Patient preferences in allergy immunotherapy (AIT) in Germany – a discrete-choice-experiment

Abstract

BackgroundAllergic Rhinitis (AR) is a common disorder in Europe with Allergic Asthma (AA) as a frequent comorbidity. Allergy immunotherapy (AIT) is the only causal therapy of AR and AA, and can be administered as subcutaneous injections at the physician or as sublingual drops or tablets at home. The usual treatment duration is 3 years.ObjectiveThis study aimed to elicit patient preferences to identify the AIT administration mode preferred by patients.MethodsA discrete-choice-experiment (DCE) was developed to determine how people weight different treatment options using a paper-based questionnaire from June to September 2014, including 16 study centres. Main inclusion criteria: >18 years, grass, birch and/or house dust mite AR with moderate to severe symptoms, AIT-naïve and AIT-indicated. DCE-attributes were: Administration form, number and duration of physician visits, frequency of life-threatening anaphylactic shocks, local side-effects and co-payments.ResultsTwo-hundred thirty-nine subjects participated, resulting in analysable 1842 choices. All attributes were significant predictors for the treatment-choice. Ranked by importance, the following first three attributes are most preferred by patients:1st Number and duration of physician visits:Fewer visits with shorter duration preferred (0.658*)2nd Frequency of life-threatening anaphylactic shocks:Lower risk of shocks preferred (0.285*)3rd Local side-effects:Preference for rash/swelling on upper arm over itching/swelling under the tongue (0.210*)(*coefficient-size represents relative importance of the attributes)ConclusionThe most important attribute is the number and duration of visits to a physician. A lower risk of life-threatening anaphylactic shocks was ranked as the second whereas co-payments and administration form play a limited role.

Sublingual Immunotherapy Tablet – a Cost-minimizing Alternative in the Treatment of Tree Pollen-induced Seasonal Allergic Rhinitis in Canada

“…This is also supported by a patient preference study conducted in Germany using a discrete choice experiment in 239 adults with moderate to severe grass, birch, and/or house dust mite AR. The study found that the attribute most preferred by patients regarding the mode of AIT administration was related to the number and duration of physician visits, with a strong preference for fewer visits with shorter durations [31]. A parallel physician patient survey found that Canadian patients, when asked about their preference for AIT options, were more likely to follow their allergists' recommendation for initiation of SLIT compared with SCIT [32].…”

Sublingual immunotherapy tablet for the treatment of house dust mite allergic rhinitis in Canada: an alternative to minimize treatment costs?

“…At-home administration of SLIT-tablet can be particularly advantageous in rural communities, where large distances from the nearest clinic may pose additional barriers to access and, with a high number of visits required for SCIT, potentially reducing the likeliness of patients to continue this therapy. A patient preference study conducted in Germany using a discrete choice experiment in 239 adults with moderate to severe grass, birch, and/or HDM AR found that the attribute most preferred by patients regarding the mode of AIT administration was the number and duration of physician visits, with a strong preference for fewer visits with shorter duration [25].…”

Shortened Up-Dosing With 7 Injections of Subcutaneous Allergy Immunotherapy (Alutard SQ) Is Safe and Well Tolerated

“…The optimal maintenance dose is reached safely and effectively by up-dosing over several weeks [6]. The convenience and practicability of SCIT, as perceived by patients and physicians, depend largely on the number of injections needed for up-dosing [7]. Short up-dosing has previously been reported to be safe [8][9][10].…”