A discrete-choice experiment study of physicians’ prioritization of attributes of medical treatments for endometriosis-associated pain

Figures & data

Figure 1. Example discrete-Choice experiment question.

Table 1. Attributes and levels for the discrete-choice experiment.

Attribute	Attribute-level labels
Improvement in dysmenorrhea	Severe-to-no pain Severe-to-mild pain Severe-to-moderate pain
Improvement in nonmenstrual pelvic pain	Severe-to-no pain Severe-to-mild pain Severe-to-moderate pain
Improvement in dyspareunia	Severe-to-mild pain Severe-to-moderate pain No change: severe pain
Mode of administration	1 pill or tablet each day 2 pills or tablets each day Intramuscular injection once per month or once every several months
Risk of pregnancy-related complications if pregnancy occurs during treatment	Unknown risk Known risk: 0 out of 100 women who become pregnant while taking the medicine will have a pregnancy-related problem (0%) Known risk: 2 out of 100 women who become pregnant while taking the medicine will have a pregnancy-related problem (2%) Known risk: 7 out of 100 women who become pregnant while taking the medicine will have a pregnancy-related problem (7%)
Risk of bone fracture later in life	Unknown risk Known risk: 0 out of 100 women (0%) Known risk: 2 out of 100 women (2%) Known risk: 5 out of 100 women (5%) Known risk: 10 out of 100 women (10%)
Risk of moderate-to-severe hot flashes	Narrow range Known risk: 0 out of 100 women (0%) Known risk: 30 out of 100 women (30%) Known risk: 50 out of 100 women (50%) Known risk: 65 out of 100 women (65%)	Wide range Known risk: 0 out of 100 women (0%) Known risk: 30 out of 100 women (30%) Known risk: 50 out of 100 women (50%) Known risk: 85 out of 100 women (85%)

Table 2. Demographic characteristics of physician respondents.

Characteristic	All respondents (N = 250)^a
What is your current age (years)?
Mean (SD)	53 (10)
Median (min, max)	54 (30, 77)
Are you a board-certified or board-eligible obstetrician or gynecologist?
Yes	250 (100.0)
What is your gender?
Female	89 (35.6)
Male	157 (62.8)
Other	0 (0.0)
Prefer not to share	1 (0.4)
Missing	3 (1.2)
Which of the following best describes your area of specialization in your day-to-day practice?
Obstetrics only	67 (26.8)
Gynecology only	0 (0.0)
Both obstetrics and gynecology	180 (72.0)
Missing	3 (1.2)
How many years have you been in practice since completing your medical training?
Less than 1 year	1 (0.4)
1–3 years	4 (1.6)
4–6 years	16 (6.4)
7–9 years	15 (6.0)
10–15 years	24 (9.6)
16–20 years	42 (16.8)
21–25 years	49 (19.6)
More than 25 years	95 (38.0)
Missing	4 (1.6)
Which of the following best describes the geographic area in which you practice?
Urban	74 (29.6)
Suburban	141 (56.4)
Rural	30 (12.0)
Missing	5 (2.0)
Which of the following best describes the practice in which you treat all your patients?
Private individual practice	52 (20.8)
Private group practice	137 (54.8)
Hospital-based practice	32 (12.8)
Academic practice	21 (8.4)
Veteran’s hospital-based practice	0 (0.0)
Other	3 (1.2)
Missing	5 (2.0)
When answering the treatment-choice questions for the patient described earlier, did you assume, at any point, that you would prescribe add-back therapy in addition to the medicine you selected?
Yes	152 (60.8)
No	95 (38.0)
Missing	3 (1.2)
When answering the treatment-choice questions for the patient described earlier, did you assume, at any point, that you would prescribe contraception in addition to the medicine you selected?
Yes	161 (64.4)
No	86 (34.4)
Missing	3 (1.2)

max indicates maximum; min, minimum; SD, standard deviation.

^aValues are n (%) unless otherwise stated.

Figure 2. Relative preference weights and conditional relative attribute importance for respondents (N = 250).

Note: Vertical lines represent the 95% confidence intervals around the point estimates of the mean preference weight for each attribute level. Shaded areas represent the conditional relative importance of the attributes; the corresponding values are the difference between the largest and smallest preference weight for each attribute.

Table 3. Descriptions of the subgroups analyzed and results of tests for systematic differences in preferences (N = 250).

Subgroup pair^a	Subgroup description	Sample size	p value from the log likelihood ${\chi }^2$ test of joint statistical significance
Gender	Male	157	0.402
	Female	89
Physicians’ prescribing patterns for elagolix	Prescribed more	101	0.998
	Prescribed less	148
Physicians’ geographic area	Urban/suburban	215	0.913
	Rural	30
Physicians’ practice setting	Private	189	0.906
	Hospital or academic or other	56
Physicians’ region	Southern states^b	75	0.661
	The rest of the states	172
Whether physicians would prescribe add-back therapy as additional treatment	Those who would prescribe add-back therapy	152	NA, no convergence of the model
	Those who would not prescribe add-back therapy	95
Whether physicians would prescribe contraception as additional treatment	Those who would prescribe contraception as additional treatment	161	0.928
	Those who would not prescribe contraception as additional treatment	86

NA = not available.

^aSome participants did not provide responses to the questions used to identify subgroups. For this reason, the totals may not add up to 250.

^bIncluding Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia, Alabama, Kentucky, Mississippi, Tennessee, Arkansas, Louisiana, Oklahoma, and Texas.

Table 4. Maximum acceptable risk calculations (N = 250).

Benefit	From	To	Additional risk of	MAR^a (95% CI)^b
Improvement in dysmenorrhea	Severe-to-moderate	Severe-to-mild	Pregnancy-related complications	> 7%
	Severe-to-moderate	Severe-to-no pain		> 7%
	Severe-to-mild	Severe-to-no pain		4.99 (−0.59 to 10.56)
Improvement in nonmenstrual pelvic pain	Severe-to-moderate	Severe-to-mild	Pregnancy-related complications	> 7%
	Severe-to-moderate	Severe-to-no pain		> 7%
	Severe-to-mild	Severe-to-no pain		6.95 (0.24 to 13.66)
Improvement in dyspareunia	No change (severe pain)	Severe-to-moderate	Pregnancy-related complications	> 7%
	No change (severe pain)	Severe-to-mild pain		> 7%
	Severe-to-moderate	Severe-to-mild pain		> 7%
Mode of administration	Injection once per month or once every several months	2 pills or tablets every day	Pregnancy-related complications	1.01 (−1.19 to 3.20)
	Injection once per month or once every several months	1 pill or tablet each day		3.54 (−2.57 to 9.65)
	2 pills or tablet each day	1 pill or tablet each day		1.67 (−0.68 to 4.02)
Improvement in dysmenorrhea	Severe-to-moderate	Severe-to-mild	Bone fracture later in life	> 10%
	Severe-to-moderate	Severe-to-no pain		> 10%
	Severe-to-mild	Severe-to-no pain		9.42 (−1.97 to 20.82)
Improvement in nonmenstrual pelvic pain	Severe-to-moderate	Severe-to-mild	Bone fracture later in life	> 10%
	Severe-to-moderate	Severe-to-no pain		> 10%
	Severe-to-mild	Severe-to-no pain		> 10%
Improvement in dyspareunia	No change (severe pain)	Severe-to-moderate	Bone fracture later in life	> 10%
	No change (severe pain)	Severe-to-mild pain		> 10%
	Severe-to-moderate	Severe-to-mild pain		> 10%
Mode of administration	Injection once per month or once every several months	2 pills or tablets every day	Bone fracture later in life	2.68 (−2.84 to 8.21)
	Injection once per month or once every several months	1 pill or tablet each day		6.87 (−3.20 to 16.94)
	2 pills or tablet each day	1 pill or tablet each day		3.96 (−1.00 to 8.92)
Improvement in dysmenorrhea	Severe-to-moderate	Severe-to-mild	Moderate-to-severe hot flashes	34.85 (25.09 to 44.60)
	Severe-to-moderate	Severe-to-no pain		46.64 (36.04 to 57.24)
	Severe-to-mild	Severe-to-no pain		17.17 (5.68 to 28.66)
Improvement in nonmenstrual pelvic pain	Severe-to-moderate	Severe-to-mild	Moderate-to-severe hot flashes	36.81 (26.01 to 47.61)
	Severe-to-moderate	Severe-to-no pain		52.42 (35.82 to 69.02)
	Severe-to-mild	Severe-to-no pain		21.65 (9.00 to 34.31)
Improvement in dyspareunia	No change (severe pain)	Severe-to-moderate	Moderate-to-severe hot flashes	28.27 (13.85 to 42.70)
	No change (severe pain)	Severe-to-mild pain		49.73 (37.92 to 61.53)
	Severe-to-moderate	Severe-to-mild pain		30.31 (19.00 to 41.61)
Mode of administration	Injection once per month or once every several months	2 pills or tablets every day	Moderate-to-severe hot flashes	5.22 (−4.18 to 14.61)
	Injection once per month or once every several months	1 pill or tablet each day		13.86 (3.05 to 24.68)
	2 pills or tablet each day	1 pill or tablet each day		8.65 (−1.80 to 19.09)

CI indicates confidence interval; DCE, discrete-choice experiment; MAR, maximum acceptable risk.

^aThe MAR estimates that are larger than the largest risk used in the DCE experimental design are reported as (>) greater than the maximum risk level presented in the experimental design and no CIs are reported for these estimates.

^bWhen the 95% CI around a mean MAR includes zero, the mean MAR is not statistically different from zero. Also, if the 95% CIs around 2 different mean MARs do not overlap, then the mean MARs are statistically significantly different at the 5% level.

Table 5. Treatment profiles and preference share results: baseline analysis results (N = 250).

Attribute	Elagolix		Leuprolide injection (95% CI)
	150 mg daily (95% CI)	200 mg twice daily (95% CI)
Improvement in dysmenorrhea	Severe-to-moderate	Severe-to-mild	Severe-to-mild
Improvement in nonmenstrual pelvic pain	Severe-to-moderate	Severe-to-mild	Severe-to-mild
Improvement in dyspareunia	Severe-to-moderate	Severe-to-mild	Severe-to-moderate
Mode of administration	Tablet	Tablet	Injection
Risk of pregnancy-related complications	0%	0%	0%
Risk of bone fracture	1%	1%	2%
Risk of moderate-to-severe hot flashes	12.8%	27.7%	64.1%
Probability of selection
Elagolix 150 mg vs. leuprolide	49.3% (28.6%-69.9%)	−	50.7% (30.1%-71.4%)
Elagolix 200 mg vs. leuprolide	−	96.0% (91.2%-100.8%)	4.0% (−0.82% to 8.81%)

CI indicates confidence interval.

Data availability statement

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