title: Considering patient preferences when selecting anti-tumor necrosis factor therapeutic options.
abstract: BACKGROUND
  Anti-tumor necrosis factor (TNF) medications for the treatment of chronic inflammatory conditions represent a large and growing expenditure for health plans. Over the past few years, there has been an increase in options for patients receiving anti-TNFs, including choice of agent, route of administration, and location for receiving the medication.
  
  
  OBJECTIVE
  To examine patient preferences regarding available anti-TNF agents and mode of administration options.
  
  
  METHODS
  This cross-sectional survey and claims study was based on administrative claims in the HealthCore Integrated Research Database. Patients were identified for this study if they were receiving infliximab (the intravenous [IV] group) or adalimumab, golimumab, etanercept, or certolizumab pegol (the subcutaneous [SC] group) between March 2012 and August 2012 and were diagnosed with conditions for which these agents are indicated by the US Food and Drug Administration. The survey questionnaire was developed specifically for this study. Participants were asked about their use of anti-TNF agents, locations of administration, preferences for IV or SC therapy, interest in anti-TNF home therapy options, and their physician's role in their decision-making process. A validated instrument, the Treatment Satisfaction Questionnaire for Medication (TSQM) version II, was used to assess treatment satisfaction by the patients.
  
  
  RESULTS
  A total of 6000 patients were included in the final list of patients, and the study was stopped when the targeted number of 500 surveys were completed. The IV group consisted of 202 (40%) patients, and the SC group consisted of 298 (60%) patients. Patients in the SC group had a higher preference for the administration route they were using compared with patients in the IV group: 89.9% of the SC group preferred the SC route of administration, whereas 71.8% of the IV group preferred the IV route (P <.001). The global treatment satisfaction scores were similar in both groups (81.9 in the IV group, 80.1 in the SC group; P = .247). The reported likelihood of patients discussing alternative anti-TNF options with their physician was low (45.5% in the IV group vs 49.7% in the SC group; P = .366).
  
  
  CONCLUSIONS
  When asked to make a hypothetical choice between IV and SC administration, patients had stronger preferences for SC routes than for IV routes. There was a strong correlation between the route of administration in use and the preference, indicating high level of satisfaction with the current treatment used, which was confirmed with the TSQM version II results. An opportunity for patient education exists, because conversations with physicians about alternative anti-TNF therapies and administration appear to be lacking.
authors.affiliation: Research Manager, Payer and Provider Research, HealthCore, Inc.
authors.forename: Gosia
authors.initials: G
authors.lastname: Sylwestrzak
authors.affiliation: Senior Research Analyst, Payer and Provider Research, HealthCore, Inc.
authors.forename: Jinan
authors.initials: J
authors.lastname: Liu
authors.affiliation: Senior Scientist, Survey-Based Research, HealthCore, Inc.
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Stephenson
authors.affiliation: Managing Medical Director, Health Care Management, WellPoint, Inc.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Ruggieri
authors.affiliation: Director, Payer and Provider Research, HealthCore, Inc.
authors.forename: Andrea
authors.initials: A
authors.lastname: DeVries