A Discrete Choice Experiment to Assess Patient Preferences for Asthma Rescue Therapy and Disease Management

Elliot Israel; Nabeel Farooqui; Chris Gillette; Ileen Gilbert; Hitesh Gandhi; Tommi Tervonen; Zaneta Balantac; Caitlin Thomas; Nicolas Krucien; Maureen George

doi:10.1016/j.jaip.2023.04.046

A Discrete Choice Experiment to Assess Patient Preferences for Asthma Rescue Therapy and Disease Management

J Allergy Clin Immunol Pract. 2023 Sep;11(9):2781-2791.e4. doi: 10.1016/j.jaip.2023.04.046. Epub 2023 May 12.

Authors

Affiliations

¹ Department of Pulmonology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
² Allergy Partners, Fishers, Ind.
³ Department of PA Studies, Wake Forest University School of Medicine, Winston-Salem, NC.
⁴ US Medical Affairs-Respiratory, AstraZeneca, Wilmington, Del. Electronic address: ileen.gilbert@astrazeneca.com.
⁵ US Medical Affairs-Respiratory, AstraZeneca, Wilmington, Del.
⁶ Patient-Centered Research, Evidera, London, United Kingdom.
⁷ Patient-Centered Research, Evidera, Boston, Mass.
⁸ School of Nursing, Columbia University, New York, NY.

PMID: 37182565
DOI: 10.1016/j.jaip.2023.04.046

Abstract

Background: With the expanding treatment landscape for asthma, the process of identifying best-fit, individualized management options is becoming increasingly complicated. Understanding patients' preferences can inform shared decision-making between clinicians and patients.

Objectives: To examine preferences of adults with asthma for therapeutic and management attributes and determine how these preferences vary among patients.

Methods: We conducted an online discrete choice experiment survey in US adults with asthma. Patient preferences were analyzed using logit models. Factors affecting patients' preferences were identified by least absolute shrinkage and selection operator analysis.

Results: A total of 1,184 patients completed the survey (60% female; mean [SD] age, 49.2 [15.0] years). Patients most valued fewer asthma attacks requiring urgent health care professional visits, fewer exacerbations requiring oral corticosteroids, and a reduced risk for oral thrush. Higher value was placed on reducing the risk of short-term (oral thrush) versus long-term side effects (diabetes). Patients were willing to increase rescue medication use in exchange for decreasing exacerbations requiring oral corticosteroids and attacks requiring urgent health care professional visits. Patients preferred a single inhaler for rescue and maintenance and least valued asthma action plans. Demographic, socioeconomic, and clinical factors affected patient preferences.

Conclusions: Patients sought convenient management options that focused mainly on decreasing the short-term morbidity associated with asthma exacerbations and therapies. Preferences varied by demographics, clinical factors, and socioeconomics. It is important for shared decision-making discussions to include conversations about morbidity and how available therapeutic options align with individual patient preferences.

Keywords: Albuterol; Asthma action plan; Exacerbations; Inhaled corticosteroid; Oral corticosteroids; Shared decision-making.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Adult
Anti-Asthmatic Agents* / therapeutic use
Asthma* / drug therapy
Disease Management
Female
Humans
Male
Middle Aged
Nebulizers and Vaporizers
Patient Preference

Substances

Adrenal Cortex Hormones
Anti-Asthmatic Agents