Patient preferences on rheumatoid arthritis second-line treatment: a discrete choice experiment of Swedish patients

Karin Schölin Bywall,Jorien Veldwijk,Mats Hansson,Marie Falahee,Karim Raza,Ulrik Kihlbom,Eva Baecklund

doi:10.1186/s13075-020-02391-w

Abstract

BackgroundPreference assessments of patients with rheumatoid arthritis can support clinical therapeutic decisions for including biologic and targeted synthetic medicines to use. This study assesses patient preferences for attributes of second-line therapies and heterogeneity within these preferences to estimate the relative importance of treatment characteristics and to calculate the minimum benefit levels patients require to accept higher levels of side effects.MethodsBetween November 2018 to August 2019, patients with rheumatoid arthritis were recruited to a survey containing demographic and disease-related questions as well as a discrete choice experiment to measure their preferences for second-line therapies using biologics or Janus kinases inhibitors. Treatment characteristics included were route of administration, frequency of use, probability of mild short-term side effects, probability of side effects changing appearance, probability of psychological side effects, probability of severe side effects and effectiveness of treatment.ResultsA total of 358 patients were included in the analysis. A latent class analysis revealed three preference patterns: (1) treatment effectiveness as the single most important attribute, (2) route of administration as the most important attribute, closely followed by frequency of use and psychological side effects and (3) severe side effects as the most important attribute followed by psychological side effects. In addition, disease duration and mild side effects influenced the patients’ choices.ConclusionRespondents found either effectiveness, route of administration or severe side effects as the most important attribute. Patients noting effectiveness as most important were more willing than other patients to accept higher risks of side effects.

Highlights

Information about patient preferences has long been considered important for supporting patient-centeredness in clinical decisions [1]
Severe side effects were the most important attribute followed by psychological side effects for class 3
This study reveals that disease duration and experience with mild side effects had an impact on patients’ choices

Summary

Introduction

Information about patient preferences has long been considered important for supporting patient-centeredness in clinical decisions [1]. The interest in quantifying treatment preferences of patients with rheumatic diseases has been expanded to regulatory marketing authorisation decisions of new rheumatic disease medicines [7, 8]. Quantitative assessments of patient preferences may be important in regulatory marketing approvals in order to adjust decisionmaking to patient opinions on the meaning and significance of treatment attributes, such as the balance between estimated effects and adverse reactions [9, 10]. Preference assessments of patients with rheumatoid arthritis can support clinical therapeutic decisions for including biologic and targeted synthetic medicines to use. This study assesses patient preferences for attributes of second-line therapies and heterogeneity within these preferences to estimate the relative importance of treatment characteristics and to calculate the minimum benefit levels patients require to accept higher levels of side effects

Methods

Discussion

Conclusion