Patient and Clinician Preferences for Biologic Treatments for Severe Uncontrolled Asthma: A Discrete Choice Experiment (DCE)

Abstract

Objectives

To estimate the preferences of patients with asthma and asthma-treating clinicians for attributes of biologic treatments, to compare patients’ and clinicians’ preferences, and to better understand the reasons for their preferences.

Methods

Adults with moderate-to-severe asthma and clinicians who treat asthma in the US completed a cross-sectional, online survey including a discrete choice experiment (DCE) that consisted of seven attributes spanning treatment efficacy, risk and convenience. Marginal utilities were estimated using a mixed logit model, and relative attribute importance scores calculated. Clinicians were also asked about the value of biomarker agnostic biologic treatments. The survey was followed by qualitative interviews targeting a sub-sample of survey participants, in which the rationale behind their survey responses was discussed.

Results

In the DCE, both patients and clinicians placed the most importance on exacerbation and hospitalization rate reduction, and risk of injection site reaction. Patients valued location of administration more than clinicians. Rationale for individual-level preferences varied, with patients and clinicians reporting their preference depended on event frequency and anticipated quality of life impacts. Clinicians mentioned compliance and financial impacts, while patients mentioned personal experience, particularly around site reactions. Most patients and clinicians would value a biomarker agnostic asthma treatment.

Conclusions

Asthma treatment preferences are largely driven by treatment efficacy and minimizing the risk of site reactions, although preferences differ between patients and clinicians across other attributes, highlighting the need for shared decision-making and individualized care.

Keywords:

• stated preference
• severe uncontrolled asthma
• biologics

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Funding

The author(s) reported there is no funding associated with the work featured in this article.