Exploring patient preference heterogeneity for pharmacological treatments for chronic pain: A latent class analysis

Abstract

Background: Several pharmaceutical treatments for chronic pain caused by osteoarthritis (OA) and chronic low back pain (CLBP) are available or currently under development, each associated with different adverse events (AEs) and efficacy profiles. It is therefore important to understand what trade-offs patients are willing to make when choosing between treatments. Methods:A discrete-choice experiment (DCE) was conducted with 437 adults with chronic pain caused by OA and/or CLBP. Respondents were presented with a series of scenarios and asked to choose between pairs of hypothetical treatments, each defined by six attributes: level of symptom control; risks of heart attack, rapidly progressive osteoarthritis and dependency; frequency and mode of administration and cost. Attributes were based on known profiles of oral nonsteroidal anti-inflammatory drugs, opioids and injected nerve growth factor inhibitors, the last of which were under clinical development at the time of the study. Data were analysed using a latent class (LC) model to explore preference heterogeneity.Results: Overall, respondents considered improving symptom control and reducing risk of physical dependency to be the most important attributes. The LC analysis identified four participant classes: an 'efficacy-focused' class (33.7%), a 'cost-averse' class (29.4%), a 'physical-dependence-averse' class (19.6%) and a 'needle-averse' class (17.3%). Subgroup membership was incompletely predicted by participant age and their responses to comprehension questions.Conclusions: Preference heterogeneity across respondents indicates a need for a personalized approach to offering treatment options. Symptom improvement, cost, physical dependence and route of administration might be important to different patients.

Patient preferences in the treatment of chronic musculoskeletal pain: a systematic review of discrete choice experiments

“…Overall, 1, 26 6, 1,9,11,17,22,43 and 8 5,6,19,27,47,51,53,56 studies had low, moderate, and high risks of bias, respectively. The risk of bias assessment was presented in Table 2 and Appendix 3 (available as supplemental digital content at http://links.lww.com/PAIN/B714).…”

“…Most studies (n = 13) included patients with low back pain and/or osteoarthritis. 1,5,6,10,17,19,22,26,27,43,51,53,56 One study examined mixed types of chronic pain, 10 and one study examined Achilles tendon pain. 47 Regarding statistical analyses, 12 studies used the logit model, 1,5,6,10,17,19,22,26,27,47,51,53,56 2 used the probit model, 10,43 and 2 used the latent class model.…”

“…The frequencies of the top 3 important attributes are shown in Figure 2. Capacity to realize daily activities 5,9,19,22,26,43,51,53 and risk of adverse events 5,9,19,22,27,43,51,53 were among the top 3 important attributes in 75.00% and 87.5% of the models, whereas effectiveness on pain reduction was among the top 3 most important attributes in 100% of models. 5,6,9,19,22,26,43 Out-of-pocket cost was ranked among the top 3 most important attributes in 57.14% of the models.…”

“…Personal (out-of-pocket) cost per month: P , 0.05; Relative weight importance: 37.76%; (ranked 1/6) Injectable nerve growth factor inhibitors, NSAIDs, and opioids ($0, $30, $55, $75, $85, $110 every month) Walsh et al52 2022 Cost: Medication ($AUS 5, 20, 35, 50) Laba et al 27 2013…”

Preferences of patients with chronic low back pain about nonsurgical treatments: Results of a discrete choice experiment

“…Different treatments were studied such as pharmaceutical treatments 14 or both pharmaceutical and surgical treatments. 15 Moreover, acupuncture and low infrared treatments were studied by Chen et al, 16 physical exercises by Aboagye et al 17 and Ferreira et al, 18 and other pain management programmes by Yi et al 19 Finally, Walsh et al 20 made focus on treatments' adverse events. The most recurrent attributes were cost, time to effect (i.e., the onset of treatment effectiveness), type of treatment (i.e., modality, type of training, the content of the programme), frequency (i.e., the number of sessions), design (i.e., individually or in the group, the size of the group) and travel time (i.e., from the clinic or the gym).…”