Patients with moderate-to-severe plaque psoriasis preferred oral therapies to phototherapies: a preference assessment based on clinical scenarios with trade-off questions.
OBJECTIVE
The importance of validly identifying and incorporating patients' views for improving health care is generally acknowledged. Common approaches to assess patients' preferences are based on the quality adjusted life year (QALY) framework, but this ignores a number of aspects that may be relevant. As an alternative, we assessed patients' treatment preferences and trade-offs for five common systemic therapies for psoriasis.


METHODS
Twenty-nine patients with moderate-to-severe psoriasis expressed treatment preferences for five oral and phototherapies and indicated the relative importance of various treatment attributes, such as adverse effects, discomforts, and safety measures. In a structured interview, they were presented with clinical scenarios that contained descriptions of process and outcome characteristics and illustrations of the anticipated treatment benefit.


RESULTS
Over all paired comparisons, methotrexate (33%), cyclosporin (30%), acitretin (15%), UV-B (14%), and PUVA (8%) were preferred to the other treatment. Patients were willing to trade-off their initial preference for more improvement of psoriasis.


CONCLUSIONS
Psoriasis patients generally prefer oral to phototherapies and consider most adverse effects and several discomforts important for selecting treatment. Our scenario-based structured interview approach to treatment preferences allowed us to incorporate a broad spectrum of potentially relevant decision components in a clinically meaningful way.
Opmeer
B C
BC
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands. b.c.opmeer@amc.uva.nl
Heydendael
V M R
VM
deBorgie
C A J M
CA
Spuls
Ph I
PI
Bossuyt
P M M
PM
Bos
J D
JD
de Rie
M A
MA
D017255:Acitretin / Q000008:administration & dosage / Q000009:adverse effects; D000284:Administration, Oral; D000328:Adult; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007641:Keratolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D011701:PUVA Therapy / Q000009:adverse effects / Q000379:methods; D017060:Patient Satisfaction; D011565:Psoriasis / Q000188:drug therapy* / Q000523:psychology / Q000532:radiotherapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000009:adverse effects / Q000379:methods
D003879:Dermatologic Agents; D007641:Keratolytic Agents; D016572:Cyclosporine; D017255:Acitretin; D008727:Methotrexate