TY - JOUR
T1 - Patient centered decision making
T2 - Use of conjoint analysis to determine risk-benefit trade-offs for preference sensitive treatment choices
AU - Wilson, Leslie
AU - Loucks, Aimee
AU - Bui, Christine
AU - Gipson, Greg
AU - Zhong, Lixian
AU - Schwartzburg, Amy
AU - Crabtree, Elizabeth
AU - Goodin, Douglas
AU - Waubant, Emmanuelle
AU - McCulloch, Charles
N1 - Funding Information:
Leslie Wilson was funded by Novartis Corporation for conduct of this study and a family member works for Biogen Idec Inc.
PY - 2014/9/15
Y1 - 2014/9/15
N2 - Understanding patient preferences facilitates shared decision-making and focuses on patient-centered outcomes. Little is known about relapsing-remitting multiple sclerosis (RRMS) patient preferences for disease modifying therapies (DMTs). We use choice based conjoint (CBC) analysis to calculate patient preferences for risk/benefit trade-offs for hypothetical DMTs. Methods Patients with RRMS were surveyed between 2012 and 2013. Our CBC survey mimicked the decision-making process and trade-offs of patients choosing DMTs, based on all possible DMT attributes. Mixed-effects logistic regression analyzed preferences. We estimated maximum acceptable risk trade-offs for various DMT benefits. Results Severe side-effect risks had the biggest impact on patient preference with a 1% risk, decreasing patient preference five-fold compared to no risk. (OR = 0.22, p < 0.001). Symptom improvement was the most preferred benefit (OR = 3.68, p < 0.001), followed by prevention of progression of 10 years (OR = 2.4, p < 0.001). Daily oral administration had the third highest DMT preference rating (OR = 2.08, p < 0.001). Patients were willing to accept 0.08% severe risk for a year delayed relapse, and 0.22% for 4 vs 2 year prevented progression. Conclusion We provided patient preferences and risk-benefit trade-offs for attributes of all available DMTs. Evaluation of patient preferences is a key step in shared decision making and may significantly impact early drug initiation and compliance.
AB - Understanding patient preferences facilitates shared decision-making and focuses on patient-centered outcomes. Little is known about relapsing-remitting multiple sclerosis (RRMS) patient preferences for disease modifying therapies (DMTs). We use choice based conjoint (CBC) analysis to calculate patient preferences for risk/benefit trade-offs for hypothetical DMTs. Methods Patients with RRMS were surveyed between 2012 and 2013. Our CBC survey mimicked the decision-making process and trade-offs of patients choosing DMTs, based on all possible DMT attributes. Mixed-effects logistic regression analyzed preferences. We estimated maximum acceptable risk trade-offs for various DMT benefits. Results Severe side-effect risks had the biggest impact on patient preference with a 1% risk, decreasing patient preference five-fold compared to no risk. (OR = 0.22, p < 0.001). Symptom improvement was the most preferred benefit (OR = 3.68, p < 0.001), followed by prevention of progression of 10 years (OR = 2.4, p < 0.001). Daily oral administration had the third highest DMT preference rating (OR = 2.08, p < 0.001). Patients were willing to accept 0.08% severe risk for a year delayed relapse, and 0.22% for 4 vs 2 year prevented progression. Conclusion We provided patient preferences and risk-benefit trade-offs for attributes of all available DMTs. Evaluation of patient preferences is a key step in shared decision making and may significantly impact early drug initiation and compliance.
KW - Conjoint analysis
KW - Decision aids
KW - Multiple sclerosis
KW - Preference sensitive care
KW - Risk-benefit trade-offs
KW - Utility
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U2 - 10.1016/j.jns.2014.06.030
DO - 10.1016/j.jns.2014.06.030
M3 - Article
C2 - 25037284
AN - SCOPUS:84906793845
SN - 0022-510X
VL - 344
SP - 80
EP - 87
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
IS - 1-2
ER -