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Research Questions

  1. What are the nexus of factors physicians consider — e.g., clinical, social and behavioural, demographic, physician–experience-related, health and social care systems, regulatory, and policy — when making HCV treatment decisions?
  2. What are the comparative influence and importance of specific factors and combinations of factors and the trade-offs implicated in the decisionmaking process?
  3. How much does thrombocytopenia impact on treatment decisions and how does it impacts treatment (e.g., its influence on decisions to begin or terminate treatment or adjust dosage and duration of treatment)?

This study aimed to inform Hepatitis C (HCV) treatment by (1) better understanding the nexus of factors physicians consider when making HCV treatment decisions; (2) investigating the comparative influence and importance of specific factors and the trade-offs implicated in the decisionmaking process; and (3) examining how much thrombocytopenia impacts treatment decisions and how it impacts treatment.

To meet this goal, we conducted five analyses, focusing on four European countries characterised by different approaches to healthcare organisation and financing, which alongside cultural differences may have potential implications for treatment pathways for patients with HCV infection. These were: France, Italy, Spain, and the United Kingdom. These analysis included:

  1. Review the academic literature and of relevant national and European guidelines;
  2. Conduct key informant interviews (KIIs) with national experts to contextualise the data from the literature review and further explore some emerging themes;
  3. Map the patient journey in the four countries to identify stages HCV patients pass through once they have entered the healthcare system and map, for each stage, potential points of departure from the typical journey;
  4. Design and conduct of Discrete Choice Experiments (DCEs) to quantitatively assess the importance of factors that influence treatment decisions;
  5. Conduct expert workshop to help build scenarios identifying challenges to HCV treatment.

The five analyses build on one another, with the first three providing evidence that fed into the design of the DCEs and with the DCE results in turn serving as the key inputs into building the scenarios for the expert workshop.

Table of Contents

  • Chapter One


  • Chapter Two

    Our methodological approach

  • Chapter Three

    Literature review identifying the diversity of factors influencing treatment decisions

  • Chapter Four

    Key informant interviews identifying and understanding the factors influencing treatment decisions

  • Chapter Five

    Mapping patients' journeys for HCV treatment

  • Chapter Six

    Using discrete choice experiments to quantify physicians' treatment decisions

  • Chapter Seven

    Using scenario building to explore future potential situations

  • Chapter Eight


  • Appendix A

    Literature review search strategy

  • Appendix B

    Internal key informant interview guide (for interviewer)

  • Appendix C

    Profile of interviewees

  • Appendix D

    Workshop agenda

  • Appendix E

    Full discrete choice experiment questionnaire

Research conducted by

The research described in this report was conducted by RAND Europe.

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