Abstract
Background: Understanding patient and caregiver preferences for treatment is important for optimizing treatment decisions. Non-stimulant therapies are an alternative treatment option to stimulant therapy for attention-deficit/hyperactivity disorder (ADHD). Guanfacine extended release (GXR) and atomoxetine (ATX) are two non-stimulant medications approved in the United States for the treatment of ADHD. Objective: To identify non-stimulant ADHD medication attributes important to caregivers/patients. Methods: US caregivers of ADHD patients (6-17 years) and child/adolescent patients (10-17 years) completed an adaptive conjoint analysis survey. Respondents selected between hypothetical treatments with different attributes. Ordinary least-squares and hierarchical Bayes regression using Sawtooth Software were used to calculate utilities, importance ratings, and preferences. Results: 483 caregivers (mean age: 41.9 years, standard deviation [SD]: 8.7; 75% female) and 211 children/adolescents (mean age: 14.5 years, SD: 2.2; 70% male) completed the survey. Based on importance ratings, the most influential attributes for both caregivers and children/adolescents were chance of somnolence, efficacy, and for caregivers, effect on oppositionality and black box warning. Most caregivers (95.3%) and children/adolescents (93.8%) preferred GXR over ATX. In several sensitivity analyses in which attribute levels varied, GXR remained the preferred medication with the exception of one scenario. Conclusions: Children/adolescents and caregivers demonstrated in this study that they can clearly express their preferences for treatment attributes and treatment choices; in this case they preferred GXR to ATX. Patients and caregiver preferences could be useful inputs to the treatment selection decision-making process.
Highlights
Understanding patient and caregiver preferences for treatment is important for optimizing treatment decisions
Children/adolescents and caregivers demonstrated in this study that they can clearly express their preferences for treatment attributes and treatment choices; in this case they preferred Guanfacine extended release (GXR) to ATX
The US government has recognized the need for a more patient-centered approach to medicine: the PatientCentered Outcomes Research Institute (PCORI), which emphasizes the role of the patient in informed decision making, was founded as part of the Patient Protection and Affordable Care Act in 2010.9 As practitioners are increasingly advocating for this patient-focused model and encouraging patients and caregivers to become more active partners in their treatment plans, it has become increasingly important to understand patient and caregiver preferences with respect to aspects of treatment, and to ensure that patients and caregivers are provided with adequate information about these aspects so they can make informed decisions
Summary
Understanding patient and caregiver preferences for treatment is important for optimizing treatment decisions. The shared decision-making model has been studied extensively within the healthcare field, only recently has it been examined within the context of mental health.[10] evidence suggests that this model shows promise across a broad range of psychiatric conditions, among both patients and their caregivers.[11,12] Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders, affecting an estimated 7% of children in the United States.[13] Symptoms of ADHD can include hyperactivity, impulsivity, and difficulties with sustained attention, and the disorder is associated with a substantial decline in the child’s HRQoL, with regard to psychosocial functioning.[14] It is often associated with comorbid conditions, such as learning disabilities, oppositional defiant disorder, conduct disorder, mood disorders, anxiety disorders, obsessive-compulsive disorder, Tourette’s syndrome, substance abuse disorders, and sleep disorders.[15,16,17,18]
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