Eliciting Preferences to Inform Patient-Centred Policies: the Case of Psoriasis

ObjectiveTo assess patient preferences for psoriasis treatment features and to investigate the heterogeneity of preferences among patients with different socio-demographic and disease-related characteristics.MethodologyA discrete choice experiment was conducted on adult patients with moderate to severe plaque-type psoriasis during a routine visit to their physician at 15 centres in Italy. We investigated the preferences of patients with respect to five treatment attributes: (1) mode and frequency of administration; (2) time to improvement; (3) time free of symptoms; (4) unintended life expectancy reduction resulting from treatment; and (5) monthly treatment cost. The heterogeneity of preferences was investigated in a mixed logit model with normally distributed random coefficients.ResultsOverall, patients preferred the subcutaneous or intravenous route of administration (versus oral administration) and treatments that took less time to show improvement, ensured a longer time free of symptoms, involved a lesser reduction in life expectancy and had lower costs. There was significant preference heterogeneity for all attributes. The cost attribute was found to be significantly more important to females and to older patients (above 60 years of age). Older patients placed significantly greater emphasis on reduced life expectancy, whereas the time free of symptoms was significantly less important to them than to patients under 60 years of age. Patients with higher scores on the Dermatology Life Quality Index (DLQI) placed higher value on the time free of symptoms than those with lower DLQI scores. For the overall sample, the marginal willingness to pay (WTP) for a month’s reduction in the time to improvement was €32.4, whereas the WTP for one additional month without symptoms was significantly higher (€68.2).ConclusionPatient-centred policies should consider the heterogeneity of patients’ expectations to identify individualized treatments that would aid in optimizing patient satisfaction and wellbeing, as well as overall treatment effectiveness.

[1]  E. Seston,et al.  Balancing the benefits and risks of drug treatment: a stated-preference, discrete choice experiment with patients with psoriasis. , 2007, Archives of dermatology.

[2]  A. Hole,et al.  Mixed logit estimation of willingness to pay distributions: a comparison of models in preference and WTP space using data from a health-related choice experiment , 2012 .

[3]  Nasir Umar,et al.  Outcomes associated with matching patients' treatment preferences to physicians' recommendations: study methodology , 2012, BMC Health Services Research.

[4]  W. Stolz,et al.  Willingness to pay and time trade-off: sensitive to changes of quality of life in psoriasis patients? , 2003, The British journal of dermatology.

[5]  E. Warshaw,et al.  Reliability of self‐reported willingness‐to‐pay and annual income in patients treated for toenail onychomycosis , 2007, The British journal of dermatology.

[6]  P. C. van de Kerkhof,et al.  Patient Compliance and Disease Management in the Treatment of Psoriasis in the Netherlands , 2000, Dermatology.

[7]  A. Kimball,et al.  Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1) , 2008, The Lancet.

[8]  Peter Martinsson,et al.  Design techniques for stated preference methods in health economics. , 2003, Health economics.

[9]  C. Griffiths,et al.  Optimal Management of Severe Plaque Form of Psoriasis , 2005, American journal of clinical dermatology.

[10]  Christopher F. Parmeter,et al.  Heterogeneity in preferences for smoking cessation. , 2008, Health economics.

[11]  A. Finlay,et al.  British Association of Dermatologists’ guidelines for biologic interventions for psoriasis 2009 , 2009, The British journal of dermatology.

[12]  Deborah Marshall,et al.  Constructing experimental designs for discrete-choice experiments: report of the ISPOR Conjoint Analysis Experimental Design Good Research Practices Task Force. , 2013, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[13]  S. Chimenti,et al.  Efficacy and Safety of Efalizumab in Patients with Moderate-to-Severe Plaque Psoriasis Resistant to Previous Anti-Psoriatic Treatment: Results of a Multicentre, Open-label, Phase IIIb/IV Trial , 2010, Archives of drug information.

[14]  M. Radtke,et al.  Willingness‐to‐pay and quality of life in patients with vitiligo , 2009, The British journal of dermatology.

[15]  Mandy Ryan,et al.  Discrete choice experiments in health economics: a review of the literature. , 2012, Health economics.

[16]  B. Strober,et al.  Efficacy and safety results from a phase III, randomized controlled trial comparing the safety and efficacy of briakinumab with etanercept and placebo in patients with moderate to severe chronic plaque psoriasis , 2011, The British journal of dermatology.

[17]  W. Peitsch,et al.  Comorbidities significantly impact patients' preferences for psoriasis treatments. , 2012, Journal of the American Academy of Dermatology.

[18]  A. Troxel,et al.  Comparative effectiveness of commonly used systemic treatments or phototherapy for moderate to severe plaque psoriasis in the clinical practice setting. , 2012, Archives of dermatology.

[19]  G. Baliva,et al.  Association of dissatisfaction with care and psychiatric morbidity with poor treatment compliance. , 2002, Archives of dermatology.

[20]  J. Louviere,et al.  Conducting Discrete Choice Experiments to Inform Healthcare Decision Making , 2012, PharmacoEconomics.

[21]  C. Jenkins,et al.  Patient preferences for managing asthma: results from a discrete choice experiment. , 2007, Health economics.

[22]  Andrew Lloyd,et al.  Conjoint analysis applications in health--a checklist: a report of the ISPOR Good Research Practices for Conjoint Analysis Task Force. , 2011, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[23]  David A. Hensher,et al.  The Mixed Logit Model: the State of Practice and Warnings for the Unwary , 2001 .

[24]  L. Puig,et al.  The efficacy and safety of etanercept when used with as-needed adjunctive topical therapy in a randomised, double-blind study in subjects with moderate-to-severe psoriasis (the PRISTINE trial) , 2013, The Journal of dermatological treatment.

[25]  A Coulter,et al.  Partnerships with Patients: The Pros and Cons of Shared Clinical Decision-Making , 1997, Journal of health services research & policy.

[26]  J. Ortonne,et al.  Efficacy and safety of infliximab vs. methotrexate in patients with moderate‐to‐severe plaque psoriasis: results of an open‐label, active‐controlled, randomized trial (RESTORE1) , 2011, The British journal of dermatology.

[27]  Anirban Basu,et al.  Value of Information on Preference Heterogeneity and Individualized Care , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[28]  A. Hole.  Fitting Mixed Logit Models by Using Maximum Simulated Likelihood , 2007 .

[29]  Arne Risa Hole,et al.  Modelling heterogeneity in patients' preferences for the attributes of a general practitioner appointment. , 2008, Journal of health economics.

[30]  Mickael Bech,et al.  Ordering effect and price sensitivity in discrete choice experiments: need we worry? , 2006, Health economics.

[31]  P. Geoffard,et al.  Therapeutic non-adherence: a rational behavior revealing patient preferences? , 2007, Health economics.

[32]  H. Richards,et al.  Adherence to treatment in patients with psoriasis , 2006, Journal of the European Academy of Dermatology and Venereology : JEADV.

[33]  Denzil G Fiebig,et al.  What influences participation in genetic carrier testing? Results from a discrete choice experiment. , 2006, Journal of health economics.

[34]  M. Goodfield,et al.  Objective assessment of compliance with psoriasis treatment. , 2004, Archives of dermatology.

[35]  E. Soriano,et al.  Patient preferences for biologic agents in rheumatoid arthritis: a discrete-choice experiment. , 2010, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[36]  A. Hauber,et al.  The value to patients of reducing lesion severity in plaque psoriasis , 2011, The Journal of dermatological treatment.

[37]  Angela Coulter,et al.  Paternalism or partnership? , 1999, BMJ.

[38]  W. Peitsch,et al.  Patient preferences for psoriasis treatments: impact of treatment experience , 2013, Journal of the European Academy of Dermatology and Venereology : JEADV.

[39]  E. Seston,et al.  Trade‐offs between the benefits and risks of drug treatment for psoriasis: a discrete choice experiment with U.K. dermatologists , 2006, The British journal of dermatology.

[40]  W. Peitsch,et al.  Patient preferences for psoriasis treatments: process characteristics can outweigh outcome attributes. , 2011, Archives of dermatology.

[41]  D. McFadden,et al.  MIXED MNL MODELS FOR DISCRETE RESPONSE , 2000 .

[42]  D. Gyrd-Hansen,et al.  Preference heterogeneity and choice of cardiac rehabilitation program: results from a discrete choice experiment. , 2008, Health policy.

[43]  R. Bissonnette,et al.  Efficacy and safety of topical WBI‐1001 in patients with mild to moderate psoriasis: results from a randomized double‐blind placebo‐controlled, phase II trial , 2011, Journal of the European Academy of Dermatology and Venereology : JEADV.