Understanding preferences for disease-modifying drugs in osteoarthritis.

Abstract

Numerous disease-modifying drugs for osteoarthritis (DMOADs) are under investigation. However, patients' preferences for drugs to prevent progression of OA are not known. The objective of this study was to quantify patient preferences for potential DMOADs. We administered a conjoint analysis survey to 304 patients attending outpatient general medicine and specialty clinics. All patients seated in the waiting rooms were asked if they would participate in a survey to elicit opinions about arthritis treatments. We performed simulations to estimate preferences for 4 options to prevent worsening of knee OA: best case (pill, highest benefit, lowest risk, lowest cost), worst case (infusion, lowest benefit, highest risk, highest cost), moderate subcutaneous injection (injection, mid-level benefit, mid-level risk, mid-level cost), and moderate infusion (same as subcutaneous injection except administered by infusion). Subjects' median age was 57 years; 55% were women and 76% were white. Segmentation analyses revealed 4 patterns of preferences. A minority (5%) did not want to perform subcutaneous injections and would only consider DMOADs under the best-case scenario. Approximately 20% were risk sensitive and were willing to take DMOADs under the best-case scenario, but would start rejecting these medications as risk increased. A significant number rejected DMOADs under all conditions (16.4%); however, the largest segment (59.2%) had a strong preference for DMOADs across all scenarios. Our results suggest that a significant percentage of a nonselected outpatient population might be willing to accept at least a moderate degree of risk in order to prevent worsening knee OA.