Abstract
Background
Most patients with bowel dysfunction secondary to neurological illness are managed by a range of nonsurgical methods, including dietary changes, laxatives, and suppository use to transanal irrigation (TAI). The aim of the present study was to explore individuals’ preferences regarding TAI devices and furthermore investigate willingness to pay (WTP) for attributes in devices in the UK.
Methods
A discrete choice experiment survey was conducted to evaluate the patients’ perceived value of TAI devices. Attributes were selected based upon a literature review and input from clinicians. Interviews were conducted with three clinicians and the survey was developed and finalized with the input from both patients and professionals. The final attributes were “risk of urinary tract infections” (UTIs), “risk of fecal incontinence” (FI), “frequency of use”, “time spent on toilet”, “ease of use”, “level of control/independence”, and “cost”. Participants were recruited by a patient panel of TAI device users in the UK. Data were analyzed using the conditional logit model whereby the coefficients obtained from the model provided an estimate of the (log) odds ratios (ORs) of preference for attributes. WTP was also estimated for each attribute.
Results
A total of 129 participants were included in the final analyses. Sixty two percent of the participants had suffered from three UTIs in the preceding year and 58% of patients reported currently experiencing FI using their current device. All attributes were significant predictors of choice. The most important attributes for participants were the “risk of FI”, “frequency of use”, and “risk of UTIs”.
Conclusion
Participants with bowel dysfunction regarded “risk of FI”, “frequency of use”, and “avoiding UTIs” as the most important features of a TAI device. These preferences are valuable in informing decision makers and clinicians regarding different bowel management solutions as well as for development of future devices.
Acknowledgments
This study was supported by research funding from Coloplast A/S to ICON plc. However, no restrictions were placed on the design of the study, the choice of included data sources, the presentation of results, or the content of the final manuscript. Frederikke Bruun Andersen and Zenia M Størling contributed with data interpretation and critical scientific review of the manuscript.
Disclosure
E has participated on advisory boards for Coloplast, Hollister, and Wellspect, all of whom are developing or have developed TAI devices. BN, AJL, and RB have conducted this study on behalf of Coloplast. The authors report no other conflicts of interest in this work.