Patient preferences for atopic dermatitis medications in the UK, France and Spain: a discrete choice experiment

Abstract

ObjectivesWe aimed to quantify patient preferences for efficacy, safety and convenience features of atopic dermatitis (AD) treatments.Design and settingOnline discrete choice experiment survey.ParticipantsAdults in the UK, France and Spain who had used AD treatments during the past 2 years.Primary and secondary outcome measuresPreferences for attributes were analysed using a multinomial logit model. Willingness to make trade-offs was expressed as the maximum acceptable decrease (MAD) in the probability of achieving clear/almost clear skin at week 16.ResultsThe survey was completed by 404 patients (44.1±12.0 years; 65% women; 64% moderate/severe eczema). Most patients (68%) had no prior experience of using self-injectable treatments for AD or any other illness. Participants most valued increasing the chance of achieving a meaningful reduction in itch at week 16 from 20% to 50%, followed by reducing the risks of serious infections from 6% to 0% and of eye inflammation from 20% to 0%. Participants were willing to accept a decrease in the possibility of achieving clear/almost clear skin to obtain a treatment that can be paused (MAD=24.1%), requires occasional check-ups (MAD=16.1%) or no check-ups (MAD=20.9%) over frequent check-ups, is administered as a one time per day or two times per day oral pill versus a subcutaneous injection every 2 weeks (MAD=16.6%), has a 2-day over 2-week onset of action (MAD=11.3%), and can be used for flare management (MAD=5.8%).ConclusionsAlthough patients with AD most valued treatment benefits and risks, they were willing to tolerate reduced efficacy to obtain a rapid onset, oral administration, less frequent monitoring and a treatment that can be paused. Understanding patients’ preferences for AD therapies, including new targeted therapies, can aid shared decision-making between clinicians and patients and support health technology assessments.

Patient Preferences in the Treatment of Moderate-to-severe Atopic Dermatitis

“…In line with the findings of the current DCE, Thomas et al ( 25 ) found that the mode of administration significantly impacted patients’ preferences. Participants in their study prioritized increased efficacy and reduced risk, but were willing to accept reduced efficacy to receive treatment orally every day instead of as injections every second week ( 25 ). In a qualitative study from 2022, Ervin et al ( 26 ) investigated the importance of treatment administration in patients with AD.…”

“…In addition, attributes of time to onset of itch relief, probability of skin clearance at 16 weeks, and mode of administration were included in the DCE. The annual risk of malignancy was identified as the most important attribute across all attributes, highlighting the importance of safety in the view of the patients ( 7 , 25 ).…”

A Multidisciplinary Approach Is Beneficial in Atopic Dermatitis

“…In this study, patients expressed the preference for drugs with a rapid onset of action, oral administration, necessity of less frequent monitoring, and a flexibility in the administration schedule. They would trade in higher efficacy for these characteristics [72]. Similar results were obtained in a qualitative interview study in the UK and USA.…”

How to Understand Personalized Medicine in Atopic Dermatitis Nowadays?

“…Most patients are ready to accept adverse events for the efficacy of the treatment in general, as well as accepting the mode of administration [89]. A once-daily pill is usually chosen over an injection every 2 weeks as the preferred form of administration [92,95]. The prevalence of needle fear has been well documented in another survey highlighting that only 50% of respondents were willing to opt for an injectable treatment [90].…”

“…The number of patients who prefer injections increases with age and is higher among those currently receiving biologics [88]. Patients prefer oral medications over topical treatments, often seeing the latter as "less convenient" and "time consuming to apply", which has a direct consequence on the adherence of the patients [89,95]. Nevertheless, some patients claim a fear of swallowing pills [89].…”