A discrete choice experiment to determine UK patient preference for attributes of disease modifying treatments in Multiple Sclerosis

Figures & data

Table 1. Participant inclusion and exclusion criteria.

Inclusion criteria	Exclusion criteria
Diagnosed with RRMS within the last 10 years	Diagnosed with primary or secondary progressive MS
Over 18 years of age	Diagnosed with clinically isolated syndrome without a MS diagnosis
Currently prescribed a DMT
Mild–moderate disease severity (PDDS score of ≤6)
Able to provide written informed consent
Has access to the internet

Figure 1. An example choice set presented to participants in the study. NB: Participants were also provided with supplementary notes to explain the context of each attribute.

Table 2. Final attributes and levels included in the survey.

Attribute	Levels
Percentage of patients relapse-free	(1)60% (2)70% (3)80%
Percentage of patients with no symptom progression	(1)70% of patients experience no change in underlying symptoms (2)80% of patients experience no change in underlying symptoms (3)90% of patients experience no change in underlying symptoms
Method of taking medication	(1)Pill taken orally, once daily (2)Pill taken orally, twice a day (3)Infusion lasting 4 h each, which is received in hospital. For the first treatment course one infusion per day would be given for 5 days (course 1). Then, 1 year later, one infusion per day would be given for 3 days (course 2) There would be no treatment in between the two courses. (4)Injection taken 3-times a week. This injection would use an autoinjector pen that hides the needle, and can be self-injected by patients in their own homes. The medication is injected under the skin (5)Once a month infusion (lasting 1 h) in hospital
Monitoring requirements	(1)Monitoring every month for up to 4 years, involving blood and urine tests. This takes place in hospital (2)Monitoring every 3–4 months, involving blood tests, which takes place in hospital. This would occur for the duration of the treatment (3)6-h heart monitoring, which takes place in hospital on the first day of treatment received. Plus, eye test at 3 months and blood tests every 3 months for the first year, then at intervals decided by your doctor
Side-effect: risk of serious infection	(1)3 in 100 patients experience a serious infection (2)5 in 100 patients experience a serious infection (3)10 in 100 patients experience a serious infection
Side-effect: risk of serious fatigue due to MS treatment	(1)2% (2)5% (3)10%
Long-term safety issue: risk of kidney disorder	(1)Currently no known risk of kidney disease (2)1 in 50 patients (3)1 in 33 patients

Figure 2. Current and previous DMTs received by participants (n = 350).

Table 3. Demographics of the study population.

Total, n	350
Gender, n female (%)	283 (81%)
Age, mean (SD)	38.6 (9.69)
Age, range	19–62
Employment, n employed (%)	238 (68%)
Years since diagnosis, mean	5.2
Years since diagnosis, range	1–19
PDDS score, median (range)	3 (0–6)^a

^a Calculated from those patients who reported experiencing symptoms (n = 294).

Table 4. Patient preference results: treatment attributes (n = 350).

	Method of taking medication	Relapse free rate	No symptom progression	Risk of kidney disorder	Risk of serious infection	Risk of serious fatigue	Monitoring requirements
Patient preference utility transformed to logit scale (relative importance out of 100%)	27%	21%	14%	13%	11%	8%	6%

Table 5. Patient preference results: attribute levels (n = 350).

		Level 1	Level 2	Level 3	Level 4	Level 5
Relapse free rate	Level	60%	70%	80%	n/a	n/a
	Relative importance (out of 100%)^a	17%	29%	53%	n/a	n/a
No symptom progression	Level	70%	80%	90%	n/a	n/a
	Relative importance (out of 100%)^a	21%	31%	48%	n/a	n/a
Method of taking medication	Level	Once a day pill, taken orally	Infusion given in hospital	Injection taken 3 times a week	Once a month infusion, lasting 1 h	Pill taken orally, twice a day
	Relative importance (out of 100%)^a	31%	14%	11%	19%	25%
Monitoring requirements	Level	6 h initial + every 3 months	Monthly	Every 3–4 months	n/a	n/a
	Relative importance (out of 100%)^a	28%	34%	38%	n/a	n/a
Risk of serious infection	Level	3 in 100 patients	5 in 100 patients	10 in 100 patients	n/a	n/a
	Relative importance (out of 100%)^a	40%	35%	25%	n/a	n/a
Risk of serious fatigue	Level	2%	5%	10%	n/a	n/a
	Relative importance (out of 100%)^a	38%	35%	27%	n/a	n/a
Risk of kidney disorder	Level	No risk	1 in 50	1 in 33	n/a	n/a
	Relative importance (out of 100%)^a	43%	32%	25%	n/a	n/a

^a Average patient preference (utility) transformed to a logit scale.

Table 6. Results of sub-group hypothesis testing to identify differences in preference by patient characteristics (n = 350).*

Chi-squared value for attribute/patient characteristic (degrees of freedom)	Age	Gender	Time since diagnosis	Disease severity (PDDS score)
Relapse free rate	n/a	n/a	0.14 (2)	1.13 (8)
No symptom progression	n/a	n/a	0.09 (2)	0.43 (8)
Monitoring requirements	n/a	n/a	0.09 (2)	n/a
Risk of serious infection	0.00 (4)	0.00 (2)	n/a	0.03 (8)
Risk of serious fatigue	0.00 (4)	0.02 (2)	n/a	0.01 (8)
Risk of kidney disorder	0.01 (4)	0.01 (2)	n/a	0.03 (8)

* no statistically significant differences (p ≤ .05) in preference between sub-groups were found.