Understanding Physicians' Decision Making Process Concerning Hepatitis-C Treatment

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Summary

A wide variety of factors influence physicians’ treatment decisions for patients with hepatitis C. These include clinical factors, comorbidities, population groups, sociodemographic factors, and patient behaviour, as well as health financing and cost-effectiveness, access to care, and more.

Background

Physicians have several options to consider when deciding what treatment to provide to Hepatitis C patients, such as whether to commence or terminate a given treatment or adjust dosage, and how long the treatment should last.

GlaxoSmithKline was interested in understanding what factors influence these decisions, including clinical, social, behavioural, and demographic factors as well as those related to the physician experience, or the health and social care systems more broadly (e.g. regulation, financing).

Goals

RAND Europe and Baird's CMC conducted a study with a multi-methodology approach to understand the drivers of treatment decisions in France, Spain, Italy, and the UK. It aimed to identify and distinguish between drivers associated with: a) individual behaviour and cultural factors; b) differences in health system functioning; and c) present and future contexts..

Methodology

The research team sought more specifically to investigate the comparative influence and importance of specific factors and combinations of factors, and the trade-offs implicated in the decision-making process through two discrete choice experiments embedded in a physician survey.

Aspects of the research study included the following tasks:

  1. A literature review to capture and review published 'codified' knowledge
  2. Key informant interviews to capture policy, clinical practitioner, scientific and innovation insights, and patient-related knowledge on the other hand
  3. An analysis of how patients progress through different health systems once they are diagnosed
  4. Quantitative interviews with physicians including discrete choice experiments
  5. A validation and scenarios workshop to explore existing and future decision making about treatment

Findings

The team identified a wide variety of factors have a role in influencing physicians’ treatment decisions, several of which can be divided into two broad categories. The first relate to the patient’s profile and include:

  • Clinical factors, such as viral genotype and haematological abnormalities (including thrombocytopenia—TCP—and anaemia)
  • Comorbidities and related conditions, such as HIV, Hepatitis B (HBV) and depression
  • Special population groups (including injecting drug users, alcohol-dependants, prison inmates, and migrants) and age-related groups, including the elderly and children
  • Sociodemographic factors, such as administrative region, income levels, and social inclusion
  • Factors related to patient behaviour, such as issues with adherence to treatment or substance misuse

The second broad category of factors relates to health system features, which include:

  • Health financing and cost-effectiveness
  • Awareness and adherence to guidelines
  • Access to care through eligibility criteria, collaboration between healthcare professionals and the wider health system stakeholders, and access to educational interventions to improve practice and alleviate fear and discrimination.

Project Team

Peter Burge
Catriona Manville
Celine Miani
Joanna Chataway
Sonja Marjanovic

Read the full study