The importance of understanding patient and physician preferences for psoriasis treatment characteristics: a systematic review of discrete-choice experiments

Figures & data

Figure 1. Selection and screening process referenced from Liberati et al.²⁶

Table 1. List of discrete choice experiment studies included in the systematic literature review of patient and physician preferences; including general characteristics of the studies.

Study	Author	Publication year	Country	Subjects included	Sample size	DCE design characteristics	Industry funded
Trade-offs between the benefits and risks of drug treatment for psoriasis: a discrete choice experiment with U.K. dermatologists.	Ashcroft et al.	2006	United Kingdom	Practicing Dermatologists in the UK who are members of the British Association of Dermatologists (BAD)	227	2 sets of 8 choice sets 6 Attributes 2 Alternatives	No
Balancing the benefits and risks of drug treatment: a stated-preference, discrete choice experiment with patients with psoriasis.	Seston et al.	2007	United Kingdom	Patients with Psoriasis	126	2 sets of 8 choice sets 6 Attributes 2 Alternatives	No
The value to patients of reducing lesion severity in plaque psoriasis.	Hauber et al.	2011	United States	Patients with a self-reported diagnosis of plaque psoriasis from a nationally representative US household panel	419	9 choice sets 6 Attributes 2 Alternatives	Yes
Patient preferences for psoriasis treatments: process characteristics can outweigh outcome attributes.	Schaarschmidt et al.	2011	Germany	Patients with moderate-to-severe psoriasis according to the criteria of the Committee for Medicinal Products for Human Use	163	24 choice sets 11 Attributes 2 Alternatives	No
Comorbidities significantly impact patients’ preferences for psoriasis treatments.	Schmieder et al.	2012	Germany	Patients with moderate-to-severe psoriasis according to the criteria of the Committee for Medicinal Products for Human Use	163	24 choice sets 11 Attributes 2 Alternatives	No
It is not always about gains: utilities and disutilities associated with treatment features in patients with moderate-to-severe psoriasis.	Umar et al.	2012	Germany	Patients with moderate-to-severe psoriasis according to the criteria of the Committee for Medicinal Products for Human Use	163	24 choice sets 11 Attributes 2 Alternatives	No
Patient preferences for psoriasis treatments: impact of treatment experience.	Schaarschmidt et al.	2013	Germany	Patients with moderate-to-severe psoriasis according to the criteria of the Committee for Medicinal Products for Human Use	163	24 choice sets 11 Attributes 2 Alternatives	No
Matching physicians’ treatment recommendations to patients’ treatment preferences is associated with improvement in treatment satisfaction.	Umar et al.	2013	Germany	Patients with moderate-to-severe psoriasis according to the criteria of the Committee for Medicinal Products for Human Use	132	24 choice sets 11 Attributes 2 Alternatives	No
Eliciting preferences to inform patient-centered policies: the case of psoriasis.	Torbica et al.	2014	Italy	Patients with moderate-to-severe plaque-type psoriasis	244	27 choice sets 5 Attributes 2 Alternatives	Yes
Psoriasis patients’ willingness to accept side-effect risks for improved treatment efficacy.	Kauf et al.	2015	United States	Patients with a self-reported physician diagnosis of plaque psoriasis	1,608	48 choice sets 6 Attributes 2 Alternatives	Yes
Patient preferences for treatment of psoriasis with biologicals: A discrete choice experiment.	Kromer et al.	2015	Germany	Patients with moderate-to-severe psoriasis according to the criteria of the Committee for Medicinal Products for Human Use	200	24 choice sets 11 Attributes 2 Alternatives	No
Patient preferences for biologicals in psoriasis: Top priority of safety for cardiovascular patients.	Schaarschmidt et al.	2015	Germany	Patients with moderate-to-severe psoriasis according to the criteria of the Committee for Medicinal Products for Human Use	200	24 choice sets 11 Attributes 2 Alternatives	No
A discrete choice experiment to explore patients’ willingness to risk disease relapse from treatment withdrawal in psoriatic arthritis.	Rothery et al.	2016	United Kingdom	PsA patients considered to have minimal disease activity on the Bradford Psoriatic Arthritis Disease Register	136	12 choice sets 3 Attributes 2 Alternatives	No
Dermatologist and patient preferences in choosing treatments for moderate-to-severe psoriasis.	Alcusky et al.	2017	United States	Physicians that both specialize in and are board-certified/eligible in dermatology – Patients with moderate to severe psoriasis based on self-report of symptoms	200 Physicians 196 patients	16 choice sets 7 Attributes 3 Alternatives	Yes
Evaluation of psoriasis patients’ attitudes toward benefit-risk and therapeutic trade-offs in their choice of treatments.	Eliasson et al.	2017	United Kingdom	Patients with formal psoriasis diagnosis and 3+ palm areas or 3% of body surface area (BSA) affected	292	32 choice sets 6 Attributes 2 Alternatives	Yes
What is clearance worth? Patients’ stated risk tolerance for psoriasis treatments.	Fairchild et al.	2017	United States	Patients with a physician confirmed diagnosis of psoriasis	927	40 choice sets 5 Attributes 2 Alternatives	Yes
Patient preference on psoriasis treatment in a Philippine Tertiary Hospital: A conjoint analysis.	Guevara et al.	2017	Philippines	Patients clinically diagnosed with moderate-to-severe psoriasis according to Psoriasis Area and Severity Index (PASI) score	62	18 choice sets 7 Attributes 2 Alternatives	No
Comparing preferences for outcomes of psoriasis treatments among patients and dermatologists in the UK: Results from a discrete-choice experiment.	Gonzalez	2017	United Kingdom	Patients that had moderate-to-severe psoriasis corroborated using a DLQI questionnaire	174 patients 100 dermatologists	48 choice sets 5 Attributes 2 Alternatives	Yes
Treatment preferences for biologicals in psoriasis: Experienced patients appreciate sustainability.	Kromer et al.	2017	Germany	Patients with moderate-to-severe psoriasis according to the criteria of the Committee for Medicinal Products for Human Use	200	24 choice sets 11 Attributes 2 Alternatives	No
Patient and physician preferences for therapy characteristics for psoriasis: A discrete choice experiment in Japan.	Bolt et al.	2018	Japan	Patients with diagnosis at least a year and are actively receiving treatment + moderate or severe – Physicians having to treat moderate-to-severe psoriasis patients each month	306 patients 161 physicians	16 choice sets 7 Attributes 2 Alternatives	Yes
Patient preference study for different characteristics of systemic psoriasis treatments (Protimisis).	Rigopoulos et al.	2018	Greece	Patients diagnosed moderate/severe plaque-type psoriasis for at least 1 year	310	18 choice sets 5 Attributes 2 Alternatives	Yes
Patients’ and physicians’ preferences for systemic psoriasis treatments: A mationwide comparative discrete choice experiment (PsoCompare).	Schaarschmidt et al.	2018	Germany	Patients with moderate-to-severe psoriasis according to the criteria of the Committee for Medicinal Products for Human Use – Physicians	222 Patients 78 Physicians	24 choice sets 10 Attributes 2 Alternatives	No
Patient preferences associated with therapies for psoriatic arthritis: A conjoint analysis.	Xu et al.	2018	United States	Patients had to have at least 2 diagnoses of PsA	258 patients in Medicare plans 210 patients in commercial plans	10 Choice sets 7 Attributes 2 Alternatives	Yes
Patient-reported outcomes are important elements of psoriasis treatment decision making: a discrete choice experiment survey of dermatologists in the United States.	Feldman et al.	2019	United States	Dermatologists or internists specializing in dermatology participating in clinical practice for at least 3 years	259	Not clear how many choice sets 6 Attributes 3 Alternatives	Yes
Patient preference for biologic treatments of psoriasis in Japan.	Tada et al.	2019	Japan	Patients with self-reported diagnosis of psoriasis and currently receiving treatment	395	16 choice sets 6 Attributes 2 Alternatives	Yes

Table 2. Quality assessment of the DCE studies included in the review according to both PREFS and ISPOR quality checklists.

Study	PREFs					ISPOR checklist				Final score
	Purpose	Respondents	Explanation	Findings	Significance	Attributes and levels	Construction of tasks	Experimental design	Preference elicitation
Ashcroft et al.^46	1	0	1	0.5	1	0.5	1	0.5	1	6
Seston et al.^47	1	0	1	0	1	1	1	0.5	1	6.5
Hauber et al.^48	1	0	1	0.5	0	1	1	0	1	4.5
Schaarschmidt et al.^20	1	0	1	1	1	0	1	0	1	6
Schmieder et al.^49	1	0	1	1	1	0	1	0	1	6
Umar et al.^50	1	0	1	1	1	1	1	0	0.5	6.5
Schaarschmidt et al.^51	1	0	1	1	1	0	1	0	1	6
Umar et al.^5	1	0	1	1	1	1	1	1	1	8
Torbica et al.^52	1	0.5	1	0.5	1	1	1	1	1	8
Kauf et al.^21	1	0	1	0.5	1	1	1	0.5	1	7
Kromer et al.^35	1	0	1	1	1	1	1	1	1	8
Schaarschmidt et al.^22	1	0	1	1	1	0.5	1	0.5	1	7
Rothery et al.^36	1	0	1	0.5	1	1	1	1	1	7.5
Alcusky et al.^17	1	0.5	1	1	1	1	1	1	1	8.5
Eliasson et al.^37	1	0	1	1	1	1	1	1	1	5
Fairchild et al.^38	1	0	1	0.5	1	1	1	0	1	6.5
Guevara et al.^39	1	0	1	1	1	1	1	1	1	8
Gonzalez^40	1	0	1	0.5	1	0	0	0.5	1	5
Kromer et al.^53	1	0	1	1	1	1	1	1	1	8
Bolt et al.^41	1	0.5	1	1	1	1	1	1	1	8.5
Rigopoulos et al.^54	1	1	0	0	1	1	1	0.5	1	6.5
Schaarschmidt et al.^42	1	0	1	1	1	1	1	1	1	8
Xu et al.^43	1	0	0.5	1	1	0	1	0	1	5.5
Feldman et al.^44	1	1	1	0.5	1	1	0	0	1	6.5
Tada et al.^45	1	0	1	1	1	1	1	1	1	8
Total	25	3.5	23.5	18.5	24	19	23	14	24.5
Percentage	100%	14%	94%	74%	96%	76%	92%	56%	98%

Table 3. Quality assessment continued.

Author	Literature/clinical trials used to attribute selection	Focus groups (Pts/MDs) used for attribute selection	Pilot tested?	Attribute number	Visual representation of attribute	Subgroup analysis?
Ashcroft et al.^46	Yes	Yes	No	6	No	No
Seston et al.^47	Yes	Yes	No	6	No	No
Hauber et al.^48	Yes	Yes	No	6	Yes	No
Schaarschmidt et al.^20	Yes	Yes	No	11 (2 groups)	No	Yes
Schmieder et al.^49	Reference another study	Yes	No	11 (2 groups)	no	Yes
Umar et al.^50	Yes	Yes	No	11 (2 groups)	No	Yes
Schaarschmidt et al.^51	Reference another study	Yes	No	11 (2 groups)	No	Yes
Umar et al.^5	Yes	Yes	Yes	11 (2 groups)	No	No
Torbica et al.^52	Yes	Yes	Yes	5	no	Yes
Kauf et al.^21	Yes	Yes	No	6	Yes	Yes
Kromer et al.^35	Yes	Yes	No	11 (2 groups)	No	Yes
Schaarschmidt et al.^22	Reference another study	Yes	No	11 (2 groups)	No	Yes
Rothery et al.^36	Yes	Yes	No	3	No	No
Alcusky et al.^17	Yes	Yes	No	7	Yes	No
Eliasson et al.^37	Yes	Yes	Yes	6	Yes	Yes
Fairchild et al.^38	Reference another study	Yes	No	5	Yes	No
Guevara et al.^39	Yes	Yes	No	7	No	Yes
Kromer et al.^53	Reference another study	Yes	No	5	No	Yes
Gonzalez^40	Yes	Yes	Yes	11	Yes	No
Bolt et al.^41	Yes	Yes	Yes	7	yes	Yes
Rigopoulos et al.^54	Yes	Yes	No	5	No	Yes
Schaarschmidt et al.^42	Yes	Yes	Yes	10 (2 groups)	No	Yes
Xu et al.^43	Yes	No	No	7	No	No
Feldman et al.^44	Yes	Yes	No	6	No	No
Tada et al.^45	Yes	Yes	No	6	No	Yes
Total	100%	96%	24%	191 (average of 7.6/study)	28%	60%

Figure 2. The final categorization of all the attributes included in the 25 DCE studies evaluated in this review.

Figure 3. Identification of the most and second most important treatment attributes, differentiated by outcome only, outcome and process and outcome, process and cost studies.

Table 4. Identification of the most and second most important attributes for each of the 25 studies included.

Study	Category	Attribute layout	Most important attribute (raw)	Most important attribute (categorized)	Second most important attribute (raw)	Second most important attribute (categorized)	Relative importance included in study
Ashcroft et al.^46	Physicians	Outcome Only	Time to moderate Improvement (weeks)	Response Speed	Risk of Skin Cancer	Serious Adverse Event	No
Seston et al.^47	PSO Patients	Outcome Only	Time to moderate Improvement (weeks)	Response Speed	Risk of Skin Cancer	Serious Adverse Event	No
Hauber et al.^48	PSO Patients	Process + Outcome + Cost	BSA affected after receiving treatment	Response Rate	Type of Treatment + Associated Experience	Process Attribute	No
Schaarschmidt et al.^20	PSO Patients	Process + Outcome + Cost	Treatment Location	Process Attribute	Probability of Benefit	Response Rate	Yes
Schmieder et al.^49	PSO Patients	Process + Outcome + Cost	Treatment Location	Process Attribute	Probability of Benefit	Response Rate	Yes
Umar et al.^50	PSO Patients	Process + Outcome + Cost	Treatment Location	Process Attribute	Probability of Benefit	Response Rate	Yes
Schaarschmidt et al.^51	PSO Patients	Process + Outcome + Cost	Treatment Location	Process Attribute	Probability of Benefit	Response Rate	Yes
Umar et al.^5	PSO Patients	Process + Outcome + Cost	Treatment Location	Process Attribute	Probability of Benefit	Response Rate	Yes
Torbica et al.^52	PSO Patients	Process + Outcome + Cost	Time Free of Symptoms	Response Maintenance	Reduced Life Expectancy	Severe Adverse Event	No
Kauf et al.^21	PSO Patients	Outcome Only	BSA Covered by PSO (after treatment)	Response Rate	Risk of lymphoma	Serious Adverse Event	No
Kromer et al.^35	PSO Patients	Process + Outcome	Risk of Severe AE	Serious Adverse Event	Probability of 90% improvement	Response Rate	Yes
Schaarschmidt et al.^22	PSO Patients	Process + Outcome	Risk of Severe AE	Serious Adverse Event	Probability of 90% improvement	Response Rate	Yes
Rothery et al.^36	PsA Patients	Outcome Only	Side effect of nausea or sickness from treatment	Mild Adverse Event	Health-related quality-of-life	Quality-of-life	No
Alcusky et al.^17	Physicians (moderate PSO)	Process + Outcome	Dosing frequency and format	Process Attribute	Probability of Improvement (PASI)	Response Rate	Yes
Alcusky et al.^17	Moderate PSO Patients	Process + Outcome	Dosing frequency and format	Process Attribute	Probability of Improvement (PASI)	Response Rate	Yes
Alcusky et al.^17	Physicians (severe PSO)	Process + Outcome	Probability of Improvement (PASI)	Response Rate	Dosing frequency and format	Process Attribute	Yes
Alcusky et al.^17	Severe PSO Patients	Process + Outcome	Probability of Improvement (PASI)	Response Rate	Probability that quality-of-life will improve	Quality-of-life	Yes
Eliasson et al.^37	PSO Patients	Process + Outcome	Increased risk of serious infection	Serious Adverse Event	Increased Risk of melanoma or NMSC	Serious Adverse Event	No
Fairchild et al.^38	PSO Patients	Process + Outcome	% Body Surface Area	Response Rate	10-year mortality risk	Serious Adverse Event	No
Guevara et al.^39	PSO Patients	Process + Outcome + Cost	Duration of Benefit	Response Maintenance	Frequency of Treatment	Process Attribute	Yes
Gonzalez^40	PSO Patients	Outcome Only	% BSA on Chest and Back	Response Rate	% BSA on Arms and Legs	Response Rate	No
Gonzalez^40	Physicians	Outcome Only	10-year Lymphoma Risk	Serious Adverse Event	% BSA on Arms and Legs	Response Rate	No
Kromer et al.^53	PSO Patients	Process + Outcome	Probability of severe AE	Serious Adverse Event	Probability of 90% improvement	Response Rate	Yes
Bolt et al.^41	PSO Patients	Process + Outcome	PASI 90%	Response Rate	Injection Type	Process Attribute	No
Bolt et al.^41	Physicians	Process + Outcome	PASI 90%	Response Rate	Risk AE	Serious Adverse Event	No
Rigopoulos et al.^54	PSO Patients	Process + Outcome + Cost	Onset of Action (in months)	Response Speed	Risk of SAEs	Serious Adverse Event	No
Schaarschmidt et al.^42	Physicians	Process + Outcome + Cost	PASI 90 response	Response Rate	Probability of Severe AE	Serious Adverse Event	Yes
Schaarschmidt et al.^42	PSO Patients	Process + Outcome + Cost	PASI 90 response	Response Rate	Probability of Mild AE	Mild Adverse Event	Yes
Xu et al.^43	Medicare PSO Patients	Process + Outcome + Cost	Route of Administration	Process Attribute	Improvement in daily tasks and activities	Quality of Life	No
Xu et al.^43	Commercially insured PSO Patients	Process + Outcome + Cost	Cost to patients	Cost	Route of Administration	Process Attribute	No
Feldman et al.^44	Physicians	Process + Outcome	Reduction in PASI (90%)	Response Rate	Combination of 3 patient-reported outcomes (itching/performance of activities/depression	Quality of Life	Yes
Tada et al.^45	PSO Patients	Process + Outcome + Cost	Sustained efficacy after drug withdrawal	Response Maintenance	Dosing Convenience	Process Attribute	Yes

Appendix A. Frequency of general characteristics of studies included by category

Characteristic	Category	Number of studies (n)	Percentage of total study sample
Country	Germany	9	36%
	Greece	1	4%
	Italy	1	4%
	Japan	2	8%
	Philippines	1	4%
	United Kingdom	5	20%
	United States	6	24%
Publication year	2000–2004	0	0%
	2005–2009	2	8%
	2010–2014	7	28%
	2015–2017	10	40%
	2018–Current	6	24%
Target population	All psoriasis patients	6	24%
	Moderate-to-severe psoriasis patients	11	44%
	Psoriatic arthritis patients	2	8%
	Dermatologists and physicians (only)	2	8%
	Both patients and physicians	4	16%
Population sample size – physician-studies	0–150	2	33.3%
	151–300	4	66.6%
	301+	0	0%
Population sample size – patient-studies	0–150	4	17.4%
	151–300	12	52.2%
	301+	7	30.4%

Appendix C. The distribution of all attributes by category for each of the 25 DCE studies included in this review

References	Attributes (total)	Outcome	Process	Cost	Outcome efficacy				Outcome safety			Process						Cost
					Quality-of-life	Speed of response	Response rate	Maintenance ofresponse (Sustainability)	Serious adverse event	Mild adverse event	AE Management	Location	Frequency	Duration	Delivery method	Combination	Other
Ashcroft et al.^46	6	6	0	0	0	1	0	1	2	2	0	0	0	0	0	0	0	0
Seston et al.^47	6	6	0	0	0	1	0	1	2	2	0	0	0	0	0	0	0	0
Hauber et al.^48	6	3	2	1	0	0	2	0	1	0	0	0	0	0	0	1	1	1
Schaarschmidt et al.^20	11	6	4	1	0	0	2	1	0	1	2	1	1	1	1	0	0	1
Schmieder et al.^49	11	6	4	1	0	0	2	1	0	1	2	1	1	1	1	0	0	1
Umar et al.^50	11	6	4	1	0	0	2	1	0	1	2	1	1	1	1	0	0	1
Schaarschmidt et al.^51	11	6	4	1	0	0	2	1	0	1	2	1	1	1	1	0	0	1
Umar et al.^5	11	6	4	1	0	0	2	1	0	1	2	1	1	1	1	0	0	1
Torbica et al.^52	5	3	1	1	0	1	0	1	1	0	0	0	0	0	0	1	0	1
Kauf et al.^21	6	5	1	0	0	0	2	0	3	0	0	0	0	0	0	0	1	0
Kromer et al.^35	11	7	4	0	0	1	3	1	1	1	0	1	1	1	1	0	0	0
Schaarschmidt et al.^22	11	7	4	0	0	1	3	1	1	1	0	1	1	1	1	0	0	0
Rothery et al.^36	3	3	0	0	1	0	0	1	0	1	0	0	0	0	0	0	0	0
Alcusky et al.^17	7	5	2	0	1	0	1	1	1	1	0	0	0	0	0	1	1	0
Eliasson et al.^37	6	5	1	0	0	0	1	0	3	1	0	0	0	0	0	1	0	0
Fairchild et al.^38	5	4	1	0	0	0	2	0	2	0	0	0	1	0	0	0	0	0
Guevara et al.^39	7	3	3	1	0	0	1	1	0	1	0	1	1	0	1	0	0	1
Gonzalez^40	5	4	1	0	0	0	1	0	3	0	0	0	0	0	0	0	1	0
Kromer et al.^53	11	7	4	0	0	1	3	1	1	1	0	1	1	1	1	0	0	0
Bolt et al.^41	7	4	3	0	0	0	1	1	1	0	1	1	1	0	1	0	0	0
Rigopoulos et al.^54	5	3	1	1	0	1	0	1	1	0	0	0	0	0	0	1	0	1
Schaarschmidt et al.^42	10	5	4	1	0	1	2	0	1	1	0	1	1	0	1	0	1	1
Xu et al.^43	7	4	2	1	1	0	2	0	1	0	0	0	1	0	1	0	0	1
Feldman et al.^44	6	5	1	0	3	0	1	0	0	1	0	0	1	0	0	0	0	0
Tada et al.^45	6	4	1	1	0	1	1	1	1	0	0	0	1	0	0	0	0	1
Total	191	123	56	12	6	9	36	17	26	18	11	11	15	8	12	5	5	12
Percentage:	100,0%	64,4%	29,3%	6,3%	8,8%	13,2%	52,9%	25,0%	47,3%	32,7%	20,0%	19,6%	26,8%	14,3%	21,4%	8,9%	8,9%	100,0%

Appendix D. All efficacy-specific outcome attributes extracted from all 25 DCE studies

Outcome attribute (efficacy-specific)	Final categorization	Reference	Study count
Probability that dermatology life quality index (DLQI) score will improve 16 weeks after treatment initiation	Quality-of-life	Alcusky et al.^17	1
Improvement in the ability to perform daily activities	Quality-of-life	Xu et al.^43; Feldman et al.^44	2
Health-related quality-of-life	Quality-of-life	Rothery et al.^36	1
Time to relapse	Response maintenance	Ashcroft et al.^46; Seston et al.^47	2
Duration of benefit	Response maintenance	Schaarschmidt et al.^20^,^51; Schmieder et al.^49; Umar et al.^5^,^50; Guevara et al.^39; Rigopoulos et al.^54	7
Sustainability of therapeutic success	Response maintenance	Kromer et al.^35^,^53; Schaarschmidt et al.^22; Tada et al.^45	4
Risk of relapse	Response maintenance	Rothery et al.^36	1
Probability of loss of response within 1 year	Response maintenance	Alcusky et al.^17	1
Probability of stopping therapy within 1 year for non-efficacy reasons	Response maintenance	Alcusky et al.^17	1
Stop rate for treatment (percentage of patients not completing treatment)	Response maintenance	Bolt et al.^41	1
Bio-holiday availability (6-month break in treatment without worsening of symptoms)	Response maintenance	Bolt et al.^41	1
Severity (color, inflammation, and texture) of psoriasis lesions after treatment	Response rate	Hauber et al.^48	1
Magnitude of benefit	Response rate	Schaarschmidt et al.^20^,^51; Schmieder et al.^49; Umar et al.^5^,^50; Guevara et al.^39	6
Time free of symptoms	Response rate	Torbica et al.^52	1
Ability to reduce daily joint pain and swelling	Response rate	Xu et al.^43	1
Patients who achieve clear or almost clear skin	Response rate	Xu et al.^43	1
Percentage of patients who achieved complete relief of itching	Response rate	Feldman et al.^44	1
Percentage of patients whose depression resolved	Response rate	Feldman et al.^44	1
Time to achieve moderate (50%) improvement	Response rate	Ashcroft et al.^46; Seston et al.^47; Torbica et al.^52	3
Percentage of body surface area (BSA) covered by lesions after treatment	Response rate	Hauber et al.^48	1
Probability of benefit	Response rate	Schaarschmidt et al.^20^,^51; Schmieder et al.^49; Umar et al.^5^,^50	5
Severity of psoriasis plaques described with photographs	Response rate	Kauf et al.^21; Gonzalez^40	2
Amount of body surface area (BSA) covered	Response rate	Kauf et al.^21	1
Probability of 50% improvement	Response rate	Kromer et al.^35; Schaarschmidt et al.^22; Kromer et al.^53	3
Probability of 90% improvement	Response rate	Kromer et al.^35; Schaarschmidt et al.^22^,^42; Kromer et al.^53; Bolt et al.^41; Feldman et al.^44	7
Probability of improvement in psoriasis plaques as measured by the psoriasis area severity index (PASI) and percentage of body surface area (BSA) that remains affected 16 weeks after treatment initiation	Response rate	Alcusky et al.^17	1
Efficacy	Response rate	Eliasson et al.^37	1
Severity of plaque lesions	Response rate	Fairchild et al.^38	1
Percentage of body, face, or hands area affected	Response rate	Fairchild et al.^38	1
Probability of PASI 75	Response rate	Schaarschmidt et al.^42; Feldman et al.^44	2
Probability of ACR 20 Response	Response rate	Kromer et al.^35^,^53; Schaarschmidt et al.^22	4
Location (chest + back + either legs or arms)	Secondary characteristic	Kauf et al.^21; Gonzalez^40	2
Time until response	Speed of response	Kromer et al.^35^,^53; Schaarschmidt et al.^22^,^42; Rigopoulos et al.^54	5
Early onset of efficacy	Speed of response	Tada et al.^45	1

Appendix E. All safety-specific outcome attributes extracted from all 25 DCE studies

Outcome attribute (safety-specific)	Final categorization	Author	Study count
Probability of AEs	Mild adverse event	Schaarschmidt et al.^20^,^51; Schmieder et al.^49; Umar et al.^5^,^50; Guevara et al.^39	6
Risk of skin irritation	Mild adverse event	Ashcroft et al.^46; Seston et al.^47	2
Probability of mild adverse events (AE)	Mild adverse event	Kromer et al.^35^,^53; Schaarschmidt et al.^22^,^42; Alcusky et al.^17	5
Side-effects of nausea or sickness from treatment	Mild adverse event	Rothery et al.^36; Eliasson et al.^37	2
Risk of high blood pressure	Severe adverse event	Ashcroft et al.^46; Seston et al.^47	2
Probability of severe AE	Severe adverse event	Kromer et al.^35^,^53; Schaarschmidt et al.^22^,^42; Alcusky et al.^17; Bolt et al.^41; Rigopoulos et al.^54	7
20-year risk of skin cancer	Severe adverse event	Ashcroft et al.^46; Seston et al.^47	2
Risk of serious lung infection	Severe adverse event	Hauber et al.^48; Eliasson et al.^37; Xu et al.^43; Tada et al.^45	4
Reduced life expectancy	Severe adverse event	Torbica et al.^52	1
10-year risks of tuberculosis	Severe adverse event	Kauf et al.^21; Eliasson et al.^37; Fairchild et al.^38; Gonzalez^40	4
10-year serious infection risk	Severe adverse event	Kauf et al.^21; Fairchild et al.^37; Gonzalez^40	3
10-year lymphoma risk	Severe adverse event	Kauf et al.^21; Gonzalez^40	2
Long-term risk of melanoma or NMSC	Severe adverse event	Eliasson et al.^37	1
AE severity	AE management	Schaarschmidt et al.^20^,^51; Schmieder et al.^49; Umar et al.^5^,^50	5
AE reversibility	AE management	Schaarschmidt et al.^20^,^51; Schmieder et al.^49; Umar et al.^5^,^50	5

Appendix F. All process attributes extracted from all 25 DCE studies

Process attribute	Final categorization	Author	Study count
Delivery method	Delivery method	Schaarschmidt et al.^20^,^22^,^42^,^51; Schmieder et al.^49; Umar et al.^5^,^50; Kromer et al.^35; Eliasson et al.^37; Guevara et al.^39	10
Injection type	Delivery method	Bolt et al.^41	1
Duration	Duration	Schaarschmidt et al.^20^,^22^,^51; Schmieder et al.^49; Umar et al.^5^,^50; Kromer et al.^35	7
Frequency	Frequency	Schaarschmidt et al.^20^,^22^,^42^,^51; Schmieder et al.^49; Umar et al.^5^,^50; Kromer et al.^35; Guevara et al.^39; Feldman et al.^44	10
Injection regimen (frequency)	Frequency	Fairchild et al.^38; Bolt et al.^41	2
Treatment location	Location	Schaarschmidt et al.^20^,^22^,^42^,^51; Schmieder et al.^49; Umar et al.^5^,^50; Kromer et al.^35; Guevara et al.^39	9
Who provides injection?	Location	Bolt et al.^41	1
Laboratory tests	Other	Schaarschmidt et al.^42	1
Injection discomfort or pain (if type of treatment included injections)	Other	Hauber et al.^48	1
Type of treatment (frequency + location)	Process combination	Hauber et al.^48; Tada et al.^45	2
Route and frequency of therapy administration	Process combination	Torbica et al.^52; Rigopoulos et al.^54	2
Dosing (route of administration [ROA], setting, and frequency)	Process combination	Alcusky et al.^17	1

Appendix G. All cost-related attributes extracted from all 25 DCE studies

Cost attribute	Final categorization	Author	Study count
Personal monthly out-of-pocket cost of treatment.	Cost to patient	Hauber et al.^48; Rigopoulos et al.^54	2
Cost for the individual	Cost to patient	Schaarschmidt et al.^20^,^42^,^51; Schmieder et al.^49; Umar et al.^5^,^50; Guevara et al.^39; Xu et al.^43; Tada et al.^45	9
Monthly treatment cost not covered by the National Health Service (NHS)	Cost to patient	Torbica et al.^52	1

Ashcroft D, Seston E, Griffiths C. Trade-offs between the benefits and risks of drug treatment for psoriasis: a discrete choice experiment with U.K. dermatologists. Br J Dermatol. 2006;155(6):1236–1241.

 PubMed Web of Science ®Google Scholar

Seston EM, Ashcroft DM, Griffiths CE. Balancing the benefits and risks of drug treatment: a stated-preference, discrete choice experiment with patients with psoriasis. Arch Dermatol. 2007;143(9):1175–1179.

 PubMedGoogle Scholar

Hauber AB, Gonzalez JM, Schenkel B, et al. The value to patients of reducing lesion severity in plaque psoriasis. J Dermatolog Treat. 2011;22(5):266–275.

 PubMed Web of Science ®Google Scholar

Schaarschmidt M-L, Schmieder A, Umar N, et al. Patient preferences for psoriasis treatments: process characteristics can outweigh outcome attributes. Arch Dermatol. 2011;147(11):1285–1294.

 PubMedGoogle Scholar

Schmieder A, Schaarschmidt M-L, Umar N, et al. Comorbidities significantly impact patients’ preferences for psoriasis treatments. J Am Acad Dermatol. 2012;67(3):363–372.

 PubMed Web of Science ®Google Scholar

Umar N, Schöllgen I, Terris DD. It is not always about gains: utilities and disutilities associated with treatment features in patients with moderate-to-severe psoriasis. Patient Preference and Adherence. 2012;6:187.

 PubMed Web of Science ®Google Scholar

Schaarschmidt ML, Umar N, Schmieder A, et al. Patient preferences for psoriasis treatments: impact of treatment experience. J Eur Acad Dermatol Venereol. 2013;27(2):187–198.

 PubMed Web of Science ®Google Scholar

Umar N, Schaarschmidt M, Schmieder A, et al. Matching physicians’ treatment recommendations to patients’ treatment preferences is associated with improvement in treatment satisfaction. J Eur Acad Dermatol Venereol. 2013;27(6):763–770.

 PubMed Web of Science ®Google Scholar

Torbica A, Fattore G, Ayala F. Eliciting preferences to inform patient-centred policies: the case of psoriasis. Pharmacoeconomics. 2014;32(2):209–223.

 PubMed Web of Science ®Google Scholar

Kauf TL, Yang J-C, Kimball AB, et al. Psoriasis patients’ willingness to accept side-effect risks for improved treatment efficacy. J Dermatolog Treat. 2015;26(6):507–513.

 PubMed Web of Science ®Google Scholar

Kromer C, Schaarschmidt M-L, Schmieder A, et al. Patient preferences for treatment of psoriasis with biologicals: a discrete choice experiment. PLoS One. 2015;10(6):e0129120.

 PubMed Web of Science ®Google Scholar

Schaarschmidt M-L, Kromer C, Herr R, et al. Patient preferences for biologicals in psoriasis: top priority of safety for cardiovascular patients. PLoS One. 2015;10(12):e0144335.

 PubMed Web of Science ®Google Scholar

Rothery C, Bojke L, Richardson G, et al. A discrete choice experiment to explore patients’ willingness to risk disease relapse from treatment withdrawal in psoriatic arthritis. Clin Rheumatol. 2016;35(12):2967–2974.

 PubMed Web of Science ®Google Scholar

Alcusky M, Lee S, Lau G, et al. Dermatologist and Patient Preferences in Choosing Treatments for Moderate to Severe Psoriasis. Dermatol Ther (Heidelb). 2017;7(4):463–483.

 PubMed Web of Science ®Google Scholar

Eliasson L, Bewley AP, Mughal F, et al. Evaluation of psoriasis patients’ attitudes toward benefit-risk and therapeutic trade-offs in their choice of treatments . Patient Prefer Adherence. 2017;11:353–362.

 PubMed Web of Science ®Google Scholar

Fairchild AO, Reed SD, Johnson FR, et al. What is clearance worth? Patients’ stated risk tolerance for psoriasis treatments. J Dermatolog Treat. 2017;28(8):709–715.

 PubMed Web of Science ®Google Scholar

Guevara B, Gonzales N, Visitacion L. patient preference on psoriasis treatment in a Philippine Tertiary Hospital: a conjoint analysis: P127. J Eur Acad Dermatol Venereol. 2017;30:62.

 Google Scholar

Gonzalez J, Johnson F, McAteer H, et al. Comparing preferences for outcomes of psoriasis treatments among patients and dermatologists in the U.K.: results from a discrete-choice experiment. Br J Dermatol. 2017;176(3):777–785.

 PubMed Web of Science ®Google Scholar

Kromer C, Peitsch WK, Herr R, et al. Treatment preferences for biologicals in psoriasis: experienced patients appreciate sustainability. J Dtsch Dermatol Ges. 2017;15(2):189–200.

 Web of Science ®Google Scholar

Bolt T, Kobayashi H, Mahlich J. Patient and physician preferences for therapy characteristics for psoriasis: a discrete choice experiment in Japan. PharmacoEconomics-open. 2018;3:255–264.

 Web of Science ®Google Scholar

Rigopoulos D, Ioannides D, Chaidemenos G, et al. Patient preference study for different characteristics of systemic psoriasis treatments (Protimisis). Dermatol Ther. 2018;31(3):e12592

 PubMed Web of Science ®Google Scholar

Schaarschmidt M-L, Herr R, Gutknecht M, et al. Patients’ and physicians’ preferences for systemic psoriasis treatments: a nationwide comparative discrete choice experiment (PsoCompare). Acta Derm Venereol. 2018;98(2):200–205.

 PubMed Web of Science ®Google Scholar

Xu Y, Sudharshan L, Hsu M-A, et al. Patient preferences associated with therapies for psoriatic arthritis: a conjoint analysis. Am Health Drug Benefits. 2018;11(8):408.

 PubMed Web of Science ®Google Scholar

Feldman SR, Regnier SA, Chirilov A, et al. Patient-reported outcomes are important elements of psoriasis treatment decision making: a discrete choice experiment survey of dermatologists in the United States. J Am Acad Dermatol. 2019;80(6):1650–1657.

 PubMed Web of Science ®Google Scholar

Tada Y, Ishii K, Kimura J, et al. Patient preference for biologic treatments of psoriasis in Japan. J Dermatol. 2019;46(6):466–477.

 PubMed Web of Science ®Google Scholar