https://orcid.org/0000-0001-5221-0067
Abstract
Background
There is evidence of improved adherence and treatment outcomes when patients’ treatment preferences are considered, and shared decision making is utilized.
Purpose
We aimed to better understand treatment preferences among Australians with treatment-resistant depression (TRD), focusing on the specific treatment attributes that people value (such as effectiveness, risk of side effects and cost) and their relative importance. The risk-benefit trade-offs that characterize treatment choices were also examined.
Patients and Methods
An online survey of 75 patients with experience of TRD was conducted, consisting of two discrete choice experiment (DCE) components – a medication DCE and a treatment plan DCE. Participants were able to prioritize and trade off different features of medications and treatment plans. Additional questions aimed to better define this population group, which in Australia is poorly understood.
Results
In both DCEs, two distinct latent classes were identified. In the medication DCE, the classes were distinguished by willingness to consider new treatment alternatives. Participants in class 1 were reluctant to give up current treatment, while those in the slightly larger class 2 preferred new treatment options. In both classes, treatment effectiveness and cost were the greatest contributors to preference. Similar behavior was seen in the treatment plan DCE, with the larger class more likely to choose a new plan over their current treatment arrangement. Participants preferred medications that were low-cost, taken orally, had a high percentage improvement in mood symptoms, high rate of remission and low risk of weight gain. A similar result was found in preferences for treatment plans such that plans with the greatest effectiveness and lowest cost were most favorable.
Conclusion
Patient preferences should routinely be considered and discussed to guide informed decisions regarding the value of new and existing medications for TRD and how they sit in the context of treatment plans.
Graphical abstract
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Acknowledgments
The authors thank Anne Dyson, MBBS of WriteSource Medical Pty Ltd, Sydney, Australia, for providing medical writing services. Medical writing support was funded by Janssen Australia and New Zealand in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).
Disclosure
AP, VS and MA are employees of Janssen-Cilag, Australia and New Zealand. SF and AC are employees of CaPPRe, who were contracted by Janssen-Cilag to conduct the research. CaPPRe has consulted to AbbVie, Amgen, AstraZeneca, Celgene, GlaxoSmithKline, Ipsen, Roche, Sanofi and Shire outside of the submitted work. CHN has previously provided consulting services for Lundbeck, Grünbiotics, Servier, Janssen-Cilag and Eli Lilly; received research grant support from Wyeth and Lundbeck; and received speaker honoraria from Servier, Lundbeck, Bristol Myers Squib, Organon, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, AstraZeneca and Pfizer. JG received an hourly rate for reviewing patient suitability for the qualitative component of the study from CaPPRe Pty Ltd. She is also the principal investigator for a Janssen Cilag trial involving esketamine and reports honorarium for being part of the Janssen Cilag advisory board. The authors report no other conflicts of interest in this work.