Patient and Neurologist Preferences in the United States for Relapsing-Remitting Multiple Sclerosis Treatments: Findings from a Discrete Choice Experiment

Figures & data

Table 1 Attributes and Levels Included in the DCE

Attribute	Description Shown	Level 1	Level 2	Level 3
2-year disability progression	X% risk of physical disability worsening over 2 years	10%	20%	35%
1-year relapse rate	X% risk of relapsing in the next year	15%	30%	40%
Rate of BVL (relative to normal)	BVL, which is associated with cognitive decline, is about X times faster than normal (total of X% loss over 5 years)	1.5 times faster; 1.76% loss	2.5 times faster; 2.62% loss	4 times faster; 3.85% loss
Risk of GI symptoms	X% risk of GI symptoms, including stomach pain, nausea, and/or diarrhea	<1%	10%	25%
Risk of flu-like symptoms	X% risk of flu-like symptoms, including fever, muscle aches, fatigue, and/or headache	<1%	30%	70%
Risk of infection	X% risk of infection, such as a respiratory or urinary tract infection or herpes (eg, shingles, cold sores)	20%	45%	80%
Risk of life-threatening event	X% (x of y) risk of life-threatening side effect	0% risk	0.01% (1 of 10,000)	0.1% (1 of 1000)

Abbreviations: BVL, brain volume loss; DCE, discrete choice experiment; GI, gastrointestinal.

Table 2 Patient Characteristics (N=150)

Age, mean ± SD	54.0 ± 11.4
Female, n (%)	126 (84.0)
Marital status, n (%)
Single/separated/divorced/widowed	54 (36.0)
Committed relationship/married	96 (64.0)
Education, n (%)
Less than college degree	60 (40.0)
College graduate or higher	90 (60.0)
Current employment status, n (%)
Employed	46 (30.7)
Retired	39 (26.0)
Long-term disability	36 (24.0)
Homemaker	17 (11.3)
Not employed	10 (6.7)
Student	2 (1.3)
Has children in household, n (%)	106 (70.7)
Household income,^a n (%)
Less than $50,000	64 (42.7)
$50,000 to $99,999	50 (33.3)
$100,000+	31 (20.7)
Comorbidities ≥10%, n (%)
Hypertension	50 (33.3)
Depression	43 (28.7)
Anxiety	36 (24.0)
Cholesterol issues	30 (20.0)
Migraines	26 (17.3)
Diabetes	19 (12.7)
Fibromyalgia	15 (10.0)
Self-reported current health status, n (%)
Excellent, very good, or good	92 (61.3)
Fair or poor	58 (38.7)
Diagnosed ≥5 years ago, n (%)	131 (87.3)
Currently on prescription medication for RRMS, n (%)	124 (82.7)
Current prescription,^b n (%)
Oral	62 (50.0)
Injection	39 (31.5)
Infusion	21 (16.9)
Line of therapy, n (%)
First	31 (25.0)
Second	45 (36.3)
Third or later	48 (38.7)
Relapses in past 12 months, n (%)
0	87 (58.0)
1	38 (25.3)
2	16 (10.7)
≥3	9 (6.0)
MSSE Scale score,^c median (range)
Self-efficacy: Function	88.9 (17.8–100)
Self-efficacy: Control	65.0 (15.6–100)
Total score	152.8 (38.9–200)
MSQOL-54 Cognitive Function Scale score,^d median (range)	70.0 (0–100)

Notes: ^aN = 5 (3.3%) respondents selected chose not to answer the household income question. ^bPatients could have been on more than one prescription medication. Oral medications included dimethyl fumarate (29.0%), fingolimod (11.3%), and teriflunomide (9.7%). Injection medications included interferon (16.1%; interferon beta-1a: 8.9%, interferon beta-1b: 5.6%, pegylated interferon: 2.4%) and glatiramer acetate (15.3%). Infusion medication included ocrelizumab (16.9%). An additional 3.2% reported being on another medication not listed in the survey. ^cThe MSSE items are rated on a scale of 10 to 100, in increments of 10 (0=very uncertain, 50=moderately certain, and 100=very certain); scores on the subscales could range from 10 to 100, and total scores could range from 20 to 200. Higher scores indicate more self-efficacy. ^dThe MSQOL is scored from 0 to 100 (0=all of the time, 20=most of the time, 40=a good bit of the time, 60=some of the time, 80=a little of the time, and 100=none of the time); higher scores indicate higher cognitive function.

Abbreviations: MSQOL-54, Multiple Sclerosis Quality of Life-54; MSSE, Multiple Sclerosis Self-Efficacy; RRMS, relapsing-remitting multiple sclerosis; SD, standard deviation.

Table 3 Neurologist Characteristics (N=150)

Years in practice, mean ± SD	17.4 ± 7.8
Male, n (%)	113 (75.3)
Age, n (%)
Less than 55 years	64.7 (97)
55 years or older	35.3 (53)
Completed a fellowship, n (%)	121 (80.7)
Fellowship area, n (%)
Multiple sclerosis	58 (47.9)
Neuroimmunology	12 (9.9)
Other	51 (42.1)
Primary practice setting, n (%)
Academic	40 (26.7)
Nonacademic	110 (73.3)
Percent of time spent in direct patient care, mean ± SD	93.8 ± 7.2
Number of MS patients in past 3 months, median (range)	87.5 (20–500)
Number of RRMS patients in past 3 months, median (range)	57.0 (10–400)
Medication most frequently prescribed to non–highly active RRMS patients, n (%)
Injectable	18 (12.0)
Oral	69 (46.0)
Both equally	63 (42.0)

Abbreviations: MS, multiple sclerosis; RRMS, relapsing-remitting multiple sclerosis; SD, standard deviation.

Figure 1 Relative importance of treatment attributes.

Notes: 95% confidence intervals are depicted.

Abbreviations: BVL, brain volume loss; GI, gastrointestinal.

Figure 2 Attribute-level preference weights.

Notes: Preference weights should not be interpreted by themselves. Instead, the magnitude of change within one attribute should be compared to change within another attribute.

Abbreviations: BVL, brain volume loss; GI, gastrointestinal.

Figure 3 Increases in attributes that patients and neurologists are willing to accept in exchange for decreasing rate of BVL from 2.5 times to 1.5 times faster than normal.

Abbreviations: BVL, brain volume loss; GI, gastrointestinal.

Figure 4 Relative importance of treatment attributes: Neurologists by years in practice.

Notes: 95% confidence intervals are depicted.

Abbreviations: BVL, brain volume loss; GI, gastrointestinal.