Real-world treatment preferences among health care providers in the United States in selecting disease modifying therapies for patients with multiple sclerosis: a discrete choice experiment

Abstract

Aims

Health care providers (HCPs) treating multiple sclerosis (MS) in clinical practice have numerous disease-modifying therapies (DMTs) to consider when evaluating treatment options. This study assessed the treatment preferences of HCPs in the United States, both direct (explicit) and derived (explicit and implicit), when selecting MS DMTs based on clinical and logistical treatment attributes.

Materials and methods

A 45-minute web-enabled questionnaire was administered to HCPs who manage patients with MS to assess the importance of treatment attributes. HCPs were recruited through an online panel. This study examined treatment attributes relevant to treatment decisions in MS, with a focus on the burden to HCPs and their staff, as well as HCP attitudes toward various aspects of MS care such as diagnosis, treatment prioritization, and ease of initiating or switching DMTs. The study also employed a discrete choice experiment (DCE) to assess direct and derived treatment preferences.

Results

The study recruited 145 HCPs. Direct assessments (a score of greater than 7.0 was considered important) suggested that safety (mean importance rating = 7.8/9) and relative risk reduction in relapses (7.6/9) and disability progression (7.5/9) were most important when selecting DMTs. In contrast, derived importance from the DCE (higher points corresponding to greater importance) suggested that logistical attributes such as dose frequency (mean relative attribute importance = 17.5%), dose titration (10.3%), formulation (9.4%), and volume of calls (9.1%) were important considerations, along with efficacy (16.5%), safety (9.8%), and gastrointestinal tolerability (9.4%).

Limitations

This study may have been subject to selection bias due to the application of eligibility criteria, the convenient sampling recruitment methodology, and recruitment of HCPs with internet access.

Conclusion

In the direct assessment, clinical attributes were chosen as the most important treatment attributes by HCPs. However, in the DCE, derived treatment decisions rated logistical attributes as also being as important in treatment choice.

PLAIN LANGUAGE SUMMARY

In this study, researchers aimed to understand what multiple sclerosis (MS) neurologists, nurse practitioners, and physician assistants think is most important when choosing medicines for their patients. They surveyed 145 health care providers (HCPs) in the United States for this study. The HCPs reported that safety and reducing the risk of relapses and disability were most important when selecting medicines. Additionally, the researchers used a method called a discrete choice experiment to determine the relative importance of medication characteristics to HCPs. They found that additional factors, such as how often the medicine needs to be taken, how it is given, and how easy it is to use, were also very important. The study may not represent the opinions of all HCPs due to the number of participants and participation criteria.

Keywords:

• Multiple sclerosis
• disease modifying therapy
• discrete choice experiment
• treatment preferences
• treatment prioritization

JEL CLASSIFICATION CODES:

• I12
• I1
• I
• I11

Transparency

Declaration of funding

This study was funded by Biogen, Cambridge, MA, USA.

Declaration of financial/other relationships

DB, consultant, and speaker bureaus for Biogen, EMD-Serono, Horizon, Janssen, Bristol Myers-Squibb, Sanofi Genzyme and Genentech; MA, consultant for Biogen and TG Therapeutics; MB, consultant for Biogen and Novartis; AG, consultant for Biogen, Novartis, Sanofi Genzyme, EMD Serono and Jansen. AA, BO, and NH are employees of Trinity Life Sciences. NH and AA hold equity in Trinity Life Sciences. JBL and SLS are employees of and hold stock or stock options in Biogen. CG and FB were employees of and held stock options in Biogen at the time of the study.

Author contributions

All authors contributed to the study concept and design. Study material preparation, data collection, analyses, and manuscript development were conducted by BO, AA, and NH. FB, CG, JBL, and SLS provided overall strategic guidance, reviewed materials, and critically revised the manuscript. DB, MA, MB, and AG provided expert guidance on designing the DCE grid and reviewed the work. All authors read and approved the final published version.

Acknowledgements

Iona Bartek, of Seshet Scribes LLC, provided medical writing services funded by Biogen. Data analysis support was provided by Josiah Edelblut, Harrison Malec, and Sarah Schneider from Trinity Life Sciences.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.