Patient preferences for topical psoriasis treatments: a discrete choice experiment

Abstract

Background Topical medication continues to be the most frequently prescribed therapy for psoriasis. However, patients are often dissatisfied with their topical medication, and adherence to this type of therapy is particularly poor. Objective To investigate the preferences of patients with psoriasis regarding the process and outcome attributes associated with topical treatments and to assess influencing factors. Methods A discrete choice experiment was conducted to analyze patient preferences for topical psoriasis treatments based on outcome attributes (probabilities of 90% improvement, 50% improvement, skin atrophy and skin irritation) and process attributes (treatment cost not covered by health insurance, treatment duration, location, frequency and formulation). Results The study cohort (N = 184) considered probabilities of 50% (Relative Importance Score (RIS)=41.0) and 90% (RIS = 33.9) improvement most important, followed by risk of skin atrophy (RIS = 26.4) and treatment cost (RIS = 22.2). Treatment location (RIS = 18.9), risk of skin irritation (RIS = 16.2), treatment frequency (RIS = 13.3) and formulation (RIS = 11.0) were considered less relevant. Income, cardiovascular disease, number of visits and current topical therapy influenced treatment preferences. Conclusions Averaged across the cohort, participants preferred an efficient topical treatment associated with a low risk of skin atrophy and reasonable personal expenses. Individual preferences should be integrated into a shared decision-making process about psoriasis treatment.