Patients with OA prefer therapy focus on disease progression with benefit to pain, walking
When presented with a range of treatment options, patients with osteoarthritis reported that the most important outcomes are disease progression and improving pain and walking, noted researchers in Seminars in Arthritis and Rheumatism.
“The patient perspective is becoming increasingly important in clinical and regulatory decision-making,” Mickael Hiligsmann, PhD, of Maastricht University, in the Netherlands, and colleagues wrote. “Information about what patients prefer, and how they value various aspects of a health intervention can be useful when designing, evaluating and implementing healthcare programs. Such insights can also help when establishing treatment guidelines and should be taken into consideration when designing new drugs or other interventions.”
“There has therefore been a growing interest in obtaining patients’ preferences for healthcare interventions,” Hiligsmann and colleagues wrote. “In particular, the use of stated-preference methods (including discrete-choice experiments [DCE]) has markedly increased in recent years. A DCE is a quantitative method used to elicit and quantify the preferences of participants that are asked to repeatedly choose between hypothetical options that systematically differ in several attributes of interest.”
To analyze the treatment preferences of patients with OA, Hiligsmann and colleagues conducted a discrete-choice experiment survey of 253 adults from seven European countries. The researchers presented participants with 12 choices sets of two treatment options, and asked them, in each, to select the strategy they prefer.
Using literature reviews, expert consultation, patient survey and expert meeting, the researchers characterized the treatment options by seven attributes: pain improvement, walking improvement, ability to manage domestic activities, ability to manage social activities, improvement in overall energy and well-being, risk of moderate or severe side effects and impact on disease progression. The researchers then used a random parameters logic model to estimate participants’ preferences, as well as a latent class model to analyze preference classes.
According to the researchers, there were significant differences between levels for all seven treatment attributes. However, given the range of levels of each attribute, the most important factors were impact on disease progression, which was noted by 29.5% of participants, followed by walking improvement, chosen by 17.1%, and pain improvement, chosen by 16.3%.
In addition, the latent class model identified two preference classes. In the first, with a probability of 56%, patients valued impact of disease progression the most, at 39%. In the second class, walking improvement and improvement in overall energy and well-being were the most important, at 23%.
“This study suggests that all seven treatment attributes selected were important for OA patients,” Hiligsmann and colleagues wrote. “Overall, the most important outcomes to OA patients were the impact on disease progression and improvement in pain and walking, although variations in preferences were observed between patients. Excluding the level ‘severe degradation’ in the calculation of the conditional relative importance substantially decreases the relative importance of the impact on disease progression.”