Patient centered decision making: use of conjoint analysis to determine risk-benefit trade-offs for preference sensitive treatment choices

Leslie Wilson; Aimee Loucks; Christine Bui; Greg Gipson; Lixian Zhong; Amy Schwartzburg; Elizabeth Crabtree; Douglas Goodin; Emmanuelle Waubant; Charles McCulloch

doi:10.1016/j.jns.2014.06.030

Patient centered decision making: use of conjoint analysis to determine risk-benefit trade-offs for preference sensitive treatment choices

J Neurol Sci. 2014 Sep 15;344(1-2):80-7. doi: 10.1016/j.jns.2014.06.030. Epub 2014 Jun 23.

Authors

Affiliations

¹ Health Policy and Economics, University of California San Francisco, Departments of Medicine and Pharmacy, 3333 California Street, San Francisco, CA 94143, USA. Electronic address: wilsonL@pharmacy.ucsf.edu.
² University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA. Electronic address: Aimee.Loucks@gmail.com.
³ University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA.
⁴ University of California San Francisco, Department of Neurology, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA. Electronic address: amy.outdoor@ucsfmedctr.org.
⁵ UCSF Multiple Sclerosis Center, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA. Electronic address: Liz.Crabtree-Hartman@ucsf.edu.
⁶ UCSF Multiple Sclerosis Center, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA. Electronic address: Douglas.Goodin@ucsf.edu.
⁷ University of California San Francisco, Regional Pediatric MS Center Director, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA. Electronic address: Emmanuelle.Waubant@ucsf.edu.
⁸ Division of Biostatistics, University of California San Francisco, Department of Epidemiology and Biostatistics, 185 Berry Street, Suite 5700, Box 0560, San Francisco, CA 94107-1762, USA. Electronic address: chuck@biostat.ucsf.edu.

PMID: 25037284
DOI: 10.1016/j.jns.2014.06.030

Abstract

Understanding patient preferences facilitates shared decision-making and focuses on patient-centered outcomes. Little is known about relapsing-remitting multiple sclerosis (RRMS) patient preferences for disease modifying therapies (DMTs). We use choice based conjoint (CBC) analysis to calculate patient preferences for risk/benefit trade-offs for hypothetical DMTs.

Methods: Patients with RRMS were surveyed between 2012 and 2013. Our CBC survey mimicked the decision-making process and trade-offs of patients choosing DMTs, based on all possible DMT attributes. Mixed-effects logistic regression analyzed preferences. We estimated maximum acceptable risk trade-offs for various DMT benefits.

Results: Severe side-effect risks had the biggest impact on patient preference with a 1% risk, decreasing patient preference five-fold compared to no risk. (OR=0.22, p<0.001). Symptom improvement was the most preferred benefit (OR=3.68, p<0.001), followed by prevention of progression of 10 years (OR=2.4, p<0.001). Daily oral administration had the third highest DMT preference rating (OR=2.08, p<0.001). Patients were willing to accept 0.08% severe risk for a year delayed relapse, and 0.22% for 4 vs 2 year prevented progression.

Conclusion: We provided patient preferences and risk-benefit trade-offs for attributes of all available DMTs. Evaluation of patient preferences is a key step in shared decision making and may significantly impact early drug initiation and compliance.

Keywords: Conjoint analysis; Decision aids; Multiple sclerosis; Preference sensitive care; Risk–benefit trade-offs; Utility.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Decision Making / physiology*
Disability Evaluation
Female
Humans
Male
Middle Aged
Multiple Sclerosis, Relapsing-Remitting / psychology*
Multiple Sclerosis, Relapsing-Remitting / therapy
Outcome Assessment, Health Care
Patient Compliance*
Patient Preference / psychology*
Retrospective Studies
Risk Assessment