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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 brittany.keen@cappre.com.auPurpose: 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

Simon Fifer,1 Thames Kularatne,1 Marcus Tan,2 Fraser Drummond,3 John Rule4,5 1Community and Patient Preference Research Pty Ltd, Sydney, NSW, Australia; 2Reimbursement & Market Access, GlaxoSmithKline Australia Pty Ltd, Melbourne, VIC, Australia; 3Medical Dept, ViiV Healthcare Australia, Melbourne, VIC, Australia; 4National Association of People with HIV Australia, Newtown, NSW, Australia; 5School of Population Health, University of New South Wales, Sydney, AustraliaCorrespondence: Simon Fifer, Level 20, 25 Bligh St, Sydney, 2000, Australia, Tel +61 403 862 091, Email simon.fifer@cappre.com.auPurpose: To better understand what is most important to people living with human immunodeficiency virus (PLWH) when choosing their treatment. We assessed how PLWH trade off the potential risks and benefits of oral and long acting injectable (LAI) treatments.Participants and Methods: Firstly, in-depth interviews were conducted with 11 PLWH to develop a holistic understanding of experiences and determine attributes that contribute to treatment decision-making. Secondly, a discrete choice experiment (DCE) was used to understand the treatment preferences for PLWH with n = 99 PLWH aged 18 years or over with a diagnosis of human immunodeficiency virus (HIV) and who were currently using anti-retroviral therapy (ART). Study participants were presented with 12 scenarios and asked to select their preferred treatment among two hypothetical injectable treatment alternatives, “injection 1” and “injection 2” and their current oral ART treatment. The DCE data were modelled using a latent class model (LCM).Results: The model revealed significant heterogeneity in preferences for treatment attributes among study participants. Two segments/classes of PLWH were identified. The first segment expressed a strong preference for their current oral treatment; the second segment showed strong preference for the injection treatment and for it to be administered in a GP clinic. Overall, out-of-pocket cost was the most important attribute for participants. One-third of PLWH were willing to switch to an LAI.Conclusion: Not all PLWH valued the same treatment attributes equally. Overall, out-of-pocket costs for treatments were considered by respondents as the most determining factor in making treatment choices. Results have important implications for healthcare policy and will serve to better inform patients and stakeholders involved in the treatment decision-making process about the treatment preferences of PLWH. Clinicians are encouraged to consider shared decision-making to establish the treatment course that best aligns with PLWH’s treatment goals.Keywords: patient preferences, discrete choice experiment, conjoint analysis, HIV, treatment goals, shared decision-making

Simon Fifer, Lili Toh Community and Patient Preference Research (CaPPRe) Pty Ltd, Sydney, New South Wales, AustraliaCorrespondence: Simon Fifer, Community and Patient Preference Research (CaPPRe), Level 20, 25 Bligh Street, Sydney, New South Wales, 2000, Australia, Tel +61 403 862 091, Email simon.fifer@cappre.com.au

Simon Fifer,1 Lili Toh,1 Hanmant Barkate,2 Vineet Aggarwal,2 Dhammraj Borade,2 Roger Hereward Gordonsmith,3 Wen Wu,3 Claire Morgan,4 Katherine Young4 1Community and Patient Preference Research (CaPPRe) Pty Ltd, Sydney, New South Wales, Australia; 2Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India; 3Global Medical Affairs, Glenmark Pharmaceuticals Europe Ltd, Watford, Hertfordshire, UK; 4Medical Affairs, Seqirus (Australia) Pty Ltd, Melbourne, Victoria, AustraliaCorrespondence: Simon Fifer, Community and Patient Preference Research (CaPPRe), Level 20, 25 Bligh Street, Sydney, New South Wales, 2000, Australia, Tel +61 403 862 091, Email simon.fifer@cappre.com.auPurpose: Combination intranasal corticosteroid and antihistamine sprays are a first-line treatment option for allergic rhinitis (AR), of which Azelastine Hydrochloride and Fluticasone Propionate nasal spray (AZE/FLU; Dymista®), and Olopatadine Hydrochloride and Mometasone Furoate Monohydrate nasal spray (OLO/MOM; Ryaltris®) are currently registered in Australia. As it is not known how patients value treatment attributes of current combination nasal sprays, this observational, real-world clinical study aimed to understand patients’ satisfaction with, and importance of, treatment attributes of OLO/MOM and AZE/FLU using an Anchored Best-Worst Scaling (ABWS) exercise.Participants and Methods: Four hundred and twenty-six adults in Australia with moderate to severe AR using either OLO/MOM or AZE/FLU completed an online survey incorporating an ABWS with 11 domains: 7 sensory (immediate taste of medication, aftertaste of medication, smell of medication, irritation to your nose, urge to sneeze, dripping out your nose/down your throat, dryness of your nose/throat) and 4 treatment-related (convenience, fast acting, duration of effect, and AR symptom control). The ABWS involved rescaling individual BWS scores using anchored ratings (0– 10) for most and least satisfied/important domains to create a total satisfaction index (TSI) (0– 100) to be compared across groups. Statistical comparisons were completed using ANOVA (TSI) and MANOVA (individual domains).Results: Participants using OLO/MOM (M = 68.26, SE = 1.39) had significantly higher TSI than participants using AZE/FLU (M=62.78, SE = 0.70) (p < 0.001), significantly higher satisfaction on 7 of 11 domains and regarded 8 of 11 domains as significantly more important compared to participants using AZE/FLU (all p < 0.05). Preferred domains were predominantly sensory attributes.Conclusion: Current findings showed that participants using OLO/MOM were more satisfied with their overall treatment compared to participants using AZE/FLU, particularly with sensory attributes, thus highlighting the suitability of OLO/MOM for people with AR who value sensory attributes. Prescribers of AR treatments are encouraged to discuss treatment attributes with patients to facilitate shared decision-making.Keywords: hay fever, patient preference, treatment satisfaction, best-worst scaling

Simon Fifer,1 Brittany Keen,1 Richard Newton,2 Andrea Puig,3 Marija McGeachie4 1Community and Patient Preference Research, Sydney, NSW, Australia; 2Monash University, Melbourne, VIC, Australia; 3Real World Evidence Department, Janssen-Cilag Australia Pty Ltd, Sydney, NSW, Australia; 4Department of Medical and Scientific Affairs, Janssen-Cilag Australia Pty Ltd, Sydney, NSW, AustraliaCorrespondence: Andrea Puig, Real World Evidence Department, Janssen-Cilag Australia Pty Ltd, 66 Waterloo Road, Macquarie Park, Sydney, NSW, 2113, Australia, Tel +61-4-2912-8695, Fax +61 2 9815 3200, Email apuig@ITS.JNJ.comPurpose: To examine the treatment and long-term outcome preferences for people living with schizophrenia.Patients and Methods: Sixty-six Australian adults, living with schizophrenia completed a novel online survey with six sections: Demographic characteristics; Disease history; Quality-of-life; Patient support programmes; Discrete Choice Experiment, and Best-Worst Scaling exercise.Results: Participants indicated that they preferred to be involved in treatment decision with their doctor. A minority of participants reported having been previously involved in a patient support programme (28.8%) and only one in six participants had a National Disability Insurance Scheme (NDIS) package (16.7%) with over a third of participants indicating that they were ineligible (37.9%). Participants’ average quality-of-life score was 60%.Conclusion: Recent hospitalisation influenced the relative importance of treatment attributes, with effectiveness on hearing voices being the most important treatment attribute. The most important long-term goals were having a stable place to live, being independent, and physical health. People with schizophrenia care about their long-term functional recovery outcomes, rating symptom control and independence as their highest priority. They want to be part of the treatment conversation with their doctors. Therefore, psychiatrists are encouraged to use shared decision-making to establish the treatment course that best aligns with individuals’ long-term goals.Keywords: discrete choice experiment, patient preference, patient value mapping, schizophrenia, shared decision-making, treatment goals

Simon Fifer,1 Andrea Puig,2 Vanessa Sequeira,3 Mustafa Acar,2 Chee H Ng,4 Michelle Blanchard,5 Ariana Cabrera,6 James Freemantle,7 Jennifer Grunfeld8 1Research and Innovation, Community and Patient Preference Research, Sydney, New South Wales, Australia; 2Real World Evidence, Janssen Australia, Macquarie Park, New South Wales, Australia; 3Medical Affairs, Janssen Australia, Macquarie Park, New South Wales, Australia; 4Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Richmond, Victoria, Australia; 5Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia; 6Data Analytics and Visualisation, Community and Patient Preference Research, Sydney, New South Wales, Australia; 7People Measures, South Melbourne, Victoria, Australia; 8Peninsula Therapeutic & Research Group, Frankston, Victoria, AustraliaCorrespondence: Andrea PuigReal World Evidence, Janssen Australia, 66 Waterloo Road, Macquarie Park, NSW, 2113, AustraliaTel +61-4-2912-8695Fax +61 2 9815 3200Email apuig@ITS.JNJ.comBackground: There is evidence of improved adherence and treatment outcomes when patients’ treatment preferences are considered, and shared decision making is utilized.Purpose: We aimed to better understand treatment preferences among Australians with treatment-resistant depression (TRD), focusing on the specific treatment attributes that people value (such as effectiveness, risk of side effects and cost) and their relative importance. The risk-benefit trade-offs that characterize treatment choices were also examined.Patients and Methods: An online survey of 75 patients with experience of TRD was conducted, consisting of two discrete choice experiment (DCE) components – a medication DCE and a treatment plan DCE. Participants were able to prioritize and trade off different features of medications and treatment plans. Additional questions aimed to better define this population group, which in Australia is poorly understood.Results: In both DCEs, two distinct latent classes were identified. In the medication DCE, the classes were distinguished by willingness to consider new treatment alternatives. Participants in class 1 were reluctant to give up current treatment, while those in the slightly larger class 2 preferred new treatment options. In both classes, treatment effectiveness and cost were the greatest contributors to preference. Similar behavior was seen in the treatment plan DCE, with the larger class more likely to choose a new plan over their current treatment arrangement. Participants preferred medications that were low-cost, taken orally, had a high percentage improvement in mood symptoms, high rate of remission and low risk of weight gain. A similar result was found in preferences for treatment plans such that plans with the greatest effectiveness and lowest cost were most favorable.Conclusion: Patient preferences should routinely be considered and discussed to guide informed decisions regarding the value of new and existing medications for TRD and how they sit in the context of treatment plans.Keywords: patient preferences, patient value mapping, behavioral economics, major depressive disorder, quantitative research, patient centricity

Simon Fifer,1 Jayne Galinsky,2 Sarah Richard3 1Community and Patient Preference Research (CaPPRe), Sydney, NSW, Australia; 2Myeloma UK, Edinburgh, Scotland; 3PRMA, Edinburgh, ScotlandCorrespondence: Simon FiferCommunity and Patient Preference Research (CaPPRe), Sydney, NSW, AustraliaTel +61 403 862 091Email simon.fifer@cappre.com.auBackground: Myeloma is an incurable life-threatening hematological cancer. Recent treatment developments have seen improvements in survival; however, while patients are living longer, they are living with symptoms and treatment side effects.Objective: To evaluate myeloma patients’ preferences for treatment using a discrete choice experiment (DCE). This study set out to define the relative importance of key treatment attributes, characterize the risk-benefit trade-offs in patients’ decision-making, and to analyze the predictive power of basic demographic factors.Methods: Four hundred seventy-five myeloma patients in the UK were invited to participate by Myeloma UK. Data were collected using DCEs through an online survey. The DCEs presented patients with 10 choice scenarios, each with 2 treatment options described by 7 attributes, and a “no treatment” option. The DCE data were modelled using a latent class model (LCM). The effects of demographic characteristics were also examined.Results: Not surprisingly, average survival was most important to all patients but there were significant contrasts between the class preferences. The LCM revealed two classes of patients. Patients in Class 1 placed greater importance on average survival and mild-to-moderate side effects, whereas patients in Class 2 focused on the mode of administration and the average out-of-pocket costs. Patients living with others and those diagnosed in the last 5 years were more likely to be in Class 1.Conclusion: Different treatment features were not valued equally among all myeloma patients. This has important implications for healthcare policy decisions and could be used to guide decisions around the value of new myeloma medicines.Keywords: discrete choice experiment, patient preferences, myeloma, health technology assessment, dashboards

Objective: To measure the prevalence of sleep problems in a working population and examine their association with health problems, health-related quality-of-life measures, work-related problems, and medical expenditures. Also, to explore the usefulness of a sleep-problems screen for mental health conditions and underlying sleep disorders.Design: Cross-sectional survey administered via voice mail and telephone interview.Setting: A San Francisco Bay Area telecommunications firm.Participants: Volunteer sample of 588 employees who worked for a minimum of six months at the company and were enrolled in its fee-for-service health plan.Measurements and Main Results: Thirty percent of respondents reported currently experiencing sleep problems and were found to have worse functioning and well-being (general health, cognitive functioning, energy), more work-related problems (decreased job performance and lower satisfaction, increased absenteeism), and a greater likelihood of comorbid physical and mental health conditions than were the respondents who did not have sleep problems. They also demonstrated a trend toward higher medical expenditures.Conclusions: Self-perceived sleep problems were common among the respondents and were associated with poorer health and health-related quality of life. A single question about sleep problems may serve as an effective screen for identifying primary care patients with mental health problems, as well as underlying sleep disorders. [ABSTRACT FROM AUTHOR]

Objective: To consider the impact on primary care patient outcomes of using both a screener to determine elevated anxiety levels among patients with previously undetected anxiety and a physician intervention to inform physicians of their patients' conditions.Design: Participating physicians were randomized to either the demonstration or the control arm, and patients were assigned to a study arm based on the randomization of their physicians. The patients were followed for change in outcome measures during the five-month study period.Setting: A mixed-model health maintenance organization serving approximately 110,000 enrollees in central Colorado.Patients/participants: 573 patients who had unrecognized and untreated anxiety identified from the approximately 8,000 patients who completed the waiting room screening questionnaire.Interventions: A physician intervention served the dual function of 1) providing an educational demonstration of anxiety in the primary care setting and 2) providing a reporting system for summarizing the anxiety symptom levels and functioning status of the patients enrolled in the study.Measurements and Main Results: Patient outcomes were measured as changes in global anxiety scores, functioning and well-being, and patients' reports of global improvements.Conclusions: The findings indicate that this method of reporting symptoms and functioning status to primary care physicians did not significantly change patient outcomes. Improvement in outcomes appeared to be more closely associated with the patient's severity of psychological distress. [ABSTRACT FROM AUTHOR]