Patient Preference and Adherence (Feb 2024)
Patient and Healthcare Professional Preferences for Prescription Weight Loss Medications in Australia: Two Discrete Choice Experiments
Abstract
Simon Fifer,1 Brittany Keen,1 Anna Porter2 1Community and Patient Preference Research (CaPPRe), Sydney, NSW, Australia; 2Novo Nordisk, Sydney, NSW, AustraliaCorrespondence: Brittany Keen, Community and Patient Preference Research (CaPPRe), Level 20, 25 Bligh St, Sydney, NSW, 2000, Australia, Tel +61 406 886 288, Email [email protected]: Overweight and obesity are common in Australia and among the leading risk factors for ill health. Maintained weight loss of > 5– 10% can prevent and reduce the risk of obesity-related comorbidities. Prescription weight loss medications plus lifestyle interventions can result in additional weight loss compared with lifestyle interventions alone, but these medications are under-prescribed in Australia. Our aim was to develop a greater understanding of the treatment preferences of people with overweight or obesity and the healthcare practitioners (HCPs) who treat them.Participants and Methods: An online survey of Australian adults with overweight or obesity and treating HCPs was conducted in 2020. A discrete choice experiment (DCE) approach was used to determine what is most important to people when evaluating oral and injectable prescription weight loss medications. Participants were asked to choose between three hypothetical treatment alternatives: “Oral pill”; “Subcutaneous injection pen (replaceable needle)”; “Disposable subcutaneous injection pen (hidden needle)”; and an opt-out option (“None of these”).Results: The online survey and DCE were completed by 193 patients and 104 HCPs. For both patients and HCPs, all treatment alternatives (oral, replaceable injection and disposable injection) were preferred over the opt-out. Gastrointestinal side effects, followed by success rate, percentage body weight lost, and cost were the most important attributes to patients. For HCPs, percentage body weight loss was the most important treatment attribute, followed by success rate, gastrointestinal side effects and cost. While most patients reported relatively low needle fear, physicians reported relatively high perceived patient needle fear.Conclusion: Clinician-patient discussions about treatments for weight loss should cover the option of prescription weight loss medications, including injectable medications, which patients may be less apprehensive about than physicians believe. Treatments with a high success rate and low or manageable risk of gastrointestinal side effects may be preferred over alternatives.Plain Language Summary: Overweight and obesity are the leading cause of health problems in Australia. Medications can be effective for people with this condition when combined with diet and exercise changes, but weight-loss medications in Australia are under-used.To understand why, we surveyed 193 people living with overweight and obesity (“patients”), and 104 healthcare professionals (“HCPs”/doctors) who prescribe weight-loss medications. The online survey asked patients and HCPs to choose between medications with different benefits and risks, to uncover what features are most important to them (eg, would they prefer a medication that helps lose more weight, even if it means more side effects?).We found that both patients and HCPs would prefer to take/prescribe weight-loss medication than go medication-free. Patients preferred to take medications with low risk of gastrointestinal side effects (nausea, diarrhea/vomiting), that would help them lose the most amount of weight, and were not too expensive.HCPs preferred to prescribe medications that would help their patients lose the most amount of weight, that had the highest chance of success, had low risk of gastrointestinal side effects, and low-cost. HCPs also thought patients were more afraid of injectable medications than they actually were (most patients said they did not mind injections).If HCPs have a better understanding of what their patients want from weight-loss medication, they can have more meaningful conversations and offer medications which align with patients’ personal values and long-term health goals. With this approach, patients are more likely to stick with treatment, which means better long-term results.Keywords: discrete choice experiment, overweight, obesity, treatment preferences, treatment, shared decision-making
