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Rojas JI, Carnero Contentti E, Alonso R, Tavolini D, Burgos M, Federico B, Patrucco L, Cristiano E. Burden of treatment and quality of life in relapsing remitting multiple sclerosis patients under early high efficacy therapy in Argentina: Data from the Argentinean registry. Mult Scler Relat Disord 2024; 85:105543. [PMID: 38520948 DOI: 10.1016/j.msard.2024.105543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/25/2024]
Abstract
The objective of this study was to describe and compare the burden of treatment (BOT) and the quality of life (QoL) in early high efficacy therapy (HET) vs. escalation therapy in relapsing remitting multiple sclerosis (RRMS) patients included in RelevarEM, the Argentinean registry of MS (RelevarEM, NCT 03,375,177). METHODS cross sectional study conducted between September and December 2022. Participating patients were adults, RRMS patients who initiated (during the last three years) their treatment with a HET (natalizumab, ocrelizumab, alemtuzumab, cladribine) or with escalation treatment (beta interferon, glatiramer acetate, teriflunomide, dimethyl fumarate or fingolimod). Clinical and demographic aspect were collected. QoL and BOT was measured with the validated to Spanish MusiQol and BOT questionnaire. Propensity score (PS)-based nearest-neighbor matching was applied to homogenize groups. Comparisons were be done using a linear regression analysis model stratified by matched pairs, with BOT and QoL assessments as main outcomes. RESULTS 269 patients were included in the analysis, mean age 33.7 ± 5.7 years, 193 (71.7 %) were female. A total of 136 patients were on early HET while 133 were on escalation therapy. In the entire group the mean total BOT score (±SD) was 48.5 ± 15.3 while in the group of patients receiving early HET we observed that the mean BOT score (±SD) was 43.5 ± 12.2 vs. 54.3 ± 13.3 in escalation treatment (p < 0.0001). Regarding the score QoL (±SD), in the entire sample we observed a global score of 77.4 ± 11.2. When we stratified groups, in HET (±SD) it was 81.3 ± 14 vs. 74.1 ± 18.3 in escalation therapy (p = 0.0003). CONCLUSION in this multicenter study that included 269 patients from Argentina we observed in early HET a significantly lower BOT and higher QoL than patients receiving escalation therapy.
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Affiliation(s)
- Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Billinghurst 1611, Buenos Aires CP 1181, Argentina.
| | - Edgar Carnero Contentti
- Unidad de Neuroinmunología, Servicio de Neurología, Hospital Alemán de Buenos Aires, Argentina
| | - Ricardo Alonso
- Hospital Ramos Mejía, Buenos Aires, Argentina; Fundación Sanatorio Güemes, Buenos Aires, Argentina
| | | | | | | | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Billinghurst 1611, Buenos Aires CP 1181, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Billinghurst 1611, Buenos Aires CP 1181, Argentina
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Bandari D, Adamson M, Bowman M, Gutierrez A, Athavale A, Oak B, Hadker N, Branco F, Geremakis C, Lewin JB, Shankar SL. Real-world treatment preferences among health care providers in the United States in selecting disease modifying therapies for patients with multiple sclerosis: a discrete choice experiment. J Med Econ 2023; 26:1507-1518. [PMID: 37934412 DOI: 10.1080/13696998.2023.2279883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
AIMS Health care providers (HCPs) treating multiple sclerosis (MS) in clinical practice have numerous disease-modifying therapies (DMTs) to consider when evaluating treatment options. This study assessed the treatment preferences of HCPs in the United States, both direct (explicit) and derived (explicit and implicit), when selecting MS DMTs based on clinical and logistical treatment attributes. MATERIALS AND METHODS A 45-minute web-enabled questionnaire was administered to HCPs who manage patients with MS to assess the importance of treatment attributes. HCPs were recruited through an online panel. This study examined treatment attributes relevant to treatment decisions in MS, with a focus on the burden to HCPs and their staff, as well as HCP attitudes toward various aspects of MS care such as diagnosis, treatment prioritization, and ease of initiating or switching DMTs. The study also employed a discrete choice experiment (DCE) to assess direct and derived treatment preferences. RESULTS The study recruited 145 HCPs. Direct assessments (a score of greater than 7.0 was considered important) suggested that safety (mean importance rating = 7.8/9) and relative risk reduction in relapses (7.6/9) and disability progression (7.5/9) were most important when selecting DMTs. In contrast, derived importance from the DCE (higher points corresponding to greater importance) suggested that logistical attributes such as dose frequency (mean relative attribute importance = 17.5%), dose titration (10.3%), formulation (9.4%), and volume of calls (9.1%) were important considerations, along with efficacy (16.5%), safety (9.8%), and gastrointestinal tolerability (9.4%). LIMITATIONS This study may have been subject to selection bias due to the application of eligibility criteria, the convenient sampling recruitment methodology, and recruitment of HCPs with internet access. CONCLUSION In the direct assessment, clinical attributes were chosen as the most important treatment attributes by HCPs. However, in the DCE, derived treatment decisions rated logistical attributes as also being as important in treatment choice.
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Affiliation(s)
- Daniel Bandari
- Multiple Sclerosis Center of California & Research Group, Laguna Hills, CA, USA
| | | | | | - Amparo Gutierrez
- Orlando Health Multiple Sclerosis Comprehensive Care Center, Orlando, FL, USA
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Rojas JI, Patrucco L, Alonso R, Lopez PA, Deri N, Pettinicchi JP, Cristiano E, Carnero Contentti E. Preferences for Disease-Modifying Therapies in Argentina: Cross-Sectional Conjoint Analysis of Patients and Neurologist. Value Health Reg Issues 2022; 31:93-100. [DOI: 10.1016/j.vhri.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 03/11/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
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Masri HE, McGuire TM, Dalais C, van Driel M, Benham H, Hollingworth SA. Patient-based benefit-risk assessment of medicines: development, refinement, and validation of a content search strategy to retrieve relevant studies. J Med Libr Assoc 2022; 110:185-204. [PMID: 35440905 PMCID: PMC9014953 DOI: 10.5195/jmla.2022.1306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Introduction: Poor indexing and inconsistent use of terms and keywords may prevent efficient retrieval of studies on the patient-based benefit-risk assessment (BRA) of medicines. We aimed to develop and validate an objectively derived content search strategy containing generic search terms that can be adapted for any search for evidence on patient-based BRA of medicines for any therapeutic area. Methods: We used a robust multistep process to develop and validate the content search strategy: (1) we developed a bank of search terms derived from screening studies on patient-based BRA of medicines in various therapeutic areas, (2) we refined the proposed content search strategy through an iterative process of testing sensitivity and precision of search terms, and (3) we validated the final search strategy in PubMed by firstly using multiple sclerosis as a case condition and secondly computing its relative performance versus a published systematic review on patient-based BRA of medicines in rheumatoid arthritis. Results: We conceptualized a final search strategy to retrieve studies on patient-based BRA containing generic search terms grouped into two domains, namely the patient and the BRA of medicines (sensitivity 84%, specificity 99.4%, precision 20.7%). The relative performance of the content search strategy was 85.7% compared with a search from a published systematic review of patient preferences in the treatment of rheumatoid arthritis. We also developed a more extended filter, with a relative performance of 93.3% when compared with a search from a published systematic review of patient preferences in lung cancer.
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Affiliation(s)
- Hiba El Masri
- , PhD Candidate, School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| | - Treasure M McGuire
- , Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia, Mater Pharmacy, Mater Health, Raymond Tce, South Brisbane, QLD, Australia
| | - Christine Dalais
- , University Library, The University of Queensland, Brisbane, QLD, Australia
| | - Mieke van Driel
- , Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Helen Benham
- , Department of Rheumatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Preventive Drugs for Huntington’s Disease: A Choice-Based Conjoint Survey of Patient Preferences. J Clin Transl Sci 2022; 6:e35. [PMID: 35433035 PMCID: PMC9003635 DOI: 10.1017/cts.2022.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: This research examined the perspective of the Huntington’s disease (HD) community regarding the use of predictive biomarkers as endpoints for regulatory approval of therapeutics to prevent or delay the onset of clinical HD in asymptomatic mutation carriers. Methods: An online, choice-based conjoint survey was shared with HD community members including untested at-risk individuals, presymptomatic mutation carriers, and symptomatic individuals. Across 15 scenarios, participants chose among two proposed therapies with differing degrees of biomarker improvement and side effects or a third option of no treatment. Results: Two hundred and thirty-eight responses were received. Attributes reflecting biomarker efficacy (e.g., prevention of brain atrophy on magnetic resonance imaging, reduced mutant huntingtin, or reduced inflammation biomarkers) had 3- to 7-fold greater importance than attributes representing side effects (e.g., increased risk of heart disease, cancer, and stroke over 20 years) and were more influential in directing choice of treatments. Reduction in mutant huntingtin protein was the most valued attribute overall. Multinomial logit model simulations based on survey responses demonstrated high interest among respondents (87–99% of the population) for drugs that might prevent or delay HD solely based upon biomarker evidence, even at the risk of serious side effects. Conclusion: These results indicate a strong desire among members of the HD community for preventive therapeutics and a willingness to accept significant side effects, even before the drug has been shown to definitively delay disease onset if the drug improves biomarker evidence of HD progression. Preferences of the HD community should inform regulatory policies for approving preventive therapies.
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Health-Related Quality of Life with Diroximel Fumarate in Patients with Relapsing Forms of Multiple Sclerosis: Findings from Qualitative Research Using Patient Interviews. Adv Ther 2022; 39:3199-3213. [PMID: 35556227 PMCID: PMC9098785 DOI: 10.1007/s12325-022-02164-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/17/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Diroximel fumarate (DRF) is an oral fumarate for relapsing multiple sclerosis (MS). Clinical and real-world studies of DRF have demonstrated improved gastrointestinal (GI) tolerability and low (< 1%) GI-related treatment discontinuation versus dimethyl fumarate (DMF) and high rates of treatment adherence. Our aim was to conduct a concept elicitation study to identify treatment-related concepts most meaningful to patients and to evaluate how these concepts shape the patient perspective of DRF. METHODS In-depth qualitative interviews were conducted with patients from October to December 2020. US adults who had been prescribed DRF through routine clinical care and had taken DRF for ≥ 3 weeks in the past 6 months were eligible to participate. Semi-structured interviews explored patient perceptions on treatment selection and impact. RESULTS Seventeen patients participated in the study. Mean (SD) age was 49.3 (12.0) years. Sixteen patients reported prior disease-modifying therapy, while 10 (58.8%) had prior DMF. DRF treatment duration ranged from ~ 6 weeks to 10 months. Four key concepts emerged: (1) overall wellness and quality of life, (2) ease of administration, (3) minimal and manageable side effects, and (4) patient optimism due to MS treatments. Mode of administration (82.4%), no/mild side effects (70.6%), convenience over injectable/infusion medications (58.8%), and effectiveness (64.7%) were cited as positive aspects of DRF treatment. Frequent dosing (52.9%) and food requirements (41.2%) were cited as negative attributes; however, 94.1% had no dietary changes since starting treatment. CONCLUSION The patient perspective is a key aspect when considering a disease-modifying therapy for MS, given the multitude of options currently available. Overall wellness, ease of administration, and minimal and manageable side effects were DRF-related concepts most meaningful to patients on therapy. Acknowledging these patient perceptions in shared decision-making may lead to greater patient adherence and optimal treatment outcomes.
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Tencer T, Will O, Kumar J, Cambron-Mellott MJ, Mackie DS, Beusterien K. Patient and neurologist preferences in the UK for relapsing-remitting multiple sclerosis treatments: findings from a discrete choice experiment. Curr Med Res Opin 2021; 37:1589-1598. [PMID: 34129418 DOI: 10.1080/03007995.2021.1940911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate and compare patient and neurologist preferences for relapsing-remitting multiple sclerosis (RRMS) treatments with respect to benefits and risks associated with common and novel disease-modifying therapies, including brain volume loss (BVL). METHODS Patients with non-highly-active RRMS and neurologists in the United Kingdom completed an online cross-sectional survey. Patients completed one discrete choice experiment (DCE) exercise and providers completed two, one focusing on treatment for non-highly-active RRMS and another focused on highly active RRMS. Respondents chose between two treatment profiles that varied on seven attributes identified in qualitative research: 2 year disability progression; 1 year relapse rate; rate of BVL; and risks of gastrointestinal symptoms, flu-like symptoms, infection and life-threatening event. Bayesian modeling was used to estimate attribute-level weighted preferences. RESULTS Patients (n = 144) prioritized slowing the rate of BVL, followed by reducing risk of infection, rate of 2 year disability progression and 1 year relapse rate. For non-highly-active patients, neurologists (n = 101) prioritized slowing the rate of BVL, followed by reducing 2 year disability progression, risk of infection and 1 year relapse rate. For highly active patients, neurologists prioritized lowering the 1 year relapse rate, followed by slowing the rate of BVL and 2 year disability progression. In all three DCEs, rate of BVL was approximately twice as important as reducing the risks of flu-like symptoms, gastrointestinal symptoms and life-threatening event. CONCLUSIONS This study highlights similarities in treatment preferences for non-highly-active RRMS among patients and neurologists and differences in neurologists' preferences for treating non-highly-active vs. highly active RRMS. This research identifies BVL as a treatment outcome that should be discussed when physicians engage in shared decision-making with patients.
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Affiliation(s)
- Tom Tencer
- Bristol Myers Squibb, Princeton, NJ, USA
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Ngorsuraches S, Poudel N. Incorporating patients' preferences in the value assessment of disease-modifying therapies for multiple sclerosis: a narrative review. Expert Rev Pharmacoecon Outcomes Res 2021; 21:183-195. [PMID: 33472451 DOI: 10.1080/14737167.2021.1880321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Despite the increasing role of patients in the US healthcare system, patients have yet been engaged in the value assessment of their treatments, including disease-modifying therapies (DMTs) for multiple sclerosis (MS). The objectives of this review were therefore to summarize existing studies on cost-effectiveness analysis (CEA) with quality-adjusted life years (QALYs) and patients' preferences of DMTs for MS, and to discuss how to incorporate patients' preferences into the value assessment of DMTs.Area covered: We reviewed previous systematic reviews and conducted further search until November 2020 for studies on CEA with QALYs and patients' preferences of DMTs for MS. We identified the outcomes that were assessed or valued in the CEA studies and the DMT attributes that were important to patients with MS.Expert opinion: Our literature review showed that the studies using CEA with QALYs failed to capture some important DMT attributes, e.g., route and frequency of administration, identified in the studies on the patients' preferences. Various approaches were available for incorporating the patients' preferences in the value assessment of DMTs for MS. We supported this incorporation, which subsequently would increase patient access to preferred DMTs.
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Affiliation(s)
- Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Auburn University, Harrison School of Pharmacy, Auburn, AL, USA
| | - Nabin Poudel
- Department of Health Outcomes Research and Policy, Auburn University, Harrison School of Pharmacy, Auburn, AL, USA
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Geba D, Mohd Sani J, Gascon M, Hahn R, Aggarwal K, Rosselli J. Hereditary angioedema patients would prefer newer-generation oral prophylaxis. J Drug Assess 2021; 10:51-56. [PMID: 33489436 PMCID: PMC7801100 DOI: 10.1080/21556660.2020.1863699] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective To explore treatment preferences of patients with Hereditary Angioedema (HAE), a debilitating disorder characterized by potentially life-threatening, recurrent episodes of swelling, resulting in significant physical, emotional, and economic burden. With newer oral prophylactic treatments on the horizon, it is important to understand patients’ preferences. Methods An online survey was conducted in 2018 among United States (US) adult patients diagnosed with Type I or II HAE. Respondents were recruited anonymously from online panels and social media. Results Online surveys were completed by 75 patients diagnosed with HAE by a healthcare provider, with a mean of 16.7 years since diagnosis. Most patients (64%) report taking at least one medication for prophylaxis of HAE attacks. While almost all patients surveyed agree it is important to take preventative medication as prescribed, over half (52%) of patients report HAE prophylactic treatment to be burdensome. Despite stating that they like their current medications, 98% of the prophylactic HAE medication users would prefer an oral treatment if available; almost all (96%) prophylaxis users agree that oral preventative medication would fit their life better than an injectable medication, with 67% of users citing convenience as the primary reason to try an oral preventative HAE medication. If a more convenient option were available, nearly all (96%) patients currently not treating their HAE prophylactically would feel encouraged to do so. Conclusions Most patients with HAE would prefer a newer generation oral prophylactic medication that would decrease treatment burden and allow them to live fuller lives.
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Kumar J, Cambron-Mellott MJ, Tencer T, Will O, Mackie DS, Beusterien K. Patient and Neurologist Preferences in the United States for Relapsing-Remitting Multiple Sclerosis Treatments: Findings from a Discrete Choice Experiment. Patient Prefer Adherence 2021; 15:1515-1527. [PMID: 34267507 PMCID: PMC8275192 DOI: 10.2147/ppa.s306498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/28/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Relapsing-remitting multiple sclerosis (RRMS) is a chronic inflammatory disease associated with central nervous system dysfunction and accelerated brain volume loss (BVL). There exists a paucity of research examining the importance of BVL to patients and neurologists and exploring whether such preferences may differ between these two groups. This study sought to evaluate the preferences of patients and neurologists for RRMS treatments by considering benefits and risks associated with novel and common disease-modifying therapies (DMTs). PATIENTS AND METHODS US patients diagnosed with non-highly active RRMS and US-based neurologists completed an online cross-sectional survey. A discrete choice experiment was used to assess patient and neurologist treatment preferences, with neurologists considering preferences for patients with non-highly active RRMS. Respondents chose between two treatment profiles with seven attributes identified in qualitative research: 2-year disability progression; 1-year relapse rate; rate of BVL; and risks of gastrointestinal symptoms, flu-like symptoms, infection, and life-threatening events. Attribute-level weighted preferences were estimated using a hierarchical Bayesian model. RESULTS Analyses included 150 patients with non-highly active RRMS (mean age: 54 years) and 150 neurologists (65% in private practice). Among patients, the most important treatment attribute was reducing the rate of BVL, followed by reducing the risk of infection and risk of flu-like symptoms. In contrast, the most important treatment attribute among neurologists was reducing the risk of a life-threatening event, followed by slowing the rate of 2-year disability progression and risk of infection. CONCLUSION The findings highlight differences in treatment preferences between US patients and neurologists for non-highly active RRMS. The importance placed by patients on slowing the rate of BVL makes this a key topic that should be covered in the shared decision-making process.
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Affiliation(s)
- Jinender Kumar
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - M Janelle Cambron-Mellott
- RWE Data and Analytics, Kantar Health, New York, NY, USA
- Correspondence: M Janelle Cambron-Mellott Kantar Health, 3 World Trade Center, 175 Greenwich Street, 35th Floor, New York, NY, 10007, USATel +1 212 706 3961 Email
| | - Tom Tencer
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - Oliver Will
- RWE Data and Analytics, Kantar Health, New York, NY, USA
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Bauer B, Brockmeier B, Devonshire V, Charbonne A, Wach D, Hendin B. An international discrete choice experiment assessing patients' preferences for disease-modifying therapy attributes in multiple sclerosis. Neurodegener Dis Manag 2020; 10:369-382. [DOI: 10.2217/nmt-2020-0034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aim: This discrete choice experiment aimed to assess patients' preferences for treatment attributes in multiple sclerosis (MS). Patients & methods: Patients with relapsing-remitting MS completed an online survey assessing treatment preferences. Descriptive statistical analysis and discrete choice hierarchical Bayesian modeling were performed. Results: Across the overall sample (n = 485), dosing regimen, efficacy and safety were equally important. Within the whole sample, and among those diagnosed <10 years ago, intravenous infusion ≤3 times/year was the preferred dosing regimen; among patients diagnosed ≥10 years ago it was preferred equally to oral treatments. Patients were more willing to accept frequent but mild over rare but severe side effects. Conclusion: Several factors influence patient preferences for MS treatments and must be considered in patient-centered care.
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Affiliation(s)
- Birgit Bauer
- Patient Advocate for MS – Manufaktur für Antworten UG, 93326 Abensberg, Germany
| | | | - Virginia Devonshire
- Department of Medicine, University of British Columbia, V6T 2B5 Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, V6T 1Z3 Vancouver, BC, Canada
| | | | - Daniela Wach
- F. Hoffmann-La Roche Ltd, 4070 Basel, Switzerland
| | - Barry Hendin
- University of Arizona Medical School, 85724 Tucson, AZ, USA
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McFerran E, Boeri M, Kee F. Patient Preferences in Surveillance: Findings From a Discrete Choice Experiment in the "My Follow-Up" Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1373-1383. [PMID: 33032782 DOI: 10.1016/j.jval.2020.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/26/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Approximately 800 000 people die globally from colorectal cancer (CRC) every year. Prevention programs promote early detection, but for people with precancerous lesions, tailoring surveillance to include lifestyle-change programs could enhance prevention potential and improve outcomes. METHODS Those with intermediate or high-risk polyps removed during CRC screening colonoscopy within the Northern Ireland CRC Screening Programme were invited to complete 8 discrete choice questions about tailored surveillance, analyzed using random-parameters logit and a latent class modeling approach. RESULTS A total of 231 participants (77% male) self-reported comorbid hypertension (53%), high cholesterol (48%), and mean body mass index of 28.7 (overweight). Although 39% of participants were unaware of their CRC risk status, 30.9% indicated they were already making changes to reduce their risk. Although all respondents were significantly risk- and cost-averse, the latent class analysis identified 3 segments (classes): 1. Class 1 (26.8%) significantly favored phone or email support for a lifestyle change, a 17-month testing interval, and noninvasive testing. 2. Class 2 (48.4%) preferred the status quo. 3. Class 3 (24.7%) significantly favored further risk reduction and invasive testing. CONCLUSIONS This is the first documented preference study focusing on postpolypectomy surveillance offering lifestyle interventions. Although current care is strongly preferred, risk and cost aversion are important for participants. Latent class analysis shows that some respondents are willing to change diet and lifestyle behaviors, reflecting a teachable moment, with opportunities to personalize and optimize surveillance. Significant discordance between perceived and known risk of recurrence and limited recall of risk information provided within current practice suggest necessary improvements to surveillance programs.
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Affiliation(s)
- Ethna McFerran
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
| | - Marco Boeri
- RTI Health Solutions, Belfast, Northern Ireland, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, Northern Ireland, UK
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Vermersch P, Oh J, Cascione M, Oreja-Guevara C, Gobbi C, Travis LH, Myhr KM, Coyle PK. Teriflunomide vs injectable disease modifying therapies for relapsing forms of MS. Mult Scler Relat Disord 2020; 43:102158. [DOI: 10.1016/j.msard.2020.102158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/24/2020] [Accepted: 04/26/2020] [Indexed: 02/08/2023]
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Engebretson E, Seale RA, Valdez B, Vollmer TL, Medina LD. Validation of the functional assessment of chronic illness therapy - General treatment satisfaction (FACIT-TS-G) in multiple sclerosis. Mult Scler Relat Disord 2020; 45:102413. [PMID: 32731202 DOI: 10.1016/j.msard.2020.102413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient-reported treatment satisfaction is associated with medication adherence and persistence, making it increasingly important in the multiple sclerosis (MS) population, where disease modifying treatments (DMTs) can be vital in preventing accumulation of disability. Therefore, the valid assessment of treatment satisfaction is critical in MS care. The current study aimed to examine the validity of the Functional Assessment of Chronic Illness Therapy - General Treatment Satisfaction (FACIT-TS-G) in an MS population. METHODS Patient-reported outcome (PRO) data were collected from 555 MS patients (mean age 47.99±11.57; 76.4% female; 78.7% White/Caucasian) as part of routine clinical care. The FACIT-TS-G reliability, validity, and factor structure were examined. FACIT-TS-G scores were compared between DMT administration type (oral, injection, infusion) and examined as a possible predictor of switching DMT type at 1-to-2-year follow-up. RESULTS The FACIT-TS-G showed good internal consistency (Cronbach's α=0.836), convergent validity, and known-group validity. Confirmatory factor analyses supported a single factor. DMT infusion administration was associated with slightly greater FACIT-TS-G scores than injection (p = 0.013, 95% CI: 0.269, 2.273) and oral administration (p = 0.030, 95% CI: 0.087, 1.717). FACIT-TS-G scores did not predict the likelihood of switching DMT type at follow-up (p>0.05). CONCLUSION Our findings support the use of the FACIT-TS-G as a PRO measure of treatment satisfaction in MS. Moreover, results suggest DMT administration via infusion is associated with greater treatment satisfaction. Future research is needed to examine treatment satisfaction in the context of other outcomes.
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Affiliation(s)
- Eric Engebretson
- Department of Neurology, University of Colorado Anschutz Medical Campus, 12469 East 17th Place, Aurora, CO, 80045 USA.
| | - Rebecca A Seale
- Department of Neurology, University of Colorado Anschutz Medical Campus, 12469 East 17th Place, Aurora, CO, 80045 USA
| | - Brooke Valdez
- Department of Neurology, University of Colorado Anschutz Medical Campus, 12469 East 17th Place, Aurora, CO, 80045 USA
| | - Timothy L Vollmer
- Department of Neurology, University of Colorado Anschutz Medical Campus, 12469 East 17th Place, Aurora, CO, 80045 USA
| | - Luis D Medina
- Department of Psychology, University of Houston, 3695 Cullen Blvd, Rm 126 Heyne, Houston, TX, 77204 USA.
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AlJumah M, Alkhawajah MM, Qureshi S, Al-Thubaiti I, Ayoub O, Bohlega SA, Bushnag A, Cupler E, Daif A, El Boghdady A, Hassan A, Al Malik Y, Saeedi J, Al-Shamrany F, Shosha E, Rieckmann P. Cladribine Tablets and Relapsing-Remitting Multiple Sclerosis: A Pragmatic, Narrative Review of What Physicians Need to Know. Neurol Ther 2020; 9:11-23. [PMID: 32056129 PMCID: PMC7229040 DOI: 10.1007/s40120-020-00177-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Indexed: 12/21/2022] Open
Abstract
Immune reconstitution therapy (IRT) is an emerging management concept for multiple sclerosis, whereby a short course of treatment provides long-lasting suppression of disease activity. "Cladribine tablets 10 mg" refers to a total cumulative dose of cladribine given over 2 years (henceforth referred to as cladribine tablets 3.5 mg/kg); it is a relatively new treatment option that is hypothesised to act as an IRT acting preferentially on the adaptive immune system. A randomised, 2-year, placebo-controlled trial (CLARITY) showed that treatment with cladribine tablets reduced indices of disease activity (relapses, lesions on magnetic resonance images, disability progression) and that this effect outlasted the pharmacologic effect of the treatment on the immune system (mainly a reduction in circulating B and T cells, with little effect on components of the innate immune system such as monocytes). CLARITY Extension, a 2-year extension to this trial, demonstrated durable efficacy, also in patients who received the standard 2-year course of cladribine tablets 3.5 mg/kg and were re-randomised to placebo for a further 2 years. Relative risk reductions for relapse rate with cladribine tablets 3.5 mg/kg were similar for patients with or without prior high disease activity. Reductions in disability progression with cladribine tablets 3.5 mg/kg were higher in patients with prior high relapse rates with or without prior treatment non-response. In this review, we describe the therapeutic profile of cladribine tablets 3.5 mg/kg and provide practical information on initiating this treatment option in the most appropriate patients.
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Affiliation(s)
- Mohamed AlJumah
- King Fahad Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
| | | | - Shireen Qureshi
- Johns Hopkins Aramco Healthcare, Dhahran, Kingdom of Saudi Arabia
| | | | - Omar Ayoub
- King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Saeed A Bohlega
- King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Areej Bushnag
- International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Edward Cupler
- King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Abdulkader Daif
- King Khaled University Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | - Ahmed Hassan
- King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Yaser Al Malik
- King Saud Bin Abdulaziz University for Health Sciences (KSBU-HS), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Jameelah Saeedi
- King Abdullah Bin Abdulaziz University Hospital, KAAUH, Riyadh, Kingdom of Saudi Arabia
| | | | - Eslam Shosha
- King Khaled Hospital, Al-Majmaah, Kingdom of Saudi Arabia
| | - Peter Rieckmann
- Bamberg Hospital and University of Erlangen, Bamberg, Germany
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16
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Inshasi JS, Almadani A, Fahad SA, Noori SI, Alsaadi T, Shakra M, Shatila AO, Zein TM, Boshra A. High-efficacy therapies for relapsing-remitting multiple sclerosis: implications for adherence. An expert opinion from the United Arab Emirates. Neurodegener Dis Manag 2020; 10:257-266. [PMID: 32438857 DOI: 10.2217/nmt-2020-0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The number of disease-modifying treatments (DMDs) for relapsing-remitting multiple sclerosis has increased. DMDs differ not only in their efficacy and safety/tolerability, but also in the treatment burden of, associated with their initiation, route/frequency of administration, maintenance treatment and monitoring. High-efficacy DMDs bring the prospect of improved suppression of relapses and progression of disability, but may have serious safety issues, and burdensome long-term monitoring. Studies of patient preferences in this area have focused on side effects, efficacy and route of administration. Adherence to DMDs is often suboptimal in relapsing-remitting multiple sclerosis and there is a need to understand more about how the complex therapeutic and administration profiles of newer DMDs interact with these barriers to support optimal adherence to therapy.
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Affiliation(s)
- Jihad Said Inshasi
- MS Section, Rashid Hospital & Dubai Medical College, Dubai Health Authority (DHA), Dubai, UAE
| | - Abubaker Almadani
- Rashid Hospital & Dubai Medical College, Dubai health Authority (DHA), Dubai, UAE
| | - Sarmad Al Fahad
- Neurology Department, Neurospinal Hospital, Baghdad Medical College, Dubai, UAE
| | | | - Taoufik Alsaadi
- Neurology Department, American Center for Psychiatry & Neurology, Dubai, UAE
| | - Mustafa Shakra
- Department of Neurology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
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17
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Poulos C, Wakeford C, Kinter E, Mange B, Schenk T, Jhaveri M. Patient and physician preferences for multiple sclerosis treatments in Germany: A discrete-choice experiment study. Mult Scler J Exp Transl Clin 2020; 6:2055217320910778. [PMID: 32215218 PMCID: PMC7065293 DOI: 10.1177/2055217320910778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/21/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To assess heterogeneity in patient and physician preferences for multiple sclerosis treatment features and outcomes via a discrete-choice experiment. Method Patients with self-reported multiple sclerosis and treating physicians participated in an online discrete-choice experiment. Patients, each considering a better or worse reference condition, and physicians, each considering two patient profiles, chose between hypothetical treatment profiles defined by seven attributes with varying levels: years until disability progression, number of relapses in the decade, mode of administration, dosing frequency, and risks of mild, moderate, and severe side effects. Latent class analysis was used to measure respondent preferences and identify potential subgroups with distinct preferences. Results Distinct treatment preferences emerged among subgroups of patients (n = 301) and physicians (n = 308). Patients in class 1 (43% of sample) were most concerned about side effects; chief concerns of class 2 patients (57%) were delaying disability progression and avoiding severe side-effect risks. The most important attributes for physicians (by class) were delaying disability (class 1, 45%), avoiding severe side-effect risks and (class 2, 33%), and avoiding all side-effect risks (class 3, 22%). Conclusion Patients and physicians have diverse preferences for multiple sclerosis treatments, reflecting heterogeneity in the disease course and available therapies and the need for shared decision making.
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18
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Jonker MF, Donkers B, Goossens LMA, Hoefman RJ, Jabbarian LJ, de Bekker-Grob EW, Versteegh MM, Harty G, Wong SL. Summarizing Patient Preferences for the Competitive Landscape of Multiple Sclerosis Treatment Options. Med Decis Making 2020; 40:198-211. [PMID: 32065023 DOI: 10.1177/0272989x19897944] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective. Quantitatively summarize patient preferences for European licensed relapsing-remitting multiple sclerosis (RRMS) disease-modifying treatment (DMT) options. Methods. To identify and summarize the most important RRMS DMT characteristics, a literature review, exploratory physician interviews, patient focus groups, and confirmatory physician interviews were conducted in Germany, the United Kingdom, and the Netherlands. A discrete choice experiment (DCE) was developed and executed to measure patient preferences for the most important DMT characteristics. The resulting DCE data (n=799 and n=363 respondents in the United Kingdom and Germany, respectively) were analyzed using Bayesian mixed logit models. The estimated individual-level patient preferences were subsequently summarized using 3 additional analyses: the quality of the choice data was assessed using individual-level R2 estimates, individual-level preferences for the available DMTs were aggregated into DMT-specific preference shares, and a principal component analysis was performed to explain the patients' choice process. Results. DMT usage differed between RRMS patients in Germany and the United Kingdom but aggregate patient preferences were similar. Across countries, 42% of all patients preferred oral medications, 38% infusions, 16% injections, and 4% no DMT. The most often preferred DMT was natalizumab (26%) and oral DMT cladribine tablets (22%). The least often preferred were mitoxantrone and the beta-interferon injections (1%-3%). Patient preferences were strongly correlated with patients' MS disease duration and DMT experience, and differences in patient preferences could be summarized using 8 principle components that together explain 99% of the variation in patients' DMT preferences. Conclusion. This study summarizes patient preferences for the included DMTs, facilitates shared decision making along the dimensions that are relevant to RRMS patients, and introduces methods in the medical DCE literature that are ideally suited to summarize the impact of DMT introductions in preexisting treatment landscapes.
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Affiliation(s)
- Marcel F Jonker
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Lucas M A Goossens
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Renske J Hoefman
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Lea J Jabbarian
- Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Esther W de Bekker-Grob
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Matthijs M Versteegh
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
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19
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Deleu D, Canibaño B, Mesraoua B, Adeli G, Abdelmoneim MS, Ali Y, Elalamy O, Melikyan G, Boshra A. Management of relapsing-remitting multiple sclerosis in Qatar: an expert consensus. Curr Med Res Opin 2020; 36:251-260. [PMID: 31530036 DOI: 10.1080/03007995.2019.1669378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Healthcare systems vary greatly between countries. International, evidence-based guidelines for the management of multiple sclerosis (MS) may need to be adapted for use in particular countries. Two years ago, the authors published a comprehensive consensus guideline for the management of MS in Qatar. Since that time, the availability of disease-modifying treatments for relapsing-remitting MS (RRMS), and our understanding of how to apply those treatments, has increased. The authors present an update to our guidance, focussing on the management of relapsing-remitting RRMS. In particular, the authors consider the optimal use of different DMTs in patients presenting with mild, medium or high disease activity.
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Affiliation(s)
- Dirk Deleu
- Department of Neurology (Neuroscience Institute), Hamad Medical Corporation, Doha, Qatar
| | - Beatriz Canibaño
- Department of Neurology (Neuroscience Institute), Hamad Medical Corporation, Doha, Qatar
| | - Boulenouar Mesraoua
- Department of Neurology (Neuroscience Institute), Hamad Medical Corporation, Doha, Qatar
| | - Gholamreza Adeli
- Department of Neurology (Neuroscience Institute), Hamad Medical Corporation, Doha, Qatar
| | - Mohamed S Abdelmoneim
- Department of Neurology (Neuroscience Institute), Hamad Medical Corporation, Doha, Qatar
| | - Yasir Ali
- Department of Neurology (Neuroscience Institute), Hamad Medical Corporation, Doha, Qatar
| | - Osama Elalamy
- Department of Neurology (Neuroscience Institute), Hamad Medical Corporation, Doha, Qatar
| | - Gayane Melikyan
- Department of Neurology (Neuroscience Institute), Hamad Medical Corporation, Doha, Qatar
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20
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Cutter G, Veneziano A, Grinspan A, Al-Banna M, Boyko A, Zakharova M, Maida E, Pasic MB, Gandhi SK, Everts R, Cordioli C, Rossi S. Satisfaction and adherence with glatiramer acetate 40mg/mL TIW in RRMS after 12 months, and the effect of switching from 20mg/mL QD. Mult Scler Relat Disord 2020; 40:101957. [PMID: 32028117 DOI: 10.1016/j.msard.2020.101957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient satisfaction with treatment in relapsing-remitting multiple sclerosis (RRMS) has a direct impact on adherence to treatment and, consequently, upon treatment outcomes and costs. Patient-reported outcomes (PROs) are a common method for determining patient satisfaction in MS and other diseases. METHODS The 12-month, open-label, Phase IV CONFIDENCE study assessed patient satisfaction and treatment adherence, using PROs, as well as safety outcomes in patients with RRMS treated with glatiramer acetate (GA). In the previously reported (Cutter et al., 2019) initial 6-month core phase of the study, patients were randomized to receive three-times-weekly (TIW) GA 40 mg/mL (GA40; n = 431) or once-daily GA 20 mg/mL (GA20; n = 430). In the 6-month, single-arm extension phase, 789 patients completing the core phase were treated with GA40 to determine whether benefits observed in the core phase were sustained during the extension phase, to ascertain if switching from GA20 to GA40 resulted in PRO changes, and to assess safety outcomes. RESULTS Superior PRO scores for patient satisfaction with treatment, patient perception of treatment convenience, and symptomatic changes (fatigue impact and mental health) observed in the GA40 group versus the GA20 group in the core phase were all maintained in the extension phase. Treatment adherence, significantly greater in the GA40 versus the GA20 group in the core phase, was sustained in patients continuing to receive GA40 in the extension phase, while those who switched from GA20 to GA40 increased their adherence during the extension phase. Safety variables remained consistent throughout the study, with no notable changes observed in patients switching from GA20 to GA40. CONCLUSIONS Data from the extension phase of the CONFIDENCE study show that the benefits associated with GA40 treatment in terms of medication satisfaction, treatment convenience perception, symptomatic changes in fatigue impact and mental health status, and treatment adherence were maintained over a 12-month observation period. These results confirm the preferential utility of GA40 versus GA20 in clinical practice, with no additional safety concerns associated with switching from GA20 to GA40.
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Affiliation(s)
- Gary Cutter
- University of Alabama at Birmingham, Ryals Public Health Building 410B, 1665 University Boulevard, Birmingham, AL 35294-0022, USA; Pythagoras, Inc., Birmingham, AL 35205, USA.
| | | | - Augusto Grinspan
- Teva Pharmaceutical Industries Ltd, 41 Moores Rd, Malvern, PA 19355, USA
| | - Mahir Al-Banna
- Teva Pharmaceutical Industries Ltd, 41 Moores Rd, Malvern, PA 19355, USA.
| | - Alexey Boyko
- Neuroimmunological Department at Federal Center of Cerebrovascular Pathology and Stroke, Multiple Sclerosis Center at Yusupov Hospital, Ulitsa Ostrovityanova, 1, Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Maria Zakharova
- Research Center of Neurology, m. Sokol, Tushinskaya, Schukinskaya Volokolamskoe shosse, 80, Moscow 125367, Russia.
| | - Eva Maida
- Multiple Sclerosis Center, Vienna, Koellnerhofgasse 4/12, 1010 Vienna, Austria.
| | - Marija Bosnjak Pasic
- Department of Neurology, University Hospital Centre Zagreb, School of Medicine, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, 31000 Osijek, Croatia; Referral Centre of the Ministry of Health of the Republic of Croatia for Demyelinating Diseases of the Central Nervous System, 10000 Zagreb, Croatia
| | - Sanjay K Gandhi
- Teva Pharmaceutical Industries Ltd, 41 Moores Rd, Malvern, PA 19355, USA.
| | - Robin Everts
- Teva Pharmaceutical Industries Ltd, 41 Moores Rd, Malvern, PA 19355, USA.
| | - Cinzia Cordioli
- Multiple Sclerosis Center, Montichiari Hospital, Via G. Ciotti, 154, 25018 Montichiari, Brescia, Italy
| | - Silvia Rossi
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria, 11, 20133 Milan, Italy.
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21
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Frost N, Freeman J, Brixner D, Mort J, Clem J, Ngorsuraches S. Patients' preferences and willingness-to-pay for disease-modifying therapies. Mult Scler Relat Disord 2019; 35:55-60. [PMID: 31323483 DOI: 10.1016/j.msard.2019.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND While disease-modifying therapies (DMTs) for multiple sclerosis (MS) treatments are costly, patient valuation of DMTs has not been examined. The objective of this study was to examine patients' preferences and willingness-to-pay (WTP) for DMTs. METHODS Six attributes (i.e., number of relapses, percentage of disability progression, percentage of severe adverse events, route of administration, frequency of administration, and out-of-pocket cost) and their levels were used to develop a discrete choice experiment questionnaire. Each questionnaire comprised seven choice sets and each choice set contained two hypothetical DMTs and an opt-out alternative. A total of 1,200 U.S. patients with MS were asked to choose a DMT option or opt-out in each choice set. Multinomial logit model was used to determine relative preferences of each attribute. WTPs for all attributes and DMTs were calculated. RESULTS A total of 508 patients were analyzed. Patients preferred DMTs with lower relapse rate, lower disability progression, lower severe adverse event, lower frequency of administration, and lower cost. In addition, they preferred oral DMTs. They were willing to pay $2,768, $289, $292, and $76 a month in exchange for every 1-time decrease in the number of relapses in two years, every 1% decrease in disability progression in two years, every 1% decrease in severe adverse events, and every 1-time decrease in the frequency of administration per month, respectively. The patients were willing to pay, in relation to market prices, between $7,020 and $134,934 per year for all DMTs, but interferon beta-1a SC. CONCLUSIONS Patients with MS considered relapse rate, disability progression, severe adverse events, route of administration, frequency of administration, and out-of-pocket cost, when they chose DMTs. Their WTPs for DMTs varied widely.
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Affiliation(s)
- Natasha Frost
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Jerome Freeman
- Department of Neurosciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
| | - Diana Brixner
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Jane Mort
- Department of Pharmacy Practice, College of Pharmacy and Allied Health Professions, South Dakota State University, Brookings, SD 57007, USA
| | - James Clem
- Department of Pharmacy Practice, College of Pharmacy and Allied Health Professions, South Dakota State University, Brookings, SD 57007, USA
| | - Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849, USA.
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22
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Buesa-Estelléz A, Cano-de-la-Cuerda R, Ortiz-Gutiérrez RM, Palacios-Ceña D. The impact of pharmacological treatment on patients with multiple sclerosis. Disabil Health J 2019; 12:615-621. [PMID: 31133483 DOI: 10.1016/j.dhjo.2019.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 05/09/2019] [Accepted: 05/20/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multiple sclerosis has considerable effects on patients' quality of life, limiting their daily activities and influencing their lifestyle. Additionally, adapting to pharmacological treatments represents a challenge for many patients. OBJECTIVE The aim of this study was to explore the views and experiences of Spanish patients with multiple sclerosis regarding their pharmacological treatment. METHODS A qualitative phenomenological study was conducted with 20 patients with Multiple Sclerosis from a hospital Neurology Unit. Data were collected through in-depth interviews and researchers' field notes. A systematic text condensation analysis was performed. The Consolidated Criteria for Reporting Qualitative Research and the Standards for Reporting Qualitative Research guidelines were followed. RESULTS Twenty patients with Multiple Sclerosis completed the study. The mean age was 39.7 years (SD: 9,17). A thematic description of all the data collected was performed based on four descriptive themes which emerged from the analysed material: a) Undergoing the injections, b) Coping strategies, with two subthemes, resignation and integrating the treatment into their life, c) Other methods of pharmacological administration, and d) Dealing with discomfort. For patients with multiple sclerosis, their experience with pharmacological treatment is an apprenticeship which is sometimes met with resignation and discomfort. Patients must learn to take responsibility for their treatment, seeking other routes of administration, as well as integrating these changes into their daily life. CONCLUSIONS Qualitative research offers insight into the way patients with Multiple Sclerosis experience their pharmacological treatment, and may be helpful in establishing a fruitful relationship with these patients.
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Affiliation(s)
| | - Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | | | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Barin L, Kaufmann M, Salmen A, Kamm CP, Gobbi C, Kuhle J, Pot C, Chan A, Czaplinski A, Ajdacic-Gross V, Rodgers S, Kesselring J, Puhan MA, von Wyl V. Patterns of care for Multiple Sclerosis in a setting of universal care access: A cross-sectional study. Mult Scler Relat Disord 2019; 28:17-25. [DOI: 10.1016/j.msard.2018.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/22/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
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