Patient Preferences for Treatments of Rheumatoid Arthritis: A Discrete Choice Experiment Evaluating Preference for Novel Neuroimmune Modulation Devices
Abstract
Despite broadening treatment options for rheumatoid arthritis (RA), challenges and unmet needs remain. This study aimed to characterize patient preferences with current pharmacologic treatments and impressions of an implantable neuroimmune modulation device. A patient survey was conducted, combined with a discrete choice experiment that included 12 choice sets, containing a device profile and drug profile, featuring 8 attributes specific to each. In total, 354 completed surveys were included, 74% female, 79% <60 years, stratified into Biologic Naïve (n = 103); Biologic-Experienced-I (n = 151); and Biologic-Experienced-II (n = 100). Lack of efficacy was the primary reason for treatment discontinuation of conventional disease-modifying antirheumatic drugs (DMARDs) and biologic or targeted synthetic DMARDs. Initial impression of device-based treatment was “Positive” or “Extremely Positive” by 45% and preference ranked higher than current drug treatment options for both Biologic Experienced groups. Key drivers of treatment preference included out-of-pocket cost, symptom improvement, physical function and fatigue, and irreversible joint damage protection. RA patients were accepting of a novel neuroimmune modulation approach, including a surgically implanted device, meeting identified attributes and expectations of safety and efficacy as observed in controlled trials.
Plain Language Summary
This study found that people with rheumatoid arthritis (RA) are accepting of a novel, surgically implanted neuroimmune modulation treatment approach, reflective of dissatisfaction with ongoing pharmacologic therapy and burden associated with regular infusions, injections, or daily oral therapy. The drivers of patient preference of RA treatment include out-of-pocket treatment cost, proportion of improvement in symptoms, improvement in physical function and fatigue as well as protection from irreversible joint damage. The study concluded that a preference for a device-based treatment remained high across all subgroups and increased as a function of satisfaction with current treatment and the number of lines of prior treatment.