Patient and retina specialists’ preferences in neovascular age-related macular degeneration treatment. A discrete choice experiment

Abstract

Introduction and objective Neovascular age-related macular degeneration (nAMD) leads to severe and permanent visual impairment, significantly impacting patients’ quality of life and functional independence. Although treatment with anti- vascular endothelial growth factor (VEGF) prevents and, in some cases, reverses visual damage, the need for frequent monitoring visits and intravitreal injections represents a significant burden on patients, caregivers and retina specialists. Objective To elicit preferences for nAMD treatment characteristics from the perspectives of patients and retina specialists. Method A discrete choice experiment was conducted. Participants (patients > 50 years with nAMD receiving anti-VEGF drugs for at least 2 years and without previous experience with anti-VEGF and retina specialists working in the Spanish National Healthcare System) were asked to select one of two hypothetical treatments resulting from the combination of five attributes (effects on visual function, effects on retinal fluid, treatment regimen, monitoring frequency, and cost); their levels were identified by reviewing the literature and two focus groups. The relative importance (RI) given to each attribute was estimated using a mixed logit model. The marginal rates of substitution (MRS) were calculated taking cost as the risk attribute. Results A total of 110 patients (P) [aged 79.0 (SD:7.4) years; 57.3% women; 2.3 (SD:0.7) years with nAMD; 2.1 years (SD:0.1) in treatment] and 66 retina specialists (RS) participated in the study. Participants gave greater RI to improvements in their visual function [60.0% (P); 52.7% (RS)], lower monitoring frequency [20.2% (P); 27.1% (RS)] and reduction in retinal fluid [9.8% (P); 13.0%(RS)]. Patients and retina specialists would agree to an increase in cost by 65.0% and 56.5%, respectively, in exchange for improvements of visual function; and 25.5% and 43.3% on delaying monitoring frequency by one month. Conclusions Efficacy of treatment, in terms of visual function improvements, is the main driver for treatment election for both patients and retina specialists. Treatment monitoring requirements are also considered, mainly from the retina specialist’s perspective. These results suggest that the use of more efficacious anti-VEGF agents with a longer duration of action may contribute to aligning treatment characteristics with patients/specialists’ preferences. A better alignment would facilitate better disease management, fulfilling the unmet needs of patients and retina specialists.

Factors affecting the treatment decision making of patients with wet age- related macular degeneration: A qualitative study in China

“…The decision-making process of patients with AMD is affected by many factors. Marion's and Mueller et al's [9][10][11] studies found that visual improvement, on-demand and less frequent injection programmes, inclusion of health insurance, side effects, respect for patients, provision of information to patients and encouragement of their participation in treatment decisions affect the participation of patients with AMD in treatment decisions to varying degrees at the medical staff level. Mueller et al [12] found that at the patient level, waiting time, treatment plan, treatment effect, and whether the condition worsened affect their participation in treatment decisions.…”