Abstract
Objective
Despite the increased availability of biologic treatments indicated for severe asthma, patient and physician preferences for these medications remains largely unknown. The purpose of this study was to understand perceptions of biologic therapies, barriers to care with biologic medications, and preferences for biologic therapy attributes.
Methods
This mixed-methods study involved quantitative surveys and qualitative telephone interviews with patients and physicians from the United States. Participants described preferences for relevant attributes, and barriers to use of biologic medications. Participants rated, ranked, and indicated importance of preferences for different levels of key attributes including: mode of administration, administration setting, dosing frequency, number of injections, and time to onset of effect. Other attributes unique to each group were also included.
Results
A total of 47 patients and 25 physicians participated. Patients ranked out-of-pocket costs, mode of administration, time to onset of efficacy, and administration setting as the most important attributes. Physicians ranked mode of administration, time to onset of efficacy, dosing frequency, and insurance reimbursement/access as most important. Both groups expressed preferences for less frequent administrations (Q8W over Q4W or Q2W) (all P<0.01) and subcutaneous (SC) over intravenous injection (both P<0.0001). Key patient barriers to biologic medications include location of treatment, administration time, scheduling, cost/insurance coverage, number of injections, and mode of administration. Physicians identified patient candidacy, convincing patients, administration setting, mode of administration, cost, and administrative burden as key barriers to initiating therapy; and efficacy, speed of onset, convenience of administration, cost, and patient compliance as barriers to staying on therapy.
Conclusions
Patients and physicians expressed strong preferences for less frequent dosing, SC administration, and faster onset. Cost/insurance coverage and convenience issues were key barriers to use. Increased awareness and understanding of preferences and barriers may be useful in facilitating physician-patient conversations with the goal of individualizing treatment.
Acknowledgments
The abstract of this paper was presented at the Academy of Managed Care Pharmacy (AMCP) Conference as a poster presentation with interim findings. The poster’s abstract was published in “Meeting Abstracts” as a supplement to Journal of Managed Care & Specialty Pharmacy: https://www.jmcp.org/doi/pdf/10.18553/jmcp.2018.24.4-a.s1. The abstract of this paper was also presented at the American Thoracic Society (ATS) International Conference as a poster presentation with final study results. The poster’s abstract was published in “Conference Abstracts” in American Journal of Respiratory and Critical Care Medicine: https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A5928. The authors would like to thank Melissa Ross, Katelyn Cutts, Regina Buachie, Kimmie McLaurin, and Kathleen M Fox for their assistance in executing the study. The authors would also like to thank Fritz Hamme and Emily Sargent for providing editing and production services in the development of the manuscript. This work was conducted by Evidera, an independent research organization and received research study support from AstraZeneca. The study was funded by AstraZeneca.
Ethics approval and informed consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Consent for publication
Informed consent was obtained from all individual participants included in the study.
Data sharing statement
Data are not publicly available, but may be provided upon request.
Abbreviations list
DCE, discrete choice experiment; HCP, health care practitioner; IV, intravenous; PFT, pulmonary function test; SC, subcutaneous; TENOR, Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens.
Author contributions
All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
Heather L Gelhorn and Zaneta Balantac are employees of Evidera. Christopher S Ambrose and Yen N Chung are employees of and own stock in AstraZeneca. Brian Stone is a member of Allergy Partners, which has received research support from ALK, AstraZeneca, Merck, and Novartis; he also participates in advisory boards and/or consults for ALK, AstraZeneca, Genentech, and Sanofi/Regeneron. He also acted as a consultant to AstraZeneca for another unrelated project. The authors report no other conflicts of interest in this work.