Preferences for Multiple Sclerosis Treatments: Using a Discrete-Choice Experiment to Examine Differences Across Subgroups of US Patients
Background: A growing number of treatments for relapsing multiple sclerosis (RMS) provide opportunities to consider patient preferences in treatment decisions. Methods: We designed a web-based, discrete-choice experiment survey to analyze treatment preferences among patients with relapsing-remitting MS (RRMS). The survey presented hypothetical MS treatments defined by six attributes: risk of MS progression, time between relapses, risk of serious infection, treatment-related flu-like symptoms and gastrointestinal symptoms, and route and frequency of administration. Preference weights were estimated with random-parameters logit and used to calculate importance scores and preference shares among three pairs of subsamples. Results: Patients with a self-reported physician diagnosis of RRMS (N = 301) completed the survey: 56% rated their disability level as “normal” or “mild”; 43% currently used a self-injectable treatment. Respondents with “normal” or “mild” disability levels placed greater weight on avoiding injections with flu-like symptoms and risk of progression, while patients with worse disability placed greater weight on reducing risk of progression and risk of serious infection. Patients taking injectables placed the most weight on risk of progression and risk of serious infection, while respondents not taking injectables placed the most weight on route and frequency of administration. Differences in preferences between subgroups were significant (P < .05). The presence of common side effects associated with daily pills and injectables altered predicted preferences for route of administration. Conclusions: Preferences of patients with RRMS varied depending on current treatment and disability level, especially regarding mode of administration. Considering patient preferences for treatment features may lead to higher treatment satisfaction and adherence.