Preferences of Patients with Chronic Hepatitis B – A Discrete Choice Experiment on the Acceptability of Functional Cure

Fraence Hardtstock, 1,* Urbano Sbarigia, 2,* Zeki Kocaata, 1 Thomas Wilke, 1 Shirley V Sylvester 3 1Ingress-Health HWM GmbH, Wismar 23966, Germany; 2Janssen Pharmaceutica, Beerse 2340, Belgium; 3Janssen Pharmaceuticals, Titusville, NJ 8560, USA*These authors contributed equally to this workCorrespondence: Fraence HardtstockIngress-Health HWM GmbH, Alter Holzhafen 19, Wismar 23966, GermanyTel +49-3841-758-1024Fax +49-3841-7581011Email fraence.hardtstock@ingress-health.comBackground: Current antiviral therapies for chronic hepatitis B (CHB) rarely achieve functional cure, thus often requiring lifelong therapy. A therapy achieving functional cure in a significant percentage of patients could change the treatment landscape substantially. However, the acceptability of functional cure by patients is unknown, especially if associated with additional treatment burden.Methods: A Discrete Choice Experiment (DCE) including patients with CHB was performed between 2018 and 2019 in Germany. Patient inclusion criteria were confirmed CHB; age of at least 18 years; no history of hepatocellular carcinoma; no HIV or HCV/HDV co-infection. The final DCE included the following attributes: route of administration (oral administration by tablets; subcutaneous injection + tablets; intramuscular electroporation + tablets), side effect frequency (0/1/3 days per month), functional cure (1%/30%/50% of patients), frequency of physician visits (monthly, half-yearly) and travel time to treating physician (15/45 min).Results: The main analysis sample consisted of 108 patients with CHB (mean age: 49.1 years, female: 37.0%, average time since CHB diagnosis: 14.0 years, 52.8% with Hepatitis B surface antigen (HBsAg) chronic HBV infection). High efficacy was found to be the main driver of decisions for/against the presented treatment options (impacted 57% of patients’ decisions), followed by therapy regimen (17%), safety profile (12%) and number of physician visits (11%). Latent class analysis revealed first insights into different decision patterns, with age, gender and previous side-effect experience affecting patients’ decisions.Conclusion: In comparison to all other treatment-related attributes such as therapy regimen or safety profile, patients with CHB showed a strong preference towards a scenario where a substantial number of patients benefit from sustained disease remission, which mimics functional cure.Keywords: hepatitis B, antiviral therapies, sustained virologic response, functional cure, discrete choice experiment, patient preferences