Patient Preferences for Psoriasis Treatments

Abstract

To assess patients' preferences for psoriasis treatments and to identify the effect of sociodemographic and socioeconomic characteristics on these preferences.Design: A computer-based conjoint analysis experiment was conducted to analyze the preferences of individuals with moderate or severe psoriasis for outcome attributes (probability, magnitude, and duration of benefit, as well as probability, severity, and reversibility of adverse effects) and process attributes (treatment location, frequency, duration, delivery method, and individual cost) of psoriasis treatments. Relative importance scores (RISs) for each attribute were calculated. The effect of sociodemographic (age, sex, and marital status) and socioeconomic (income and employment) characteristics and Psoriasis Area and Severity Index and Dermatology Life Quality Index scores on preferences was assessed using analysis of variance, post hoc testing, and multivariate regression analysis.Setting: Outpatient dermatology clinic at a German university medical center.Participants: Patients with moderate or severe psoriasis (N=163).Main Outcome Measure: Relative importance scores for treatment attributes. Results:The attribute considered to be most important in patients' preferences for psoriasis treatments was treatment location (RIS, 26.76), followed by probability of benefit (RIS, 23.77) and method of delivery (RIS, 23.49). The RISs for all process attributes were higher than for adverse effect-related attributes. Older individuals (Ն65 years) were less concerned about the probability of benefit (␤=−0.24; P=.005) compared with younger individuals.Conclusions: When choosing among treatment options, individuals with psoriasis appear to be willing to accept treatment-related adverse effects to obtain process attributes compatible with their personal and professional life. Incorporating preferences in shared decision making may facilitate treatment adherence and optimize outcome.

Adherence, satisfaction and preferences for treatment in patients with psoriasis in the European Union: a systematic review of the literature

“…Five publications examined patient preferences for treatment; four of them described the results of a conjoint analysis based on a discrete choice experiment that aimed to analyze the preferences of individuals with moderate or severe psoriasis for outcome and process attributes42–45 (Table 3). In a study published by Schaarschmidt et al,42 the attribute regarded as most important was treatment location (where the treatment takes place) (relative importance score [RIS]: 26.76), followed by probability of benefit (RIS: 23.77) and method of delivery (RIS: 23.49).…”

“…In a study published by Schaarschmidt et al,42 the attribute regarded as most important was treatment location (where the treatment takes place) (relative importance score [RIS]: 26.76), followed by probability of benefit (RIS: 23.77) and method of delivery (RIS: 23.49). The RISs for all process attributes were higher than for adverse effect (AE)-related attributes, indicating that participants were willing to trade an increased risk of AEs for increased probability and magnitude of therapeutic benefit.…”

Evaluation of psoriasis patients’ attitudes toward benefit–risk and therapeutic trade-offs in their choice of treatments

“…These results were consistent with an earlier report by Seston et al27 who found that attributes such as adverse effects, time to improvement, and relapse time frames influence treatment choices of individuals with psoriasis. Although Seston et al found a preference for minimizing the risk of adverse events, Schaarschmidt et al, in a 2011 study,26 reported that patients were willing to trade an increased risk of adverse events for better therapeutic outcomes. Unlike our study, neither study considered the previous treatment history of patients and how this might impact decision making.…”

Patient Adherence to Biologic Agents in Psoriasis

“…Suboptimal management of psoriasis can cause considerable physical impairment and have a strong impact on the emotional and social well-being as well as the socioeconomic status of patients [4,5,6]. Previous research showed that nonadherence to drugs may be an important reason for unsatisfactory efficacy of the treatment.…”

“…Previous research showed that nonadherence to drugs may be an important reason for unsatisfactory efficacy of the treatment. Many patients, especially those with severe psoriasis, are dissatisfied with the management of their disease and frustrated by the perceived ineffectiveness of the treatments, resulting in a high level of dissatisfaction and low adherence to treatments [4]. The rate of nonadherence may be as high as 40% of individuals with psoriasis [7].…”