Patient Preferences for Anti-Vascular Endothelial Growth Factor Treatment for Wet Age-Related Macular Degeneration in Japan: A Discrete Choice Experiment

Takeshi Joko,1 Yoshimi Nagai,2 Ryusaburo Mori,3 Koji Tanaka,3 Yuji Oshima,4 Yusuke Hikichi,5 Tetsushi Komori,6 Joao Carrasco,7 Martine C Maculaitis,8 Oliver Will,8 Kathleen Beusterien,8 Kanji Takahashi2 1Department of Ophthalmology, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan; 2Department of Ophthalmology, Kansai Medical University, Hirakata, Osaka, Japan; 3Division of Ophthalmology, Department of Visual Sciences, Nihon University of School of Medicine, Chiyoda-ku, Tokyo, Japan; 4Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; 5Department of Market Access, Bayer Yakuhin, Ltd., Chiyoda-ku, Tokyo, Japan; 6Department of Research & Product Development, Bayer Yakuhin, Ltd., Kita-Ku, Osaka, Japan; 7Department of Market Access, Bayer Consumer Care AG, Basel, Canton of Basel-Stadt, Switzerland; 8Health Division, Kantar, New York, NY, USACorrespondence: Takeshi JokoDepartment of Ophthalmology, Matsuyama Red Cross Hospital, 1 Bunkyocho, Matsuyama, Ehime 790-8524, JapanTel +81 89 924 1111Email takeshijoko@matsuyama.jrc.or.jpBackground: In Japan, intravitreal anti-vascular endothelial growth factor (anti-VEGF) dosing regimens for wet age-related macular degeneration (wAMD) include pro re nata, every 2 months, and treat-and-extend, resulting in different outcomes and patient burden. Although reflecting patient preferences in treatment decision-making is desirable, few studies have examined this in Japan. This study assessed the patients willingness to trade-off between different dosing regimens.Patients and Methods: Patients with wAMD were recruited from four Japanese university hospitals to complete a face-to-face cross-sectional survey. In a discrete choice experiment, patients were asked to choose their preferred option from two anti-VEGF treatment profiles shown side-by-side across a series of choice tasks. The profiles varied on four attributes: number of injections in 12 months, number of physician consultations in 12 months, chance of 1-year visual acuity (VA) improvement, and chance of 2-year VA maintenance. Preference weights were estimated using hierarchical Bayes’ models.Results: Overall, 120 patients (30 treatment naïve and 90 anti-VEGF experienced) completed the survey. Patients were willing to accept an increase from three to approximately eight injections in 12 months to increase the chance of 1-year VA improvement from 25% to 40%. They would be willing to accept 11 injections in 12 months if the chance of 2-year VA maintenance increased from 80% to 96%. The most valued attributes were increasing the chance of 2-year VA maintenance and reducing the number of injections in 12 months, which were each about twice as important as decreasing physician consultations in 12 months and increasing the chance of 1-year VA improvement (p< 0.001). Among the dosing regimens, patients most preferred treat-and-extend because of its higher chance of 2-year VA maintenance.Conclusion: Informing patients with wAMD about the likelihood of long-term VA maintenance when selecting treatment may increase the acceptance of an optimal treatment regimen and number of injections.Keywords: wet age-related macular degeneration, patient preference, anti-vascular endothelial growth factor treatment, dosing regimen, treat-and-extend