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AbstractObjectives To assess preferences and willingness to pay (WTP) for maintenance inhaler attributes among chronic obstructive pulmonary disease (COPD) patients in Thailand. Methods A discrete choice experiment was conducted among 543 COPD patients attending COPD outpatient clinics. Five attributes were assessed: likelihood of medication-use error, number of maintenance inhalers, dosing frequency, inspiratory effort, and out-of-pocket cost. Preferences and WTP were estimated using a mixed logit model, and preference heterogeneity was explored using a latent class model. Predicted relative choice probabilities were calculated to examine relative uptake by comparing a once-daily single inhaler across cost levels with a 0-cost, twice-daily 2-inhaler reference. Results A total of 541 participants (99. 6%) passed the dominance test and were included. All 5 attributes significantly influenced inhaler choices. Monthly out-of-pocket cost was the most influential attribute (relative importance, 40. 3%), followed by number of maintenance inhalers (24. 3%) and likelihood of medication-use error (23. 6%). Reducing maintenance inhalers from 3 to 1 and medication-use errors from frequent to none translated into the highest WTP values of US29. 34 and US28. 53 per month, respectively. The largest preference segment (47. 1%) was identified as a "cost-sensitive" class, in which 79. 6% of participants selected the 0-cost option whenever available. Predicted relative choice probability declined sharply when the monthly out-of-pocket cost exceeded US20. Conclusions Thai patients with COPD value regimen simplification and medication-use error reduction but remain sensitive to out-of-pocket costs. Reimbursement policies that support both simplified regimens and improved inhaler usability, together with financial protection, may align access policies with patient-valued treatment attributes.
Kuagoolsirirot et al. (Fri,) studied this question.