Stated Preferences of At-Risk Populations for the Treatment of Osteoporosis: A Systematic Review

Poor adherence to anti-osteoporosis treatment is a well-recognized problem, partly due to misalignment with patient preferences. In recent years, several quantitative preference studies have been conducted. This study aimed to systematically review stated preference research to provide a comprehensive overview of patient preferences in osteoporosis, in particular on conditional relative attribute importance and preference heterogeneity.

This systematic review was conducted in MEDLINE and Embase up to February 29th, 2024. It includes all English-language, peer-reviewed, stated preference articles related to osteoporosis management and treatment in patients with or at risk of osteoporosis. Conditional relative importance of attributes as well as heterogeneity was assessed, and attributes classified into outcome, process, and cost attributes. Quality assessment was performed using a combined checklist of Purpose, Respondents, Explanation, Findings, and Significance (PREFS) and International Society for Pharmacoeconomics and Outcomes Research (ISPOR) items.

Fourteen studies including 4714 participants were evaluated. Attributes were mostly classified as process related (50%) and outcome related (40%), both of which significantly influence patient preferences. In pairwise attribute comparison, efficacy was dominant over cost, administration, and side-effects. Preference heterogeneity was observed in the majority of studies (86%). Quality assessment indicated an overall improvement in study quality over time, with recent studies adhering more closely to established methodological standards.

The findings highlight the importance of considering patient preferences in the management of osteoporosis, underscoring the need for a patient-centered approach. The readiness of patients to engage in trade-offs between attributes suggests that healthcare providers should ensure treatments are aligned with individual patient preferences to improve adherence and optimize outcomes.