A discrete choice experiment to explore patients' willingness to risk disease relapse from treatment withdrawal in psoriatic arthritis

Preferences for biologic treatment in patients with psoriatic arthritis: a discrete choice experiment

OBJECTIVES

We aimed to assess patient preferences for the characteristics and outcomes of biologic and targeted synthetic DMARDs to manage psoriatic arthritis.

METHODS

We conducted a discrete choice experiment in patients with psoriatic arthritis from three rheumatology centers in Sydney, Australia. We assessed preferences for different attributes of biologic medications. The route and frequency of medications had a range of five levels and the following seven attributes had a range of three levels: the ability to attend to normal activities, improvements in joint pain, enthesitis and skin disease, chance of disease remission, risk of infection and risk of severe adverse events. Multinomial logit models including a latent class model were used to calculate preferences.

RESULTS

Of the 150 participants, 58.3% were female, with a median age of 53.5 years. The attributes in order of preference were (β coefficient in absolute values, 95% confidence interval): oral route compared to subcutaneous and intravenous routes (β coefficient 1.00, fixed-parameter), avoiding severe side effects (0.72, 0.50 to 0.95), increasing ability to attend to normal activities (0.66, 0.36 to 0.96), avoiding infections (0.38, 0.23 to 0.53), improvement in enthesitis pain (0.28, 0.20 to 0.36), improvement in psoriasis (0.28, CI 0.20 to 0.36), increasing chance of remission (0.27, 0.19 to 0.36) and improvement in joint pain (0.26, 0.00 to 0.52).

CONCLUSION

When choosing biologic medications, patients with psoriatic arthritis preferred oral medications. Patients prioritized avoiding severe complications, maintaining the ability to attend to work and normal activities and avoiding infection over clinical measures of efficacy.

Impact of clinical and demographic characteristics on patient preferences for psoriasis treatment features: Results from a discrete-choice experiment in a multicountry study

OBJECTIVES

This study aimed to elicit preferences for psoriasis treatment features and to test for preference heterogeneity across groups of respondents.

MATERIALS AND METHODS

A discrete-choice experiment was employed to elicit preferences of patients with plaque psoriasis in multiple countries. The survey instrument included a series of choice questions between three hypothetical treatments, each characterized by varying levels of six attributes (namely, lesion reduction, risk of impairing side effects, time to reach results, mode and frequency of administration, itching reduction, and side effects). Random parameters logit was used to model the data. Results were compared across a total of 18 subgroup sets.

RESULTS

The data analysis from 1,123 respondents showed that, on average, respondents receive more utility gain from higher levels of lesion reduction and lower risks of impairing side effects than changes in other attributes included in the study. Systematic differences were detected for 13 sets; the most pronounced differences were observed based on disease severity, nail psoriasis, biologic experience, and quality-of-life scores.

CONCLUSION

These many sources of preference heterogeneity identified by our analysis suggest that to improve patient satisfaction and, probably, adherence and persistence, clinicians should discuss options with patients when prescribing their treatment.

The importance of understanding patient and physician preferences for psoriasis treatment characteristics: a systematic review of discrete-choice experiments

Introduction: Treatment adherence continues to be a major challenge in psoriasis. Patient preference studies, especially discrete-choice experiments, are gaining popularity to gather insights into patient reported treatment outcomes. This systematic literature review aimed to critically assess all discrete choice experiments exploring patients' and physicians' preferences for psoriasis treatment characteristics.Methods: PubMed and EMBASE databases were searched using keywords "psoriasis" and "preferences" to identify relevant literature. Discrete-choice experiments conducted in French or English from the year 2000 onwards, that focused on evaluating psoriasis treatment preferences in patients and/or physicians, were included. The relative importance of treatment attributes was assessed and studies were critically appraised using validated checklists.Results: Out of 987 articles identified, 25 articles fulfilled the inclusion criteria. Overall, patients and physicians prioritize efficacy-specific outcomes. Patients are shown to place greater importance to process attributes when compared to physicians, especially route and location of administration. Physicians focus primarily of efficacy attributes, however when the top two attributes are considered, safety outcomes increasingly become considered important. Of the studies, 60% conducted subgroup analysis, of which many reported associations between specific patient characteristics and preferences. Factors such as age, disease severity, and duration of condition significantly affected preferences for treatment attributes.Conclusions: This review provides insight into the types of attributes that patients and physicians value most, and therefore can help improve shared decision-making. The findings of this study also encourage regulatory agencies to continue integrating patient preferences in their decision-making.

Tapering biologic therapy for people with rheumatoid arthritis in remission: A review of patient perspectives and associated clinical evidence

OBJECTIVES

Biologic therapies have increased the control of disease activity in rheumatoid arthritis (RA). Questions remain about tapering biologics when remission is achieved in RA. The patient perspective has to be incorporated in pragmatic applications of tapering but is rarely accounted for in clinical studies of tapering. The aim of the present review was to summarize the evidence about RA patient perspectives on biologic tapering.

METHODS

We provided a narrative summary of the currently small body of research on patient perspectives retrieved through systematic searches with an emphasis on seeking qualitative research. In addition, we provided an update on relevant clinical research and financial considerations that frame the findings on patient perspectives.

RESULTS

Financial considerations around commencing/continuing on biologic therapies in RA vary internationally and have implications for patient perspectives. Recent clinical studies indicate that the benefit of tapering biologic therapy when in remission are predicted by drug concentration and aspects of disease activity, severity and duration. Three major concerns have been identified from studies of patient perspectives on biologic tapering: (a) disease relapse; (b) access to treatment in the case of disease flare when tapering; and (c) local motivation for dose reduction (i.e., driven by funding or health benefit).

CONCLUSIONS

More research is needed on tapering biologics, and should include studies of patient perspectives as well as health economic evaluations. Patient decision aids are a potential way of applying clinical and patient-focused evidence to help all parties come to a decision, but require developmental research and pragmatic evaluation.

Practical guidance for engaging patients in health research, treatment guidelines and regulatory processes: results of an expert group meeting organized by the World Health Organization (WHO) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)

There is increasing emphasis on patient-centred research to support the development, approval and reimbursement of health interventions that best meet patients' needs. However, there is currently little guidance on how meaningful patient engagement may be achieved. An expert working group, representing a wide range of stakeholders and disciplines, was convened by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the World Health Organization (WHO). Through a structured, collaborative process the group generated practical guidance to facilitate optimal patient engagement in clinical development and regulatory decisions. Patient engagement is a relational process. The principles outlined in this report were based on lessons learned through applied experience and on an extensive dialogue among the expert participants. This practice guidance forms a starting point from which tailoring of the approach to suit different chronic diseases may be undertaken.

Patients', physicians', nurses', and pharmacists' preferences on the characteristics of biologic agents used in the treatment of rheumatic diseases

OBJECTIVE

To estimate preferences in relevant treatment characteristics evaluated by different groups involved in the management of patients with rheumatic diseases.

SUBJECTS AND METHODS

We surveyed patients with rheumatic diseases, and rheumatologists, nurses, and pharmacists with experience in treatment with/provision of biologic drugs for these patients. Through a discrete choice experiment, participants evaluated 16 possible scenarios in which pairs of similarly efficacious treatments were described with six characteristics: 1) frequency of administration; 2) mode and place of administration; 3) manner, helpfulness, efficiency, and courtesy of health personnel; 4) frequency of reactions at the site of drug administration; 5) severity of generalized undesired/allergic reactions; and 6) additional cost. The direction and strength of preferences toward each characteristic level and the relative importance of each characteristic were estimated through a random-effects conditional logistic regression model.

RESULTS

In total, 513 patients, 110 rheumatologists, 51 nurses, and 46 pharmacists from 30 centers in Italy participated. Characteristics 3, 4, and 6 were the most important for every subgroup; 1 was least important for patients and rheumatologists, 2 was least important for pharmacists, and 2 and 5 were least important for nurses. For characteristic 2, pharmacists preferred subcutaneous self-injection with a syringe; nurses preferred assisted infusion at an infusion center close to the patient's home; patients and rheumatologists preferred subcutaneous self-injection with a pen.

CONCLUSION

The different preferences for some characteristics shown by the different groups can play an important role, together with purely clinical aspects, in the choice and consequent benefit of treatments, contributing also to a more satisfactory use of resources.

Patient-reported outcomes in European spondyloarthritis patients: a systematic review of the literature

OBJECTIVE

This review aims to summarize the current literature on patient-reported outcomes (PROs) in spondyloarthritis (SpA).

PATIENTS AND METHODS

We performed a systematic literature review to identify studies (original articles and narrative and systematic reviews) regarding PROs (health-related quality of life [HRQoL], satisfaction, preferences, adherence/compliance, and persistence) in SpA patients published in the European Union through December 2016. International databases (Medline/PubMed, Cochrane Library, ISI Web of Knowledge, Scopus) were searched using keywords in English. The methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine criteria.

RESULTS

A total of 26 publications met the inclusion criteria. Generally, studies indicated that SpA has a negative impact on patients' HRQoL. In patients with ankylosing spondylitis, physical domains were more affected than emotional ones, whereas for psoriatic arthritis, both physical and psychological factors were strongly affected by the disease. Data indicated that biological agents (BAs) greatly contributed to improvement in HRQoL in both ankylosing spondylitis and psoriatic arthritis patients. Findings on compliance with BAs were heterogeneous. However, persistence rates exceeded 50% irrespective of the BA administered. Results on preferences indicated that most SpA patients prefer being involved in decisions regarding their treatment and that besides efficacy and safety, frequency and route of administration may influence patients' preferences for BAs.

CONCLUSION

Implementing management programs for SpA patients focuses on the physical, emotional, and social consequences of the disease, in addition to assessing and including patient preferences in the treatment decision-making process, could be crucial to improve patients' HRQoL and ensure their satisfaction and compliance with treatment.