BMJ  2004;328:382 (14 February), doi:10.1136/bmj.37972.497234.44 (published 29 January 2004)

Paper

Patients' preferences for the management of non-metastatic prostate cancer: discrete choice experiment

Mark Sculpher, professor1, Stirling Bryan, professor2, Pat Fry, research fellow3, Patricia de Winter, research nurse3, Heather Payne, consultant in clinical oncology4, Mark Emberton, senior lecturer3

1 Centre for Health Economics, University of York, Heslington, York YO10 5DD, 2 Health Economics Facility, Health Services Management Centre, University of Birmingham, Birmingham B15 2RT, 3 Institute of Urology, Royal Free and University College Medical School, London W1P 7PN, 4 Meyerstein Institute of Oncology, Middlesex Hospital, London W1T 3AA

Correspondence: M Sculpher mjs23{at}york.ac.uk

Objective To establish which attributes of conservative treatments for prostate cancer are most important to men.

Design Discrete choice experiment.

Setting Two London hospitals.

Participants 129 men with non-metastatic prostate cancer, mean age 70 years; 69 of 118 (58%) with T stage 1 or 2 cancer at diagnosis.

Main outcome measures Men's preferences for, and trade-offs between, the attributes of diarrhoea, hot flushes, ability to maintain an erection, breast swelling or tenderness, physical energy, sex drive, life expectancy, and out of pocket expenses.

Results The men's responses to changes in attributes were all statistically significant. When asked to assume a starting life expectancy of five years, the men were willing to make trade-offs between life expectancy and side effects. On average, they were most willing to give up life expectancy to avoid limitations in physical energy (mean three months) and least willing to trade life expectancy to avoid hot flushes (mean 0.6 months to move from a moderate to mild level or from mild to none).

Conclusions Men with prostate cancer are willing to participate in a relatively complex exercise that weighs up the advantages and disadvantages of various conservative treatments for their condition. They were willing to trade off some life expectancy to be relieved of the burden of troublesome side effects such as limitations in physical energy.


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