Analysis of patient and nurse preferences for self-administered FSH injection devices in select European markets

Figures & data

Table 1 The list of tested attributes and levels associated with each attribute

ID	Attributes	Levels	Description
1	Injection device	• Single-use pen • Multiple-use pen, reusable • Multiple-use pen, disposable • Syringe and vials; or prefilled syringes	Type of injector used for administering the drug
2	With “Steady Grip” feature	• Yes • No	Grip that helps the user to stably hold the pen injector
3	Visibility of remaining product in cartridge	• Yes • No	User can see the level of leftover drug in the loaded cartridge
4	Number of needles in the package	Range from 5 to 14	The number of replacement needles in the package
5	With large display	• Yes • No	A large display window for the amount of drug to be injected
6	Dosing accuracy	Percentage of errors (range from 1% to 3%)	Variation per day measured as percentage of the total daily injection amount
7	Minimum dosing	Range from 8.33 IU to 150 IU	Smallest amount of drug that can be injected using the device
8	Unit display	• Dash • Numerical	This attribute describes how the injection amount can be read from the device.
9	Dial back function	• Yes • No	Dose correction can be made by turning the dial backwards to set a lower dose
10	Daily injection volume	• 0.01, 0.1, 0.3 mL for pens • 1–2 mL for syringes	Total volume of liquid being injected
11	Operation	• Side button (semi-automatic) • Push plunge (manual)	The mechanism by which the injection is being performed • Push plunge requires user to push the plunger down as far as possible to deliver the medicine • The side button mechanism is semiautomatic: the injection is completed automatically following a single button press
12	Has overfilled cartridge for device priming	• Yes • No	Overfilled cartridge provides additional medicine for injector preparation
13	Able to use multiple cartridges for one injection	• Yes • No	Multiple cartridges can be combined in pen to supply sufficient medicine to complete the required dose in a single injection
14	Dosing increment	12.5–25 IU for pens (should not exceed 150 IU per adjustment for syringes)	Smallest incremental value for which the injection can be adjusted
15	Treatment diary	• Yes • No	Allows the user to track their injection activities
16	Product wastage	• High • Low	Medicine wasted due to dosing change. • Low wastage: <50 IU • High wastage: >100 IU
17	Easy for nurse to teach	• Yes • No	This is a general assessment about how easy it is to teach a patient to use the device for self-injection
18	Time to remove from refrigerator before use	• 10 minutes • 30 minutes	Time required between the medicine being removed from the refrigerator and administration
19	Needle size	Range from 27 to 30 gage	Size of needle, where larger number indicates a smaller needle
20	Carrying pouch size	• Standard • Small	Size of the container for the injection product bundle: • Standard refers to a dimension of 23 cm (9.10") × 11 cm (4.33") × 5 cm (1.97") • Small size is half the standard size

Table 2 The list of tested attributes and levels associated with each attribute

ID	Attributes	Levels	Description
1	Injection device	• Pen • Syringe and vials (1–2 mL)	Type of injector used for administering the drug
2	Pen type	• Single-use pen • Multiple-use pen, reusable • Multiple-use pen, disposable	Type of pen used for administration
3	Visibility of remaining product in cartridge	• Yes • No	User can see the level of leftover drug in the loaded cartridge
4	Daily injection volume	• 0.01, 0.1, 0.3 mL for pens • 1–2 mL for syringes	Total volume of liquid being injected
5	Product wastage	• High • Low	Medicine wasted due to dosing change: • Low wastage: <50 IU • High wastage: >100 IU
6	Easy for nurse to teach	• Yes • No	General assessment of how easy it is to teach a patient to use the device for self-injection

Table 3 Example of conjoint analysis question

Hypothetical product A	Hypothetical product B
It is provided in an injection pen	It is provided in either a prefilled syringe or a syringe that needs to be filled prior to injection
The pen can be used for multiple injections as long as the reservoir is not depleted. The pen is also disposable	The pen can be used for a single injection only and is non-reusable
The remaining drug in a loaded cartridge cannot be seen through a window on the pen	The remaining drug in a loaded cartridge cannot be seen through a window on the pen
On average, this product will have an injection error within 1.5% of the patient’s prescribed daily dosage	On average, this product will have an injection error within 3.0% of the patient’s prescribed daily dosage
The daily injection volume using product A is 0.3 mL	The daily injection volume using product B is 0.01 mL
The product wastage is more than 100 IU	The product wastage is less than 50 IU

Table 4 Baseline characteristics of female patients participating in the survey

	UK	Germany	France	Italy	Spain	The Netherlands	Belgium
Patients, n	76	94	76	69	55	20	12
Mean age, years	33.30	35.51	33.64	35.42	33.56	31.58	31.5
Previously on IVF treatments, n (%)	75 (98.68)	89 (94.68)	74 (93.37)	63 (91.30)	50 (90.90)	18 (90.00)	10 (83.33)
Previously on non-IVF treatments, n (%)	1 (1.32)	5 (5.32)	2 (2.63)	6 (1.50)	5 (9.10)	2 (10.00)	2 (16.67)
Pregnancy with IVF (%)	57.33	56.18	60.81	44.44	58.00	44.44	40.00
Live birth with IVF (%)	57.33	49.44	56.76	42.86	52.00	44.44	40.00

Abbreviation: IVF, in vitro fertilization.

Table 5 Baseline characteristics of nurses participating in survey

Total number of nurses who have completed the surveys	40
Total number of nurses who work in reproductive endocrinologist practice	11
Total number of nurses who work in infertility clinics	37
Average number of physicians at the practice where the nurse works	5
Average number of nurses at the practice where the nurse works	6
Average number of patients that the nurse sees monthly	299
Percentage of patients that these nurses see who are using self-administered injectable ovarian stimulation treatments	69
Percentage of patients who are using self-administered ovarian stimulation treatments via injection pens	67
The average number of years of infertility treatment experience	9

Figure 1 Patient preference ranking of the tested attributes from the MaxDiff analysis.

Abbreviation: MaxDiff, maximum differential scaling.

Figure 2 Nurse preference ranking of the tested attributes from the MaxDiff analysis.

Abbreviation: MaxDiff, maximum differential scaling.

Figure 3 Patient preference ranking of selected attributes from the conjoint analysis.

Figure 4 Nurse preference ranking for the selected attributes from the conjoint analysis.

Table 6 The attribute characteristics of two hypothetical products in scenario analysis 1

		Product A	Product B
1	Injection device	Pen	Syringe and vial (1–2 mL)
2	Pen type	Single-use pen
3	Visibility of leftover product	No
4	Dosing accuracy	3% error	3% error
5	Pen daily injection volume	0.3 mL
6	Product wastage	High	High

Table 7 The attribute characteristics of two hypothetical products in scenario analysis 2

		Product A	Product B
1	Injection device	Pen	Pen
2	Pen type	Multiple-use reusable pen	Single-use pen
3	Visibility of leftover in cartridge	No	No
4	Dosing accuracy	3% error	3% error
5	Pen daily injection volume	0.3 mL	0.3 mL
6	Product wastage	High	High

Figure 5 The country-wise comparison of the relative importance score of attributes among patients.

Abbreviations: BE, Belgium; NL, the Netherlands; IT, Italy; FR, France.

Figure 6 The country-wise comparison of the relative importance score of attributes among nurses.

Abbreviations: CZ, Czech Republic; IT, Italy; FR, France.

Table 8 Selected preferred product attributes of currently available FSH injection devices

	Attributes	Gonal-f^®	Puregon^®	Bemfola^®	Ovaleap^®	Bravelle^®	Menopur^®
1	Daily injection volume (150 IU)	0.25 mL	0.18 mL	0.25 mL	0.25 mL	1–2 mL	1–2 mL
2	Injection device	Single-use, multidose, pen	Multi-use, multidose, pen	Single-use, single-dose, pen	Multi-use, multidose, pen	Syringe and vials	Syringe and vials
3	Dial-back function	Yes	No	Yes	Yes	–	–
4	Dosing increments	12.5 IU	25 IU	12.5 IU	12.5 IU	–	–
5	Perform injection	Push knob	Push knob	Plunger	Release button
6	Visibility of leftover in cartridge	Yes	No	NA	Yes