title: Patient centered decision making: use of conjoint analysis to determine risk-benefit trade-offs for preference sensitive treatment choices.
abstract: Understanding patient preferences facilitates shared decision-making and focuses on patient-centered outcomes. Little is known about relapsing-remitting multiple sclerosis (RRMS) patient preferences for disease modifying therapies (DMTs). We use choice based conjoint (CBC) analysis to calculate patient preferences for risk/benefit trade-offs for hypothetical DMTs.
  
  
  METHODS
  Patients with RRMS were surveyed between 2012 and 2013. Our CBC survey mimicked the decision-making process and trade-offs of patients choosing DMTs, based on all possible DMT attributes. Mixed-effects logistic regression analyzed preferences. We estimated maximum acceptable risk trade-offs for various DMT benefits.
  
  
  RESULTS
  Severe side-effect risks had the biggest impact on patient preference with a 1% risk, decreasing patient preference five-fold compared to no risk. (OR=0.22, p<0.001). Symptom improvement was the most preferred benefit (OR=3.68, p<0.001), followed by prevention of progression of 10 years (OR=2.4, p<0.001). Daily oral administration had the third highest DMT preference rating (OR=2.08, p<0.001). Patients were willing to accept 0.08% severe risk for a year delayed relapse, and 0.22% for 4 vs 2 year prevented progression.
  
  
  CONCLUSIONS
  We provided patient preferences and risk-benefit trade-offs for attributes of all available DMTs. Evaluation of patient preferences is a key step in shared decision making and may significantly impact early drug initiation and compliance.
authors.affiliation: Health Policy and Economics, University of California San Francisco, Departments of Medicine and Pharmacy, 3333 California Street, San Francisco, CA 94143, USA. Electronic address: wilsonL@pharmacy.ucsf.edu.
authors.forename: Leslie
authors.initials: L
authors.lastname: Wilson
authors.affiliation: University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA. Electronic address: Aimee.Loucks@gmail.com.
authors.forename: Aimee
authors.initials: A
authors.lastname: Loucks
authors.affiliation: University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Bui
authors.affiliation: University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Gipson
authors.affiliation: University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA.
authors.forename: Lixian
authors.initials: L
authors.lastname: Zhong
authors.affiliation: University of California San Francisco, Department of Neurology, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA. Electronic address: amy.outdoor@ucsfmedctr.org.
authors.forename: Amy
authors.initials: A
authors.lastname: Schwartzburg
authors.affiliation: UCSF Multiple Sclerosis Center, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA. Electronic address: Liz.Crabtree-Hartman@ucsf.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Crabtree
authors.affiliation: UCSF Multiple Sclerosis Center, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA. Electronic address: Douglas.Goodin@ucsf.edu.
authors.forename: Douglas
authors.initials: D
authors.lastname: Goodin
authors.affiliation: University of California San Francisco, Regional Pediatric MS Center Director, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA. Electronic address: Emmanuelle.Waubant@ucsf.edu.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Waubant
authors.affiliation: Division of Biostatistics, University of California San Francisco, Department of Epidemiology and Biostatistics, 185 Berry Street, Suite 5700, Box 0560, San Francisco, CA 94107-1762, USA. Electronic address: chuck@biostat.ucsf.edu.
authors.forename: Charles
authors.initials: C
authors.lastname: McCulloch
mesh_terms: D000328:Adult; D003657:Decision Making / Q000502:physiology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000523:psychology* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D057240:Patient Preference / Q000523:psychology*; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Conjoint analysis; Decision aids; Multiple sclerosis; Preference sensitive care; Risk–benefit trade-offs; Utility