Using a multidimensional unfolding approach to assess multiple sclerosis patient preferences for disease-modifying therapy: a pilot study

Abstract

Angel Perez Sempere,1 Vanesa Vera-Lopez,2 Juana Gimenez-Martinez,1 Elena Ruiz-Beato,3 Jesús Cuervo,4 Jorge Maurino5 1Department of Neurology, Hospital General Universitario de Alicante, Alicante, 2Department of Statistics, University of Salamanca, Salamanca, 3Health Economics and Outcomes Research Unit, Roche Farma SA, Madrid, 4Health Economics and Outcomes Research, Oviedo, 5Medical Department, Roche Farma SA, Madrid, Spain Purpose: Multidimensional unfolding is a multivariate method to assess preferences using a small sample size, a geometric model locating individuals and alternatives as points in a joint space. The objective was to evaluate relapsing–remitting multiple sclerosis (RRMS) patient preferences toward key disease-modifying therapy (DMT) attributes using multidimensional unfolding. Patients and methods: A cross-sectional pilot study in RRMS patients was conducted. Drug attributes included relapse prevention, disease progression prevention, side-effect risk and route and schedule of administration. Assessment of preferences was performed through a five-card game. Patients were asked to value attributes from 1 (most preferred) to 5 (least preferred). Results: A total of 37 patients were included; the mean age was 38.6 years, and 78.4% were female. Disease progression prevention was the most important factor (51.4%), followed by relapse prevention (40.5%). The frequency of administration had the lowest preference rating for 56.8% of patients. Finally, 19.6% valued the side-effect risk attribute as having low/very low importance. Conclusion: Patients’ perspective for DMT attributes may provide valuable information to facilitate shared decision-making. Efficacy attributes were the most important drug characteristics for RRMS patients. Multidimensional unfolding seems to be a feasible approach to assess preferences in multiple sclerosis patients. Further elicitation studies using multidimensional unfolding with other stated choice methods are necessary to confirm these findings. Keywords: multiple sclerosis, multidimensional unfolding, patient preferences, disease-modifying therapy, decision-making 

Keywords

• Multiple sclerosis - Multidimensional unfolding - Patient preferences - Disease-modifying therapy – Decision-making