Modeling the impact of patient treatment preference on health outcomes in relapsing-remitting multiple sclerosis

Abstract

Aims: Model how moving from current disease-modifying drug (DMD) prescribing patterns for relapsing-remitting multiple sclerosis (RRMS) observed in the United Kingdom (UK) to prescribing patterns based on patient preferences would impact health outcomes over time. Materials and methods: A cohort-based Markov model was used to measure the effect of DMDs on long-term health outcomes for individuals with RRMS. Data from a discrete choice experiment were used to estimate the market shares of DMDs based on patient preferences (i.e. preference shares). These preference shares and real-world UK market shares were used to calculate the effect of prescribing behavior on relapses, disability progression, and quality-adjusted life-years (QALYs). The incremental benefit of patient-centered prescribing over current practices for the UK RRMS population was then estimated; scenario and sensitivity analyses were also conducted. Results: Compared to current prescribing practices, when UK patients with RRMS were treated following patient preferences, health outcomes were improved. This population was expected to experience 501,690 relapses and gain 1,003,263 discounted QALYs over 50 years under patient-centered prescribing practices compared to 538,417 relapses and 958,792 discounted QALYs under current practices (À6.8% and þ4.6%, respectively). Additionally, less disability progression was observed when prescribed treatment was based on patient preferences. In a scenario analysis where only oral treatments were considered, the results were similar, although the magnitude of benefit was smaller. Number of relapses was most sensitive to how the annualized relapse rate was modeled; disability progression was most sensitive to mortality rate assumptions. Limitations: Treatment efficacy estimates applied to various models in this study were based on data derived from clinical trials, rather than real-world data; the impact of patient-centered prescribing on treatment adherence and/or switching was not modeled. Conclusions: The population of UK RRMS patients may experience overall health gains if patient preferences are better incorporated into prescribing practices.

Patient Preferences for Treating “OFF” Episodes in Parkinson’s Disease: A Discrete Choice Experiment

“… 34 Research in another neurological disorder, relapsing/remitting multiple sclerosis, used the results from a DCE survey to compare actual prescribing behavior in the UK with prescribing patterns based on the preferences estimated in the DCE. 35 Overall, the model predicted that patients might have better health outcomes if prescribing patterns were based on patient preferences. There are a number of reasons why the predictions based on a DCE might be different from actual treatment usage, a phenomenon attributed not only to the treatment characteristics put forth in the DCE, but also prescription and reimbursement policies, physician preferences, and brand marketing.…”

“…There are a number of reasons why the predictions based on a DCE might be different from actual treatment usage, a phenomenon attributed not only to the treatment characteristics put forth in the DCE, but also prescription and reimbursement policies, physician preferences, and brand marketing. 35 , 36 In addition, the attributes and levels included in the DCE questions in this study do not reflect all attributes and levels of on-demand treatments for “OFF” episodes currently available or in development. In particular, AE attributes related only to mode of administration and the risks of these events vary with initial versus chronic exposure.…”

Treatment preferences in relation to fatigue of patients with relapsing multiple sclerosis: A discrete choice experiment

“…In MS, shared decision-making between patients and clinicians can improve adherence to DMTs, 12 and modeling studies suggest that incorporating patient preferences into prescribing practices may provide health benefits. 13…”

“…In MS, shared decision-making between patients and clinicians can improve adherence to DMTs, 12 and modeling studies suggest that incorporating patient preferences into prescribing practices may provide health benefits. 13 Attribute-based stated preference studies, especially discrete choice experiments (DCEs), have been used to examine the MS patient preferences in their choice of DMT. 14 Although many studies have investigated important attributes of MS DMTs, most were performed 4 or more years ago and did not consider attributes relevant to contemporary MS therapies.…”

Individual Differences in the Patient Experience of Relapsing Multiple Sclerosis (RMS): A Multi-Country Qualitative Exploration of Drivers of Treatment Preferences Among People Living with RMS

“…The National Health Service treatment algorithm for MS DMTs in the United Kingdom (UK) [ 25 ] highlights treatment-specific features such as administration, efficacy and side effects as important to consider and discuss with PLwRMS [ 4 , 21 , 26 , 27 ]. However, the guidance does not consider broader, non-treatment-specific factors which may also influence decision making, such as the impact of treatment on a patients’ lifestyle (e.g.…”