A discrete choice experiment to determine patient preferences for injection devices in multiple sclerosis

Abstract

Objective:

Relapsing-remitting multiple sclerosis (MS) is usually managed with disease modifying drugs (DMDs), most commonly administered via self-injection. The aim of this study was to estimate the influence that different treatment-related attributes have for MS patients on their choice of MS DMD device. By establishing the relative importance of these characteristics for patients it should be possible to better understand the acceptability of a given device and to optimize the development of future devices.

Methods:

A discrete choice experiment (DCE) survey was developed on the basis of a review of published literature. Attributes identified for inclusion in the survey were: ease of use; comfort of use; presence of additional functions, needle visibility; practicality and efficacy. Choice sets were presented as pairs of hypothetical treatments based upon a fractional factorial design. One-hundred device-using MS patients completed the survey online. Analysis was conducted using a mixed-logit approach.

Results:

Analysis of the DCE data revealed that all attributes significantly predicted treatment choice. Efficacy exhibited the largest effect on treatment selection and this provided context for understanding the magnitude of impact for the other attributes. Reducing the discomfort associated with device use and eliminating the necessity for assembly or drug reconstitution were highly valued. The addition of reminder and time-stamping functions, improved needlestick injury prevention, and reduction in device size were secondary concerns but still deemed desirable.

Conclusion:

Efficacy is of primary importance to MS patients, but characteristics of drug delivery devices can play an important role in treatment decision-making. Not all device characteristics could be included, and results are based upon 100 participants only. Findings suggest there is significant potential value in developing self-injection devices that are not only efficacious but also convenient and comfortable to use. Reducing barriers to adherence could potentially translate into improved treatment outcomes for patients with MS.

Keywords::

• Multiple sclerosis
• Patient preference
• Discrete choice experiment
• Health-related quality-of-life

Transparency

Declaration of funding

This study was funded by Merck Serono.

Declaration of financial/other relationships

Sarah Shingler, Paul Swinburn, Shehzad Ali, and Andrew Lloyd have disclosed that they are all employees of Oxford Outcomes, an ICON plc Company that received funding from Merck Serono to conduct this research. Rodolphe Perard has disclosed that he is an employee of Merck Serono. JME Peer Reviewers on this manuscript have no financial or other relationships to disclose.