What is clearance worth? Patients’ stated risk tolerance for psoriasis treatments

Abstract

Purpose: The purpose of this study was to provide quantitative evidence of patients’ tolerance for therapeutic risks associated with psoriasis treatments that could offer psoriasis improvements beyond the PASI 75 benchmark.

Materials and methods: We used a discrete-choice experiment in which respondents chose between competing psoriasis treatments characterized by benefits (i.e. reduced plaque severity, reduced plaque area), risks (i.e. 10-year risk of tuberculosis, 10-year risk of death from infection), and treatment regimen. We analyzed choice data using random-parameters logit models for psoriasis affecting the body, face, or hands.

Results: Of 927 eligible members of the National Psoriasis Foundation who completed the survey, 28% were unwilling to accept any greater risk of treatment-related infection mortality. Among the remaining 72%, respondents were willing to accept higher risks of infection-related mortality associated with treatment to completely remove plaques covering only 1% of the body, compared to reducing lesions from 10 to 1% of the affected area. This finding was more pronounced for lesions on the face.

Conclusions: Most patients placed greater value on eliminating even very small plaques compared to avoiding treatment-related risks. The perceived importance of complete versus near-complete clearance was stronger than previously documented.

Keywords:

• Psoriasis
• skin clearance
• patient preferences
• discrete-choice experiment
• benefit-risk
• tradeoffs

Acknowledgements

The authors acknowledge the Eli Lilly and Company study team (listed below), as well as Michael Siegel, PhD, director of research programs at the National Psoriasis Foundation; David van Veen, BA, former associate director of digital strategy at the National Psoriasis Foundation; and Catie Coman, MA, former vice president of marketing and communications at the National Psoriasis Foundation. The authors extend special thanks to the members of the National Psoriasis Foundation who completed the study survey.

Members of the Eli Lilly and Company study team: Russel Burge, PhD, senior research advisor, global patient outcomes and real-world evidence; Jillian Venci Fuhs, PharmD, JD, RPh, regulatory consultant; Stacy Holdsworth, PharmD, senior regulatory advisor; Chin H. Lee, MD, MPh, senior medical director, immunology; John R. Richards, RPh, advisor, global advocacy and professional relations; Sarah al Sawah Folian, PhD, research scientist, United States real-world outcomes; Kathleen Solotkin, MSN, senior clinical research scientist, dermatology and inflammation medical affairs; Joy Somerset, MBA, market research consultant, autoimmune; Brian Wagner, PharmD, regulatory advisor; Robin Pitts Wojcieszek, RPh, senior regulatory advisor.

Disclosure statement

Eli Lilly and Company provided a monetary contribution to the National Psoriasis Foundation on behalf of respondents for each completed survey in this study. G.A., A.M.W., and R.A.N are employees and shareholders of Eli Lilly and Company. S.D.R has made available online detailed listings of financial disclosures at https://www.dcri.org/about-us/conflict-of-interest/.

Additional information

Funding

This study was supported by a research agreement between Eli Lilly and Company and Duke University.