Boeri M, Sutphin J, Hauber B, Cappelleri JC, Romero W, DiBonaventura M. Identifying patient preferences for systemic atopic dermatitis treatments using a discrete choice experiment. Poster presented at the 2020 Virtual 29th European Academy of Dermatology and Venerology Congress; October 28, 2020.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition. Patients and physicians can choose from a variety of treatments characterized by different attributes such as efficacy, safety, and route of administration. It is important to understand how (and to what degree) these attributes influence patients’ treatment preferences. Therefore, the purpose of this study was to elicit patient preferences for the attributes of systemic AD treatments.

MATERIALS AND METHODS: The study was conducted in 2 phases: (1) a qualitative phase involving in-depth individual interviews with patients of various ages and AD severities (in the United States and the United Kingdom) to identify the AD treatment attributes that patients consider most important (and why) when making treatment decisions, and (2) a quantitative discrete-choice experiment (DCE) online survey administered to patients with moderate-to-severe AD (based on treatment history and Patient Oriented Eczema Measure scores) to estimate the relative importance of attributes that are important to patients and to differentiate among treatments for moderate-to-severe AD. In the DCE survey, respondents were presented with 12 experimentally designed choices between 2 hypothetical alternative AD treatments. The resulting data were analyzed using a random-parameters logit model to estimate preference weights and maximum acceptable risk.

RESULTS: In the qualitative phase, in-depth interviews revealed that the most important AD treatment attributes were time to itch improvement, chance of clear or almost clear skin, route of administration, and safety risks (serious infections, malignancy, and venous thromboembolism [VTE] were the specific safety risks assessed). Of those with moderate-to-severe AD, 320 patients completed the DCE survey (74% female; mean age=35 years). Regarding efficacy, the probability of skin clearance after 16 weeks (levels assessed: 15%, 35%, 50%) was the most important attribute followed closely by time to itch improvement (1, 3, 7, 14 days). Regarding safety, annual malignancy risk (0.1%, 0.5%, 1.5%) was the most important attribute followed by annual VTE (0.1%, 0.5%, 1.5%) and serious infection risk (0.1%, 1%, 3%). Patients exhibited a strong preference for a daily oral treatment over an injectable treatment. Patients were willing to accept higher safety risks to obtain increases in efficacy and convenience. For example, for a reduction in time to itch improvement from 14 days to 1 day, patients were willing to accept an increase in serious infection risk from 0.1% to 3% (maximum level), VTE risk from 0.1% to 1.5% (maximum level), or malignancy risk from 0.1% to 0.38%. Similar trade-offs were observed for an increase in chance of skin clearance from 15% to 50% and for an increase in convenience from an injectable treatment to a daily oral treatment.

DISCUSSION: High probability of skin clearance, rapidity of itch relief, the convenience of oral administration, and low long-term safety risks were identified as the most important AD treatment attributes for patients with moderate-to-severe AD. Patients were willing to accept notably higher safety risks for increases in efficacy and convenience. However, it is unknown what degree of understanding patients had in assessing these risks. This research highlights the patient perspective surrounding the relevant benefits and risks of different AD treatments, which can help inform joint patient-physician decision making.

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