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Eliciting Preferences to Inform Patient-Centred Policies: the Case of Psoriasis

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Abstract

Objective

To assess patient preferences for psoriasis treatment features and to investigate the heterogeneity of preferences among patients with different socio-demographic and disease-related characteristics.

Methodology

A discrete choice experiment was conducted on adult patients with moderate to severe plaque-type psoriasis during a routine visit to their physician at 15 centres in Italy. We investigated the preferences of patients with respect to five treatment attributes: (1) mode and frequency of administration; (2) time to improvement; (3) time free of symptoms; (4) unintended life expectancy reduction resulting from treatment; and (5) monthly treatment cost. The heterogeneity of preferences was investigated in a mixed logit model with normally distributed random coefficients.

Results

Overall, patients preferred the subcutaneous or intravenous route of administration (versus oral administration) and treatments that took less time to show improvement, ensured a longer time free of symptoms, involved a lesser reduction in life expectancy and had lower costs. There was significant preference heterogeneity for all attributes. The cost attribute was found to be significantly more important to females and to older patients (above 60 years of age). Older patients placed significantly greater emphasis on reduced life expectancy, whereas the time free of symptoms was significantly less important to them than to patients under 60 years of age. Patients with higher scores on the Dermatology Life Quality Index (DLQI) placed higher value on the time free of symptoms than those with lower DLQI scores. For the overall sample, the marginal willingness to pay (WTP) for a month’s reduction in the time to improvement was €32.4, whereas the WTP for one additional month without symptoms was significantly higher (€68.2).

Conclusion

Patient-centred policies should consider the heterogeneity of patients’ expectations to identify individualized treatments that would aid in optimizing patient satisfaction and wellbeing, as well as overall treatment effectiveness.

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Acknowledgments

This study was funded by an institutional grant and honoraria from Janssen Italia SpA. A.T. and G.F. received grants from Janssen Italia SpA during the conduct of the study. F.A. served as a consultant to Janssen Italia SpA during the conduct of the study and outside the submitted work.

An independent contract research organization, paid by the funding source, was responsible for the study’s deployment and survey administration in the hospitals. The views expressed in this paper are solely those of the authors, who have no conflicts of interest directly relevant to the content of the paper. The publication of the study results was not contingent on the sponsor’s approval or censorship of the manuscript.

All authors contributed to the conception and design of the study. G.F. and F.A. were in charge of defining the study protocol, while A.T. was involved in the design of the DCE part of the survey and conducted analysis on the experiment data. All authors were involved in drafting the manuscript and revising it critically for important intellectual content. All authors gave final approval of the version to be published. A.T. and G.F. had full access to all of the data in the study, and they both take complete responsibility for the integrity of the data and the accuracy of the data analysis.

Authors are particularly thankful to Stefania Casalini and Antonio Castiglia from Janssen Italia SpA for their support and contribution to the realization of the research project. Finally, authors wish to express their gratitude to all study investigators from 15 hospitals participating in the study: 1) De Simone Clara, D'Agostino Magda (Policlinico Gemelli, Roma), 2) Simonacci Marco, Bettacchi Alberta (Ospedale di Macerata), 3) Papini Manuela, Cicoletti Michela (Azienda Ospedaliera Santa Maria di Terni), 4) Cottoni Francesca, Montesu M. Antonietta (Clinica Dermatologica Università di Sassari), 5) Micali Giuseppe, Musumeci Letizia (Azienda Ospedaliera Universitaria “Policlinico-Vittorio Emanuele”, Presidio Gaspare Rodolico, Catania), 6) La Greca Stefano, Massimino Daniela (Azienda Ospedaliera “Garibaldi-S.L.Currò-Ascoli Tomaselli”, Catania), 7) Patrizi Annalisa, Bardazzi Federico (Policlinico S. Orsola-Malpighi, Bologna), 8) Peserico Andrea, Piaserico Stefano (Azienda Ospedaliera Universitaria di Padova), 9) Girolomoni Giampiero, Del Giglio Micol (Ospedale Civile Maggiore-Università degli Studi di Verona), 10) Parodi Aurora, Cozzani Emanuele (Azienda Ospedaliera San Martino, Genova), 11) Cattaneo Angleo, Carrera Carlo (Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano), 12) Colombo Enrico, Tiberio Rossana (Ospedale maggiore della Carità, Novara), 13) Valenti Giancarlo, D'Amico Domenico (Azienda Ospedaliera Pugliese Ciaccio, Catanzaro), 14) Balato Nicola (Università degli Studi di Napoli) 15) Griseta Vito, Lerario Andrea (Ospedale Generale Regionale "F. Miulli", Bari).

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Authors and Affiliations

  1. Department of Policy Analysis and Public Management, Università Commerciale Luigi Bocconi, Via Roentgen 1, 20136, Milan, Italy

    Aleksandra Torbica & Giovanni Fattore

  2. Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy

    Aleksandra Torbica & Giovanni Fattore

  3. Università di Napoli Federico II, Naples, Italy

    Fabio Ayala

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  1. Aleksandra Torbica
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  2. Giovanni Fattore
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  3. Fabio Ayala
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Correspondence to Giovanni Fattore.

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Torbica, A., Fattore, G. & Ayala, F. Eliciting Preferences to Inform Patient-Centred Policies: the Case of Psoriasis. PharmacoEconomics 32, 209–223 (2014). https://doi.org/10.1007/s40273-013-0126-6

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