title: Patient Preferences Regarding Rheumatoid Arthritis Therapies: A Conjoint Analysis.
abstract: BACKGROUND
  Tofacitinib, an oral Janus kinase inhibitor approved for the treatment of rheumatoid arthritis (RA), provides patients with an alternative to subcutaneously or intravenously administered biologic disease-modifying antirheumatic drugs (DMARDs). Little is known about patient preference for novel RA treatments.
  
  
  OBJECTIVE
  To investigate patient preferences for attributes associated with RA treatments.
  
  
  METHODS
  A choice-based conjoint survey was mailed to 1400 randomly selected commercially insured patients (aged 21-80 years) diagnosed with RA, who were continuously enrolled from May 1, 2012, through April 30, 2013, and had ≥2 medical claims for International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 714.0 and no previous biologic DMARD use. Treatment attributes included route of administration; monthly out-of-pocket cost; frequency of administration; ability to reduce daily joint pain and swelling; likelihood of serious adverse events; improvement in the ability to perform daily tasks; and medication burden. Mean attribute importance scores were calculated after adjusting for patient demographics (eg, age, sex, years since diagnosis) using a hierarchical Bayes model. Patient preferences for each treatment attribute were ranked by the importance score. Part-worth utilities (ie, preference scores) were used to perform a conjoint market simulation.
  
  
  RESULTS
  A total of 380 patients (response rate, 27.1%) returned the survey. Their mean age (± standard deviation) was 54.9 (± 9.3) years. Nonrespondents were 2 years younger (mean, 52.9 years; P = .002) but did not differ significantly from respondents in known clinical characteristics. After adjustment for demographic characteristics, mean patients' ranking of treatment attribute importance, in decreasing order, was route of administration, 34.1 (± 15.5); frequency of administration, 16.4 (± 6.8); serious adverse events, 12.0 (± 9.3); cost, 10.1 (± 6.2); medication burden, 9.8 (± 8.2); joint pain reduction, 8.9 (± 3.8); and daily tasks improvement, 8.8 (± 4.7). For the route of administration attribute, the part-worth utility was highest for the oral route. Conjoint simulation results showed that 56.4% of respondents would prefer an oral route of administration.
  
  
  CONCLUSIONS
  Based on this survey completed by 380 patients with RA, commercially insured patients with RA consider the route of administration to be the most important attribute of their RA treatment. In this study, the majority (56.4%) of patients preferred the oral route of administration over other routes. Understanding patient preferences may help to inform provider and payer decisions in treatment selection that may enhance patient adherence to therapy.
authors.affiliation: Principal Researcher, Comprehensive Health Insights, Louisville, KY.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Louder
authors.affiliation: Vice President, Global Health and Value, Pfizer, New York, NY.
authors.forename: Amitabh
authors.initials: A
authors.lastname: Singh
authors.affiliation: Research Leader, Comprehensive Health Insights.
authors.forename: Kim
authors.initials: K
authors.lastname: Saverno
authors.affiliation: Senior Director, Statistics, Pfizer, Groton, CT.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cappelleri
authors.affiliation: Consultant, Humana Pharmacy Solutions Specialty Strategy, Humana, Louisville, KY.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Aten
authors.affiliation: Group Lead, Inflammation and Immunology North America Medical Affairs, Pfizer, New York, NY.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Koenig
authors.affiliation: Research Manager, Collaboration Research, Comprehensive Health Insights.
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Pasquale
keywords: Bayes model; Janus kinase inhibitors; choice-based conjoint analysis; disease-modifying antirheumatic drugs; medication attributes; part-worth utility; patient preference; rheumatoid arthritis; route of administration