Autoinjector preference among patients with multiple sclerosis: results from a national survey

Figures & data

Figure 1 Flowchart of the survey.

Note: The diagram displays the progress through the steps of the market survey (instructions and evaluation of device in use, questions regarding ideal device, instructions and evaluation of the two non-used devices, and total evaluation of the devices).

Table 1 Demographic characteristics

Characteristic	Number (%) of main analysis group (n=85)	Number (%) of validation group (n=15)
Gender
Females	58 (68)	12 (80)
Males	27 (32)	3 (20)
Age (years)
<18	0 (−)	0 (−)
18–35	25 (29)	8 (53)
36–55	44 (52)	6 (40)
56–75	15 (18)	1 (7)
Not specified	1 (1)	0 (−)
Geographic distribution
Cologne	11 (13)	15 (100)
Munich	11 (13)	0 (−)
Frankfurt	17 (20)	0 (−)
Berlin	17 (20)	0 (−)
Hamburg	29 (34)	0 (−)
Current MS medication (autoinjector)
Betaferon^® (Betaconnect^®)	39 (46)	7 (47)
Rebif^® (RebiSmart™)	36 (42)	5 (33)
Extavia^® (ExtaviPro™)	10 (12)	3 (20)
MS type
Relapsing-remitting MS	63 (74)	14 (93)
Secondary progressive MS	6 (7)	0 (−)
Not specified/unaware	16 (19)	1 (7)
Diagnosis
Before 1990	3 (4)	1 (7)
1990–1999	9 (11)	1 (7)
2000–2004	24 (28)	0 (−)
2005–2009	16 (19)	1 (7)
2010–2014	23 (27)	6 (41)
2015–2016	9 (11)	6 (40)
Not specified/unaware	1 (1)	0 (−)

Abbreviation: MS, multiple sclerosis.

Figure 2 Satisfaction level with device currently in use.

Notes: Participants evaluated their device in use via scale points (1= not satisfied at all, 10= very satisfied). The percentage of participants rating with 8–10 points (top three rankings) is highlighted in red (mean values).

Table 2 Most desired improvements of own device proposed by the participants

Feature	Betaconnect^® users (device A) n=39	RebiSmart™ users (device B) n=36	ExtaviPro™ users (device C) n=10
Handling/application	26%	22%	20%
Easier handling	5%	22%a	20%
Changes concerning sensor/more sensible sensor/more reliable skin contact sensor	18%b	–	–
Other	26%	53%a	50%
Lighter weight/weight	–	19%a	–
No noise/less noise	3%	3%	30%a,b

Notes: n=85, multiple answers possible.

a,b P<0.05 comparing the respective device with device A, B, or C, respectively.

‘–’ indicates users did not desire changes.

Table 3 Comparison of ideal device features and availability of these features in the devices ranked by non-users

Notes: Patients’ top three rankings (8–10 points on rating scale);

b,c P<0.05 comparing the respective device with device A, B, or C, respectively. For example, regarding “Easy injection process”, the Betaconnect (device A) was significantly rated better than the RebiSmart (device B) and the ExtaviPro (device C).

Figure 3 Feature evaluation of the autoinjectors not in use.

Notes: Agreement level of participants with statements regarding features of the devices not in use (non-users) were queried via scale points (1= not agree at all, 10= totally agree). Top three rankings (8–10 points on rating scale, mean values) are listed and significance is indicated (^b,cP<0.05 comparing the respective device with device A, B, or C, respectively). For example, regarding “Easy handling of the injection device”, the Betaconnect (device A) was rated significantly better than the RebiSmart (device B) and the ExtaviPro (device C). The percentage of participants with top-three rankings (8–10 scale points) is illustrated.

Figure 4 Final assessment of all three injection devices.

Notes: Participants indicated their autoinjector preference after presentation of all devices (dark; number of patients). Currently used injection devices are depicted for comparison (light; number of users).

Table S1 Questionnaire used for the structured face-to-face interviews

	Answer by marking	Answer by rating 1 (worst) – 10 (best)	Open question
Step 1: Indication of the autoinjector currently in use
1. Which autoinjector do you currently use?	x
Step 2: Instruction videos of the device currently in use and questions about own device
2. Please show on a scale from 1 (not satisfied at all) to 10 (very satisfied), how satisfied you are in general with your current injection device for your MS therapy.		x
3. Why did you choose the value x on the scale?			x
4. When thinking of your injection device, what do you like most?			x
5. Which feature of your device do you not like?			x
6. Did you use other devices before? If so, which?			x
7. In comparison to your current device, did you like the former one more, less or the same?	x
8. (If better) Why was the former one better?			x
9. (If worse) Why was the former one worse?			x
10. What would you like to change regarding your current injection device if you could?			x
11. Please show on a scale from 1 (not agree at all) to 10 (totally agree), how much you agree/disagree with all of the following statements regarding your current MS therapy and the related device.		x
Step 3: Question regarding an ideal injection device
12. Please show on a scale from 1 (not important at all) to 10 (most important), how important each of the following features is for an ideal injection device for MS therapy. Please choose 10 only for one feature.		x
Step 4: Questions about the two devices not in use after instruction video presentation and performing dummy injections. Comparison of the autoinjectors
13. Please now compare the two injection devices with each other with the help of a feature list and show us on a scale from 1 (not agree at all) to 10 (totally agree), how much you agree/disagree with respect to each injection device.		x
14. Please show on a scale from 1 (not at all) to 10 (best), which injection device fulfills the following properties.		x
15. How much do you agree with the statements, if you compare our current injection device XX with the device XY (Table with injection device XY)? Scale from 1 (not agree at all) to 10 (totally agree).		x
16. How much do you agree with the statements, if you compare our current injection device XX with the device XZ (Table with injection device XZ)? Scale from 1 (not agree at all) to 10 (totally agree).		x
17. Which features of the injection device XY do you like most in comparison to your current device?			x
18. Which features do you like the least?			x
19. Which features of the injection device XZ do you like most in comparison to your current device?			x
20. Which features do you like the least?			x
Step 5: Total evaluation of the injection devices
21. On the assumption that your own medication is suitable for all 3 autoinjectors: How do you rate the injection device in comparison? Please make a sequence from 1 to 3.	x
22. If you could freely choose, which injection device would you prefer to use – provided your own medication is suitable for all 3 autoinjectors?	x

Notes: XX, XY and XZ were dependent on which device was used by the respective patient: XX was the device in current use. XY and XZ were the two devices not in use. For example, if XX is the Betaconnect^®, then XY and XZ are the RebiSmart™ and the ExtaviPro™, respectively.

Abbreviation: MS, multiple sclerosis.