Patient Preferences for Biologic Agents in Rheumatoid Arthritis: A Discrete-Choice Experiment

Augustovski, Federico; Beratarrechea, Andrea; Irazola, Vilma; Rubinstein, Fernando; Tesolin, Pablo Daniel; Gonzalez, Juan Marcos; Lencina, Verónica; Scolnik, Marina; Waimann, Christian A.; Navarta, David A.; Citera, Gustavo; Soriano, Enrique R.

doi:10.1016/j.jval.2012.11.007

Cited by 76 publications

(73 citation statements)

References 38 publications

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“…However, findings by Augustovski et al,43 who used frequencies of administration that resembled our levels more closely (eg, “every day” as highest frequency) clearly contradict our findings. However, methodological differences between their study and ours could explain these divergent findings: while we excluded unrealistic level combinations (such as twice-daily infusions), Augustovski et al included all theoretically possible combinations in their design.…”

Section: Discussioncontrasting

confidence: 97%

“…Similarly to our results, they demonstrated a preference for pills over parenteral (IV) routes of administration in RA patients. Our findings are thus generally in line with their study,43 and add to similar findings with other diseases using different methodologies 11–13. However, the ability of Augustovski et al43 to quantify exactly the relative importance of oral administration was limited, due to the coding procedure they used.…”

Section: Discussionsupporting

confidence: 91%

“…In fact, a highly implausible combination was even used as reference case (“an oral agent taken every 10 months”), which has been previously noted to interfere with reasonable trade-offs 30. Moreover, Augustovski et al43 included some entirely different attributes than our study, ie, cost and efficacy. Cost was not used in our DCE, as this attribute would be difficult to judge by our sample (in the German health care system, patients do not need to pay their RA treatment out of pocket); similarly, efficacy was not considered in our design, as it does not differ between relevant second-line treatments 9…”

Section: Discussionmentioning

confidence: 99%

“…Augustovski et al43 were the only ones to include oral administration in their DCE. Similarly to our results, they demonstrated a preference for pills over parenteral (IV) routes of administration in RA patients.…”

Section: Discussionmentioning

confidence: 99%

“…With regard to frequency of administration, the authors found a linear increase in preferences with lower frequencies, ie, every 8 weeks was most preferred and twice daily was least preferred. Notably, as in Augustovski et al,43 Louder et al45 included costs and efficacy parameters in their design – which we excluded for the reasons mentioned earlier – and did not control for implausible level combinations in their design (eg, “oral intake once every 8 weeks”). Such design differences may well account for the divergent findings relative to our study.…”

Section: Discussionmentioning

confidence: 99%

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Examining patient preferences in the treatment of rheumatoid arthritis using a discrete-choice approach

Alten¹,

Krüger²,

Rellecke³

et al. 2016

PPA

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BackgroundBiological disease-modifying antirheumatic drugs (bDMARDs) used in second-line treatment of rheumatoid arthritis (RA) are administered parenterally. However, so-called targeted synthetic DMARDs (tsDMARDs) – developed more recently – offer alternative (ie, oral) administration forms in second-line treatment. Since bDMARDs and tsDMARDs can be regarded as equal in terms of efficacy, the present study examines whether such characteristics as route of administration drive RA patients’ treatment choice. This may ultimately suggest superiority of some second-line DMARDs over equally effective options, at least according to RA-patient preferences.ObjectiveThe current study assessed the importance of oral administration among other treatment characteristics differing between available second-line DMARDs for RA patients’ preferences using a discrete-choice experiment (DCE).Materials and methodsThe DCE involved scenarios of three hypothetical treatment options in a d-efficient design with varying levels of key attributes (route and frequency of administration, time till onset of drug effect, combination therapy, possible side effects), as defined by focus groups. Further patient characteristics were recorded by an accompanying questionnaire. In the DCE, patients were asked to choose best and worst options (best–worst scaling). Results were analyzed by count analysis and adjusted regression analysis.ResultsA total of 1,588 subjects completed the DCE and were eligible for final analyses. Across all characteristics included in the DCE, “oral administration” was most desired and “intravenous infusion” was most strongly rejected. This was followed by “no combination with methotrexate” being strongly preferred and “intake every 1–2 weeks” being strongly rejected. On average, levels of route of administration showed strongest influences on patients’ decisions in post hoc bootstrapping analysis.ConclusionAccording to the results, an oral DMARD that does not have to be combined with methotrexate and is not administered (only) every 1–2 weeks appears a highly favorable treatment option for patients with RA. DMARDs meeting these preferences may increase compliance and adherence in RA treatment.

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Section: Discussioncontrasting

confidence: 97%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Examining patient preferences in the treatment of rheumatoid arthritis using a discrete-choice approach

Alten¹,

Krüger²,

Rellecke³

et al. 2016

PPA

View full text Add to dashboard Cite

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Use and Spending for Biologic Disease‐Modifying Antirheumatic Drugs for Rheumatoid Arthritis Among US Medicare Beneficiaries

Yazdany

Tonner

Schmajuk

2015

Arthritis Care & Research

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Objectives Biologic therapies have assumed an important role in treating rheumatoid arthritis (RA). We sought to investigate use, spending, and patient cost-sharing for Medicare beneficiaries using biologic drugs for RA, comparing patients exposed to minimal cost-sharing because of a Part D low-income subsidy (LIS) to those facing substantial out-of-pocket costs (OOP). Methods We performed a retrospective, nationwide study using 2009 Medicare claims for a 5% random sample of beneficiaries with RA who had at least one RA drug dispensed. We analyzed biologic drug utilization and costs across the Part B (medical benefit) and Part D (pharmacy benefit) programs by LIS status using multinomial regression. We also projected OOP costs as the Affordable Care Act (ACA) mandates closure of the Part D coverage gap by 2020. Results Among 6932 beneficiaries, 1812 (26.1%) received a biologic drug. LIS beneficiaries were significantly more likely to obtain Part D home-administered biologics (RRR 2.98, 95% CI 2.50–3.56), while non-LIS beneficiaries were less likely to receive Part D biologics (RRR 0.58, 95% CI 0.48–0.69). OOP costs in Part D were lower, as expected, for LIS beneficiaries ($72 vs. $3,751/year for non-LIS). Non-LIS beneficiaries had lower costs for Part B facility-administered biologics (range $0–$2,584) than for Part D home-administered biologics. ACA reforms will narrow OOP differences between Part D and B for non-LIS beneificiaries. Conclusions In contrast to LIS beneficiaries who receive mostly Part D home-administered biologic DMARDs, non-subsidized beneficiaries have significant cost-based incentives to obtain facility-administered biologic DMARDs through Part B. The ACA will result in only slightly lower costs for Part D biologic drugs for these beneficiaries.

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Preferences for Biologic Treatment in Patients With Psoriatic Arthritis: A Discrete Choice Experiment

Sumpton

Kelly

Craig

et al. 2022

Arthritis Care & Research

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Objective. We aimed to assess patient preferences for the characteristics and outcomes of biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) to manage psoriatic arthritis.Methods. We conducted a discrete choice experiment in patients with psoriatic arthritis from 3 rheumatology centers in Sydney, Australia. We assessed preferences for different attributes of biologic medications. The route and frequency of medications had a range of 5 levels, and the following 7 attributes had a range of 3 levels: the ability to attend to normal activities, improvements in joint pain, enthesitis and skin disease, chance of disease remission, risk of infection, and risk of severe adverse events. Multinomial logit models including a latent class model were used to calculate preferences.Results. Of the 150 participants, 58.3% were female, with a median age of 53.5 years. The attributes in order of preference using the β coefficient in absolute values (95% confidence interval [95% CI]) were as follows: oral route compared to subcutaneous and intravenous routes (β coefficient 1.00 [fixed parameter]), avoiding severe side effects (β coefficient 0.72 [95% CI 0.50, 0.95]), increasing ability to attend to normal activities (β coefficient 0.66 [95% CI 0.36, 0.96]), avoiding infections (β coefficient 0.38 [95% CI 0.23, 0.53]), improvement in enthesitis pain (β coefficient 0.28 [95% CI 0.20, 0.36]), improvement in psoriasis (β coefficient 0.28 [95% CI 0.20, 0.36]), increasing chance of remission (β coefficient 0.27 [95% CI 0.19, 0.36]), and improvement in joint pain (β coefficient 0.26 [95% CI 0.00, 0.52]).Conclusion. When choosing biologic medications, patients with psoriatic arthritis preferred oral medications. Patients prioritized avoiding severe complications, maintaining the ability to attend to work and normal activities, and avoiding infection over clinical measures of efficacy.

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Patient Preferences for Biologic Agents in Rheumatoid Arthritis: A Discrete-Choice Experiment

Cited by 76 publications

References 38 publications

Examining patient preferences in the treatment of rheumatoid arthritis using a discrete-choice approach

Examining patient preferences in the treatment of rheumatoid arthritis using a discrete-choice approach

Use and Spending for Biologic Disease‐Modifying Antirheumatic Drugs for Rheumatoid Arthritis Among US Medicare Beneficiaries

Preferences for Biologic Treatment in Patients With Psoriatic Arthritis: A Discrete Choice Experiment

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