Alignment of preferences in the treatment of multiple myeloma – a discrete choice experiment of patient, carer, physician, and nurse preferences

Abstract

Background: Multiple Myeloma (MM) is a cancer characterised by the proliferation of malignant plasma cells in the bone marrow. This study examined the treatment preferences of people living with MM compared to the treatment preferences of other groups involved in treatment decision making, including carers, as well as physicians and nurses who treat people living with MM in Australia. Methods: Data were collected using discrete choice experiments (DCEs) through an online survey. The DCEs presented participants with a traditional treatment generic choice experiment (e.g., treatment A vs treatment B), focusing on the clinical benefits of treatments and the associated risks. The attributes and levels of the attributes were selected based on previous research, literature review, qualitative research and expert opinion. The DCE data were modelled using a Latent Class Model (LCM). Results: The model revealed significant heterogeneity in preferences for treatment attributes. In particular, overall survival, remission period and annual out of pocket cost were the attributes with the most variation. In comparison to people living with MM, carers were less cost-sensitive and more concerned with quality of life (remission period). Physicians and nurses were generally more concerned with overall survival and more cost sensitive than people living with MM. Conclusions: This study demonstrated that not all people living with MM valued the same treatment attributes equally. Further, not all groups involved in MM treatment decision making had preference alignment on all treatment attributes. This has important implications for healthcare policy decisions and shared decision making. Results from this study could be used to guide decisions around the value of new MM medicines or the medical plan surrounding the needs of those living with MM, as well as those caring for them.

Preferences and Priorities for Relapsed Multiple Myeloma Treatments Among Patients and Caregivers in the United States

“…However, this finding was echoed in the Australian DCE where out-of-pocket costs were also more important to patients than caregivers. 24 However, it must be noted that out-of-pocket costs were not highly important to either group, ranking behind OS, remission duration, mode/frequency of treatment and severe side effects. In the UK study, out-of-pocket costs was the least important of all attributes.…”

“…Two recent DCE studies examined preferences for MM treatment among patients in the UK and Australia. 23 , 24 In both studies, patients placed significantly more importance on overall survival (OS) than other attributes. However, the levels of the attribute for OS ranged from 1 to 5 years in one study and 1 to 9 years in the other, which may have attributed to its high preference weight.…”

“…Some studies of cancer therapy preferences that included mode of administration have found that patients prefer oral to intravenous administration, including the two aforementioned DCE studies in MM. 23 , 24 , 26–30 Future research should explore how mode of administration influences patient preferences, perhaps separately from assessing benefit-risk tradeoffs between efficacy and adverse events. In such a study, a survey to evaluate treatment satisfaction and burden of illness among patients undergoing treatment for MM found that patients treated with oral therapy reported greater effectiveness, satisfaction, and convenience than patients treated with injectable therapy.…”

Management of patients with multiple myeloma beyond the clinical-trial setting: understanding the balance between efficacy, safety and tolerability, and quality of life

“…Patients are becoming increasingly involved in their own treatment decision-making 53 , and their specific preferences, including the importance they attach to each of the factors discussed in the previous section, as well as their overall treatment goals, must be considered when selecting a regimen 54 . As MM is a heterogeneous disease with a heterogeneous patient population, these preferences and goals of treatment may differ between patients, depending on multiple patient-related, diseaserelated, and treatment-related factors [3][4][5]14,54,55 . 'Efficacy' therefore means different things to different patients.…”

The key factors influencing patients in selecting autologous hematopoietic stem-cell transplantation as the main therapy for multiple myeloma: A population-based epidemiological study

“…In the real-world practice, however, the proportion of patients who are accepting ASCT is very low. As MM is a heterogeneous disease, treatment preferences and goals may differ between patients, depending on multiple patient-related, disease-related, and treatment-related factors [6,7]. These factors include clinical symptoms, treatment burden, and toxicities, ability to participate in daily activities, nancial burden, accessibility to treatment, and convenience of treatment [8] and could affect treatment goals and patients' treatment choices, and eventually affect the quality of life.…”