Patient Preferences for Low Back Pain Treatments in Iran: A Discrete Choice Experiment

Low back pain (LBP) is a leading cause of disability worldwide, especially in LMICs like Iran, yet patient preferences for treatment remain unquantified, hindering patient-centered care. This study aimed to investigate and quantify Iranian patients' preferences for LBP treatment attributes using a discrete choice experiment (DCE).

A cross-sectional DCE was conducted involving 331 adult patients in Kermanshah city, western Iran, between July and December 2024. The treatment attributes include pain reduction, risk of recurrence, treatment cost, time required for recovery, and type of treatment. A total of 24 treatment choice sets were developed using a D-efficient design and divided into four blocks. Patient preferences were analyzed using conditional and mixed logit regression models.

The study population (N=331) had a mean age of 38.51 years and was 51.06% female. The conditional logit model identified pain reduction as the most influential attribute affecting patient preferences (coefficient = 0.836; 95% Confidence Interval(CI): 0.629 1.042; P< 0.001). A significant preference was observed for non-surgical treatments (coefficient = 0.665; 95% CI: 0.561-0.767; P < 0.001), while higher treatment costs, particularly those exceeding 500 million IRR, were negatively associated with choice (coefficient = -0.751; 95% CI:-0.905 -0.595; P <0.001). The mixed logit model revealed significant heterogeneity in preferences, especially for pain reduction (Standard Deviation(SD) up to 1.352; 95% CI: 0.634 -2.071; P< 0.001), treatment type (SD = 1.827; 95% CI: 1.296-2.358;P< 0.001), and high treatment costs (SD = 1.477; 95% CI: 0.928-2.025; P< 0.001), indicating diverse patient valuations. In contrast, risk of recurrence and recovery time showed less variability across individuals.

This study showed strong preferences for pain reduction, affordability, and non-surgical treatments. Significant heterogeneity highlights diverse patient values and the need for individualized, patient-centered care. These findings inform clinical practice and health policy, supporting shared decision-making and improved access to effective, affordable, and non-invasive treatment options in low- and middle-income settings.