Patient Preferences for Biologic Therapies in Chronic Disease: A Systematic Review of Discrete Choice Experiments

Introduction: Balancing high efficacy against significant toxicity risks a central challenge in biologic therapy selection for chronic diseases. This systematic review evaluated discrete choice experiments (DCEs) of patient preferences for biologic therapy to identify the treatment attributes that most consistently influence patient choice. Methods: MEDLINE, Embase, Scopus, CINAHL, and Web of Science were searched (PROSPERO CRD420251271716) for Discrete Choice Experiments (DCEs) evaluating patient preferences for biologic therapies. Two reviewers independently screened eligible studies, extracted study characteristics and treatment attributes, evaluated methodological quality using an ISPOR-based quality assessment instrument, and identified the two most important treatment attributes reported in each study. Results: Twenty-four studies (2010-2025), most published after 2020, met inclusion criteria across a range of chronic diseases, most frequently psoriasis, rheumatoid arthritis, and inflammatory bowel disease. Of 173 attributes identified, 61% were outcome attributes, 34% process, and 5% cost. Patients most often prioritized the risk of serious adverse events, followed by treatment response; process features gained importance when efficacy and safety differences were minimal, and cost carried greater weight where out-of-pocket expenditure was higher. Twenty-three of 24 studies achieved the maximum ISPOR score of 9/9 Conclusions: Patient preferences in biologic selection follow a clear hierarchy determined by perceived risk, expected benefit, and treatment context. Incorporating these preferences into shared decision-making might improve treatment alignment and long-term patient adherence. This evidence supports patient-centered care and counseling at the initiation of treatment.