Patient and physician preferences for attributes of biologic medications for severe asthma

Figures & data

Table 1 Selected attributes and definitions

Attribute	Patients	Physicians
Mode of administration	How the medication is administered (injected under the skin versus injected into a vein (intravenous or IV))	Mode of administration (subcutaneous injection versus intravenous)
Setting of administration	Where you receive the medication (administration at home versus administration by a health care provider in a doctor’s office or clinic)	Setting for administration (whether the medication must be administered in a health care setting or whether it can be administered at home by the patient)
Dosing frequency	Frequency of treatment (whether you receive the biologic therapy every 2, 4, or 8 weeks)	Dosing frequency (every 2 weeks or 4 weeks or 8 weeks)
Number of injections	Number of injections each time you receive a treatment (how many needle sticks are required each time you receive a treatment)	Number of injections each treatment (how many needle sticks are required each treatment)
Time to onset of efficacy	Speed of onset (how long it takes when you first start taking the medication until you notice an improvement in your asthma symptoms)	Time to onset of efficacy after a patient starts taking the medication (a few days to 6 or more months)
Time required for medication to be administered	Time required for the medication to be administered (how long you spend in the doctor’s office each time you receive biologic therapy)	Not included
Scheduling treatment	Scheduling treatment (the availability of appointments for receiving biologic therapy at a time and place that are convenient for you)	Not included
Out-of-pocket costs	Your out-of-pocket cost (how much you pay out-of-pocket for your biologic therapy)	Not included
Insurance reimbursement/access	Not included	Insurance reimbursement/access (the degree to which the medication is covered by insurance and the time required to obtain insurance authorization)
Formulation^a	Not included	Formulation (premixed liquid in prefilled syringe versus lyophilized vial that requires reconstitution)
Administration burden	Not included	Administration burden (time and effort required for clinic staff to prepare the medication, administer the medication, and monitor the patient)

Note: ^aPreparation process or procedures for reconstitution of the medication prior to administration.

Table 2 Patient-reported sociodemographic characteristics (N=47)

Patient sociodemographic characteristics	Total N=47
Age (years)
Mean (SD) [Range]	49.9 (13.1) [18.0–79.0]
Gender, n (% female)	35 (74.5%)
Ethnicity
Not Hispanic or Latino	46 (97.9%)
Hispanic or Latino	1 (2.1%)
Race^a
White	36 (76.6%)
Black or African American	11 (23.4%)
Employment status
Employed, full-time	27 (57.5%)
Employed, part-time	1 (2.1%)
Homemaker	4 (8.5%)
Student	1 (2.1%)
Unemployed	4 (8.5%)
Retired	6 (12.8%)
Disabled	4 (8.5%)
Highest level of education
Secondary/high school	18 (38.3%)
Associate degree, technical or trade school	7 (14.9%)
College/university degree	13 (27.7%)
Postgraduate school	9 (19.1%)
Self-reported years since asthma diagnosis^b
Mean (SD) [Range]	26.7 (14.4) [3.0–54.0]
Asthma exacerbations in the past 12 months^b
Mean (SD) [Range]	6.5 (15.2) [0–99.0]
Other health conditions^a
Allergy diagnosed by blood or skin testing	36 (76.6%)
Allergic rhinitis	35 (74.5%)
Arthritis	23 (48.9%)
GERD	22 (46.8%)
Chronic sinusitis	19 (44.4%)
Sleep apnea	14 (29.8%)
Hypertension	13 (27.7%)
Anaphylaxis	12 (25.5%)
Anxiety	11 (23.4%)
Nasal polyps	10 (21.3%)
Depression	7 (14.9%)
Aspirin sensitivity	5 (10.7%)
Atopic dermatitis/eczema	3 (6.4%)
Diabetes	2 (4.3%)
Heart disease	1 (2.1%)
Stroke	1 (2.1%)
Other^c	7 (14.9%)
No other health conditions	1 (2.1%)

Notes: ^aResponse options were not mutually exclusive. Participants were given the option to “check all that apply.” ^bn=46. ^cOther includes: psoriasis (n=2), allergic asthma (n=1), common variable immune deficiency (n=1), psoriatic arthritis (n=1), peanut allergy (n=1), Grave’s disease (n=1), Churg-Strauss syndrome (n=1), hiatal hernia (n=1).

Abbreviation: GERD, gastrointestinal reflux disorder.

Table 3 Site-reported patient clinical characteristics (N=47)

Patient clinical characteristics	Total N=47
Years since asthma diagnosis (n=47)
Mean (SD) [Range]	26.2 (16.8) [6.0–67.0]
Years since severe asthma diagnosis (n=47)
Mean (SD) [Range]	9.5 (8.4) [3.0–39.0]
BMI (n=47)
Mean (SD) [Range]	33.6 (8.0) [21.5–53.4]
Months since last PFT in a stable state (n=37)
Mean (SD) [Range]	5.8 (4.1) [0–13.0]
FEV1 % predicted (n=38)
Mean (SD)	74.0 (17.5) [24.0–113.0]
FEV/FVC ratio (n=38)
Mean (SD)	0.7 (0.2) [0.4–1.3]
Currently diagnosed with eosinophilic asthma (n=47)
Yes	9 (19.2%)
Asthma exacerbations in the past 12 months^a (n=47)
Mean (SD) [Range]	1.2 (1.8) [0–9.0]
Emergency department visits for asthma in the past 12 months (n=47)
Mean (SD) [Range]	0.5 (1.3) [0–6.0]
Hospital admissions for asthma in the past 12 months (n=47)
Mean (SD) [Range]	0.2 (0.7) [0–4.0]

Note: ^aAsthma exacerbations requiring course (3+ days) of oral corticosteroids or an injection of corticosteroids in the past 12 months.

Abbreviations: PFT, pulmonary function test; FeNO, exhaled nitric oxide level; BMI, body mass index.

Table 4 Physician sociodemographic characteristics

Physician sociodemographic characteristic	Total N=25
Age
Mean (SD) [Range]	56.6 (6.3) [46.0–73.0]
Gender (% female)	5 (20.0%)
Practice setting
Group practice	16 (64.0%)
Private solo practice	4 (16.0%)
Hospital-based practice	5 (20.0%)
Practice geographical setting
Urban	11 (44.0%)
Suburban	14 (56.0%)
Minimum age of severe asthma patients treated
Mean (SD) [Range]	10.2 (7.8) [1.0–21.0]
Maximum age of severe asthma patients treated
Mean (SD) [Range]	86.7 (10.1) [70.0–100.0]
Type of insurance for majority of severe asthma patients treated
Commercial insurance	23 (92.0%)
Medicare	1 (4.0%)
No insurance	1 (4.0%)
Number of asthma patients seen per year
Mean (SD) [Range]	583.6 (365.2) [150–1,500]
Number of severe asthma patients seen per year
Mean (SD) [Range]	135.8 (93.2) [25–350]
Number of severe asthma patients currently on biologic therapy seen per year
Mean (SD) [Range]	28.4 (21.4) [5–85]

Figure 1 Patients’ rankings of importance of biologic medication attributes (N=46). Only n=46 were included in final analysis. One patient was excluded due to low literacy that prevented accurate collection of quantitative data.

Figure 2 Physicians’ rankings of importance of biologic medication attributes (N=25).

Figure 3 Preferences for biologic characteristics. Only n=46 were included in final analysis. One patient was excluded due to low literacy that prevented accurate collection of quantitative data.

Figure 4 Preferences among 4 biologic treatment profiles. Only n=46 were included in final analysis. One patient was excluded due to low literacy that prevented accurate collection of quantitative data. Treatment profiles presented to patients provided information on how the medication is administered, the frequency of treatment, and the number of injections in each treatment. The profile descriptions were: Biologic A—injected under the skin, every 8 weeks (after first 3 doses given every 4 weeks), 1 injection per treatment; Biologic B—injected under the skin, every 4 weeks, 1 injection per treatment; Biologic C – injected into a vein, every 4 weeks, 1 injection per treatment; and Biologic D – injected under the skin, every 2 or 4 weeks, 1 to 3 injections per treatment. Treatment profiles presented to physicians contained similar information as patients, but also included information on the process required for administration (based on FDA prescribing information). The profile descriptions were: Biologic A—subcutaneous injection, every 8 weeks (after first 3 doses given every 4 weeks), remove from refrigerator & allow to reach room temperature (30 mins) prior to administration. No health care practitioner (HCP_ action required during that time, 1 injection per treatment; Biologic B—subcutaneous injection, every 4 weeks, needs to reconstitute lyophilized powder: Add sterile water to center of powder, gently swirl for 10 s at 15-s intervals until powder dissolves (5–6 mins); ensure solution is clear to opalescent and colorless to pale yellow, 1 injection per treatment; Biologic C—intravenous injection, every 4 weeks, weight-based dosage; insert into infusion bag & invert; administer immediately after preparation, 1 injection per treatment; and Biologic D—subcutaneous injection, every 2 or 4 weeks, determine dose & dosing frequency by serum total IgE level & body weight using dose charts; need to reconstitute lyophilized powder: vial must be upright to inject sterile water & swirl for 5–10 s every 5 mins to dissolve; takes 15–20 min to dissolve; invert vial before administration, 1–3 injections per treatment.