be mindful to qualify the implications of a ‘new’ treatment in terms of ambiguity in estimates of risks and benefits.