Physicians' preferences for direct-acting antivirals in the treatment of chronic hepatitis C: evidence from a discrete choice experiment in China.

Abstract

Background: Chronic hepatitis C (CHC) remains a major public health challenge in China. Currently, direct-acting antivirals (DAAs) are the mainstay of clinical treatment. This study employed a discrete choice experiment (DCE) to investigate physicians' preferences regarding DAAs for the treatment of CHC.

Methods: A DCE was designed based on the Chinese Guideline for Comprehensive Clinical Evaluation of Drugs and relevant literature, incorporating seven core attributes: safety, efficacy, economy, innovativeness, appropriateness, accessibility, and affordability. Fourteen choice sets were constructed. Physicians' preferences were analyzed using conditional logit models, from which willingness-to-pay (WTP) and relative importance of attributes were derived. Latent class analysis (LCA) was further applied to explore heterogeneity in physicians' preferences.

Results: Data were collected from 159 hospitals across 27 provinces in China, with 185 valid questionnaires included. Efficacy emerged as the most important determinant of prescribing preference, followed by affordability and economy, then accessibility, safety, and appropriateness, while innovativeness was not a significant concern. The LCA identified three distinct latent classes, which were significantly associated with demographic variables.

Conclusions: In China's healthcare setting, beyond the central importance of efficacy, physicians also place great emphasis on affordability and economic value, with marked heterogeneity in preferences depending on background characteristics.