Improving Patient-Centered Care by Assessing Patient Preferences for Multiple Sclerosis Disease-Modifying Agents: A Stated-Choice Experiment

CONTEXT: Long-term adherence to pharmaceutical treatment for multiple sclerosis (MS) is poor. A focus on patient preferences when determining the patient's therapeutic plan may improve this experience.

OBJECTIVE: To identify factors important to patients with MS when evaluating their options for pharmaceutical agents that deliver disease-modifying therapy.

DESIGN: Stated-choice experiment to a sample of patients with MS from privately and publicly insured enrollees in a regional health plan. The experiment presented each respondent with a set of 8 drug choices for MS, asking them to select their preferred disease-modifying agent (DMA). Each respondent was randomized to 1 of 6 possible sets of 8 drug choices, for a total of 48 drug pairings in the experiment. Each choice included 2 hypothetical DMAs and a "no drug" option. Drug attributes included dosage type and modality, efficacy, relapse risk, and drug side effects.

RESULTS: The "no drug" alternative was a stronger substitute than the alternative drug when the focal drug characteristics changed, and the most important drivers of choice were type of side effects and risk of severe relapse.

DISCUSSION: The heterogeneity of our sample and the inclusion of a "no drug" alternative in the DMA choice scenarios make this study an important contribution to this body of literature. The importance of the "no drug" alternative in our results is consistent with poor long-term adherence to DMAs.

CONCLUSION: Patient-centered MS therapy using DMAs should include discussion of side effects and relapse risk.