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Patients’ Preferences for Systemic Lupus Erythematosus Treatments—A Discrete Choice Experiment

Author

Listed:
  • Hannah Collacott

    (Evidera)

  • Andrea Phillips-Beyer

    (Innovus Consulting)

  • Nicolas Krucien

    (Evidera)

  • Bruno Flamion

    (Idorsia Pharmaceuticals Ltd)

  • Kevin Marsh

    (Evidera)

Abstract

Background Symptoms of systemic lupus erythematosus (SLE) vary between patients, but those of increased disease activity typically include musculoskeletal and mucocutaneous manifestations such as joint pain, swelling, and rashes. Several treatment options are available to patients with SLE with variable efficacy. Many treatments, especially corticosteroids, cause unwanted side effects, although little is currently known about patients’ preferences for treatments of SLE. Objective We aimed to identify which attributes of SLE treatment are valued by patients and to quantify their relative importance. Methods Adult participants with moderate-to-severe SLE were asked to make a series of choices between two hypothetical treatments in an online discrete choice experiment (DCE). A latent class model (LCL) was estimated to analyze choice data. Relative attribute importance (RAI) was calculated to determine the importance of each attribute to participants. Results A total of 342 participants from the USA completed the survey. A three-class LCL model was found to have the best fit. Class 1 (non-attenders) had non-significant preferences across all attributes. To achieve a better fit, a constrained LCL (cLCL) model was run with the two remaining classes. The most important attributes for participants in class 2 (benefit-seekers) were joint pain (RAI = 32.0%), non-joint pain (RAI = 21.8%), fatigue (RAI = 20.1%), and skin rashes and itching (RAI = 19.1%). The most important attributes for participants in class 3 (risk-avoiders) were risk of non-severe side effects from corticosteroids (RAI = 28.4%), risk of severe side effects from corticosteroids (RAI = 21.4%), and the risk of infections (RAI = 19.2%). Risk-avoiders were more likely to have been diagnosed with SLE for a longer period (>1 year) and were more likely to have experience with oral corticosteroids. Conclusions SLE patients fall into two groups with distinct preferences: benefit-seekers, who prioritize reducing the impact of disease symptoms, and risk-avoiders, who prioritize avoiding treatment risks. The implication of this finding will depend on the reasons for these differences, which warrant further research. Our study suggests that these differences arise due to the impact of disease and treatment experience on preferences. If so, well-informed patients may not be willing to tolerate the risks associated with oral corticosteroids in exchange for their benefits.

Suggested Citation

  • Hannah Collacott & Andrea Phillips-Beyer & Nicolas Krucien & Bruno Flamion & Kevin Marsh, 2024. "Patients’ Preferences for Systemic Lupus Erythematosus Treatments—A Discrete Choice Experiment," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 17(3), pages 287-300, May.
    • Handle: RePEc:spr:patien:v:17:y:2024:i:3:d:10.1007_s40271-023-00670-7
    DOI: 10.1007/s40271-023-00670-7
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    References listed on IDEAS

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    1. Lancsar, Emily & Louviere, Jordan & Flynn, Terry, 2007. "Several methods to investigate relative attribute impact in stated preference experiments," Social Science & Medicine, Elsevier, vol. 64(8), pages 1738-1753, April.
    2. Isaac M. Lipkus & Greg Samsa & Barbara K. Rimer, 2001. "General Performance on a Numeracy Scale among Highly Educated Samples," Medical Decision Making, , vol. 21(1), pages 37-44, February.
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