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Understanding Clinician Preferences for Treatment Attributes in Oncology: A Discrete Choice Experiment of Oncologists’ and Urologists’ Preferences for First-Line Treatment of Locally Advanced/Unresectable Metastatic Urothelial Carcinoma in Five European Countries

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Abstract

Introduction

Prior discrete choice experiments (DCE) in oncology found that, on average, clinicians rank survival as the most important treatment attribute. We investigate heterogeneity in clinician preferences within the context of first-line treatment for advanced urothelial carcinoma in Spain, France, Italy, Germany, and the UK.

Methods

The online DCE included 12 treatment choice tasks, each comparing two hypothetical therapy profiles defined by treatment attributes: grade 3/4 treatment-related adverse events (TRAEs), induction and maintenance administration schedules, progression-free survival, and overall survival (OS). We used a random parameters logit model to estimate attribute relative importance (RI) (0–100%) and generate preference shares for four treatment profiles. Results were stratified by country. Preference heterogeneity was evaluated by latent class analysis.

Results

In August and September 2022, 498 clinicians (343 oncologists and 155 urologists) completed the DCE. OS had the strongest influence on clinicians’ preferences [RI = 62%; range, 51.6% (Germany) to 63.7% (Spain)] followed by frequency of grade 3/4 TRAEs (RI = 27%). Among treatment profiles, the chemotherapy plus immune checkpoint inhibitor maintenance therapy profile had the largest preference share [51%; range, 38% (Italy) to 56% (UK)]. Four latent classes of clinicians were identified (N = 469), with different treatment profile preferences: survival class (30.1%), trade-off class (22.4%), no strong preference class (40.9%), and aggressive treatment class (6.6%). OS was not the most important attribute for 30.0% of clinicians.

Conclusion

While average sample results were consistent with those of prior DCEs, this study found heterogeneity in clinician preferences within and across countries, highlighting the diversity in clinician decision making in oncology.

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Acknowledgments

This study was sponsored by Merck (CrossRef Funder ID: https://doi.org/10.13039/100009945), and was previously conducted under an alliance between Merck and Pfizer. Data reported in this manuscript were presented in part at ISPOR 2023, 7–13 May 2023. Medical writing support was provided by Amy Davidson of Nucleus Global and funded by Merck and Pfizer.

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Authors and Affiliations

  1. PRECISIONheor, New York, NY, USA

    Laura Panattoni, Natalie Land, Thomas Flottemesch & Patrick Sullivan

  2. Merck Healthcare KGaA, Darmstadt, Germany

    Mairead Kearney

  3. Pfizer, New York, NY, USA

    Melissa Kirker & Brett Hauber

  4. EMD Serono, Research & Development Institute, Inc. (an Affiliate of Merck KGaA), Billerica, MA, USA

    Murtuza Bharmal

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  1. Laura Panattoni
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Correspondence to Laura Panattoni.

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Funding

This study was sponsored by Merck (CrossRef Funder ID: https://doi.org/10.13039/100009945) and was previously conducted under an alliance between Merck and Pfizer.

Conflict of Interests

LP, NL, TF, and PS are employees of PRECISIONheor, a research consultancy that provides health economics and outcomes research services to life sciences companies, which received funding from the sponsor to conduct this study. MKe is an employee of Merck Healthcare KGaA, Darmstadt, Germany. MKi and BH are employees of Pfizer. MB was an employee of EMD Serono, Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA, at the time the study was conducted.

Ethics Approval

The study protocol and materials were reviewed by an Advarra Institutional Review Board and were determined to be exempt from full review (protocol no. 00046328).

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All survey participants provided informed consent.

Data Availability Statement

The dataset for this study is available from the corresponding author on reasonable request.

Author Contributions

All authors made a significant contribution to this research, including the conception, study design, execution, acquisition of data, and analysis. All authors took part in drafting, revising, or critically reviewing the article and gave final approval of the version to be published.

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Panattoni, L., Kearney, M., Land, N. et al. Understanding Clinician Preferences for Treatment Attributes in Oncology: A Discrete Choice Experiment of Oncologists’ and Urologists’ Preferences for First-Line Treatment of Locally Advanced/Unresectable Metastatic Urothelial Carcinoma in Five European Countries. PharmacoEconomics (2024). https://doi.org/10.1007/s40273-024-01359-x

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