Relative Importance of Mode of Administration in Treatment Preferences among Plaque Psoriasis Patients in the United States

Background: Some aspects of psoriasis treatments can negatively influence patients’ quality of life. There is evidence from previous preference-elicitation research in psoriasis that administration characteristics are at least as important as treatment outcomes to patients. Objectives: Our objective was to test the hypothesis that patients’ preferences for reduced disease and treatment burden are as important as preferences around treatment efficacy. We evaluated patient preferences for attributes of psoriasis treatments, including efficacy, tolerability, and mode and frequency of administration. Methods: Adult patients in the United States with a self-reported physician diagnosis of psoriasis completed an online discrete-choice experiment survey. The survey included eight choice questions, each asking respondents to choose between pairs of hypothetical psoriasis medications defined by attributes including efficacy, adverse reactions, and mode and frequency of administration. A random-parameters logit regression model was used to model the preference data. Results from this model were used to calculate respondents’ willingness to trade efficacy for reduced treatment burden. Results: A total of 397 respondents, with a mean self-assessed Psoriasis Activity and Severity Index score of 8.2 (SD, 9.8), provided data for analysis. Improvements in treatment efficacy were more important than improvements in speed of onset and were more important than most increases in the chance of treatment side effects. The maximum possible improvement in treatment efficacy offered in the study was not enough to match the improvements in well being associated with some changes in mode of administration. For example, respondents were willing to accept a reduction in the percentage of patients who achieve clear or almost-clear skin after treatment from approximately 70% to 40% to avoid injections at home and use a topical treatment. Topical treatments were the most preferred option of administration followed by oral agents and intravenous infusion. Conclusions: Psoriasis patients had well-defined preferences for changes in the treatment attributes considered. Avoiding injections in favor of oral or topical treatment was more important to patients than some improvements in efficacy. These findings support previous research regarding the importance of treatment burden relative to outcomes in psoriasis and emphasize the importance of individual patient preferences in determining treatment strategy.