Patient and neurologist preferences in the UK for relapsing–remitting multiple sclerosis treatments: findings from a discrete choice experiment

Figures & data

Table 1. Attributes and levels included in the DCE.

Attribute	Description shown	Level 1	Level 2	Level 3
2 Year disability progression	X% risk of physical disability worsening over 2 years	10%	20%	35%
1 Year relapse rate	X% risk of relapsing in the next year	15%	30%	40%
Rate of BVL (relative to normal)	BVL, which is associated with cognitive decline, is about X times faster than normal (total of X% loss over 5 years)	1.5 times faster; 1.76% loss	2.5 times faster; 2.62% loss	4 times faster; 3.85% loss
Risk of GI symptoms	X% risk of gastrointestinal symptoms, including stomach pain, nausea and/or diarrhea	<1%	10%	25%
Risk of flu-like symptoms	X% risk of flu-like symptoms, including fever, muscle aches, fatigue and/or headache	<1%	30%	70%
Risk of infection	X% risk of infection such as a respiratory or urinary tract infection or herpes (e.g. shingles, cold sores)	20%	45%	80%
Risk of life-threatening event	X% (x out of y) risk of life-threatening side effect	0% risk	0.01% (1 out of 10,000)	0.1% (1 out of 1000)

Abbreviations. BVL, Brain volume loss; DCE, Discrete choice experiment; GI, Gastrointestinal.

Figure 1. Example of a DCE choice task seen by respondents. Abbreviation. DCE, Discrete choice experiment.

Table 2. Patient characteristics.

Characteristic	N = 144
Age, mean ± SD	42.8 ± 11.5
Age, median (range)	42.5 (21–71)
Female, n (%)	99 (68.8)
Marital status, n (%)
Single/separated/divorced/widowed	46 (31.9)
Committed relationship/married	98 (68.1)
Education, n (%)
Less than college degree	78 (54.2)
College graduate or higher	66 (45.8)
Current employment status, n (%)
Employed	80 (55.6)
Long-term or short-term disability	28 (19.4)
Not employed	14 (9.7)
Retired	12 (8.3)
Homemaker	7 (4.9)
Student	3 (2.1)
Has children in household, n (%)	89 (61.8)
Household income^a, n (%)
Less than £50,000	87 (60.4)
£50,000 to £99,999	32 (22.2)
£100,000+	13 (9.0)
Comorbidities ≥ 5%, n (%)
Depression	26 (18.1)
Anxiety	22 (15.3)
Hypertension	18 (12.5)
Migraines	13 (9.0)
Cholesterol issues	9 (6.3)
Self-reported current health status, n (%)
Excellent, very good or good	84 (58.3)
Fair or poor	60 (41.7)
Diagnosed ≥5 years ago, n (%)	81 (56.3)
Currently on prescription medication for RRMS, n (%)	105 (72.9)
Current prescription^b, n (%)
Injection	55 (52.4)
Oral	52 (49.5)
Infusion	11 (10.5)
Line of therapy^c, n (%)
First	39 (31.7)
Second	56 (45.5)
Third or later	28 (22.8)
Relapses in past 12 months, n (%)
0	53 (36.8)
1	49 (34.0)
2	27 (18.8)
≥3	15 (10.4)
MSSE Scale score^d, median (range)
Self-efficacy: Function	71.1 (10–100)
Self-efficacy: Control	56.7 (10–100)
Total score	131.1 (20–200)
MSQOL-54 Cognitive Function Scale score^e, median (range)	60.0 (0–100)

Abbreviations. MSQOL-54, Multiple Sclerosis Quality of Life-54; MSSE, Multiple Sclerosis Self-Efficacy.

^a N = 12 (8.3%) respondents selected chose not to answer the household income question.

^b Patients could have been on more than one prescription medication. Injection medications included interferon (34.3%; interferon beta-1a: 8.6%, interferon beta-1b: 19.0%, and pegylated interferon: 8.6%) and glatiramer acetate (21.0%). Oral medications included dimethyl fumarate (23.8%), fingolimod (15.2%) and teriflunomide (10.5%). Infusion medication included ocrelizumab (10.5%). An additional 2.9% reported being on another medication not listed in the survey.

^c Answered by patients who indicated they were currently on (n = 105) or previously on (n = 18) a prescription medication for RRMS.

^d The MSSE items are rated in increments of 10 on a scale of 10 to 100 (10 = very uncertain, 50 = moderately certain and 100 = very certain); scores on the subscales could range from 10 to 100, and total scores could range from 20 to 200. Higher scores indicate more self-efficacy.

^e The MSQOL is scored from 0 to 100 (0 = all of the time, 20 = most of the time, 40 = a good bit of the time, 60 = some of the time, 80 = a little of the time and 100 = none of the time); higher scores indicate higher cognitive function.

Table 3. Neurologist characteristics.

Characteristic	N = 101
Years in practice, mean ± SD	12.8 ± 5.6
Male, n (%)^a	70 (69.3)
Completed a fellowship, n (%)	69 (68.3)
Fellowship area
Multiple sclerosis	45 (65.2)
Stroke/vascular neurology	7 (10.1)
Other	17 (24.6)
Primary practice setting, n (%)
Academic	81 (80.2)
Community	20 (19.8)
Percentage of time spent in direct patient care, mean ± SD	85.5 ± 7.3
Number of MS patients in past 3 months, median (range)	75.0 (15–350)
Number of RRMS patients in past 3 months, median (range)	40.0 (10–250)
Medication most frequently prescribed to non-highly-active RRMS patients, n (%)
Injectable	6 (5.9)
Oral	45 (44.6)
Both equally	50 (49.5)

Abbreviations. MS, Multiple sclerosis; RRMS, Relapsing–remitting multiple sclerosis.

^an = 8 neurologists declined to state their gender.

Figure 2. Relative importance of treatment attributes; 95% confidence intervals are depicted. Abbreviations. BVL, Brain volume loss; GI, Gastrointestinal; RRMS, Relapsing–remitting multiple sclerosis.

Figure 3. Attribute-level preference weights. Preference weights should not be interpreted by themselves. Instead, the magnitude of change within one attribute should be compared with change within another attribute. Abbreviations. BVL, Brain volume loss; GI, Gastrointestinal.

Figure 4. Increases in attributes that patients and neurologists are willing to accept in exchange for decreasing rate of BVL from 2.5 times to 1.5 times relative to normal. Abbreviations. BVL, Brain volume loss; GI, Gastrointestinal; RRMS, Relapsing–remitting multiple sclerosis.

Figure 5. Relative importance of treatment attributes in highly active RRMS DCE: neurologists by most frequently prescribed medication for non-highly-active RRMS. Note: 95% confidence intervals are depicted. Abbreviations. BVL, Brain volume loss; DCE, Discrete choice experiment; GI, Gastrointestinal, RRMS, Relapsing–remitting multiple sclerosis.

Data availability statement

BMS policy on data sharing may be found at https://www.bms.com/researchers-and-partners/independent-research/data-sharing-request-process.html.