US general population food allergy treatment preferences: a discrete choice experiment

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Objective To quantify treatment preferences for food allergy management options (oral immunotherapy, biologic therapy, and allergen avoidance), overall and by sociodemographic strata. Methods A US general population (≥13 years) discrete choice experiment (DCE) conducted comprised of 12 treatment-feature focused DCE choice sets; the Intolerance of Uncertainty─12 Scale (IUS-12); and clinical/demographic questions. Conditional logistic regression analyses were conducted overall and by age, income, urbanization, educational attainment, food and other sociodemographic factors, and presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results Participants (n = 294) mean (standard deviation) age was 47 (19.7) years; 48.6% were male. Treatment features associated with statistically significant odds against preferring a treatment included: 1% reduction in risk of having an exposure resulting in a moderate-to-severe reaction (tested within a range of 0-10%; OR: 1.10 [CI:1.04-1.16] p < 0.01); treatment-related, severe anaphylaxis (0.85; 0.74-0.97 for a 1% risk); gastrointestinal symptoms (0.99; 0.99-0.99 per +1% risk); daily treatment (versus every 2-4 weeks; 0.81; 0.72-0.91); in-clinic administration (versus at-home; 0.76; 0.66-0.87); subcutaneous administration (versus oral; 0.69; 0.61-0.78); three-hour post-treatment physical activity limitation (0.84; 0.77-0.93); one-year reduction in life expectancy (0.87; 0.85-0.89). Preferences for at-home use and against activity limitations was stronger in rural versus urban dwellers; lower-income respondents strongly preferred convenience-related factors (oral, less frequent, at-home administration). Teens strongly preferred (2.75; 1.09–6.9) being bite-safe (versus fully allergic). Conclusion When making food allergy management decisions, US general population respondents had strong preferences for features related to safety and convenience; however, the magnitude of preferences varied by sociodemographic factors. These findings may be pertinent for population-level health decision makers.