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What matters most to patients when choosing treatment for mild–moderate asthma? Results from a discrete choice experiment
  1. Christina Baggott1,
  2. Paul Hansen2,
  3. Robert J Hancox3,4,
  4. Jo Katherine Hardy1,
  5. Jenny Sparks1,
  6. Mark Holliday1,
  7. Mark Weatherall5,
  8. Richard Beasley1,6,
  9. Helen K Reddel7,
  10. James Fingleton1,6
  11. on behalf of the PRACTICAL discrete choice experiment study team
    1. 1Asthma Programme, Medical Research Institute of New Zealand, Wellington, New Zealand
    2. 2Economics, University of Otago, Dunedin, New Zealand
    3. 3Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
    4. 4Respiratory Medicine, Waikato Hospital, Hamilton, Waikato, New Zealand
    5. 5Medicine, University of Otago Wellington, Wellington, New Zealand
    6. 6Respiratory Medicine, Capital and Coast District Health Board, Wellington, New Zealand
    7. 7Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
    1. Correspondence to Dr Christina Baggott, Medical Research Institute of New Zealand, Wellington, New Zealand; christina.baggott{at}mrinz.ac.nz

    Abstract

    Background An as-needed combination preventer and reliever regimen was recently introduced as an alternative to conventional daily preventer treatment for mild asthma. In a subgroup analysis of the PRACTICAL study, a pragmatic randomised controlled trial of budesonide–formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild asthma, we recently reported that about two-thirds preferred as-needed combination preventer and reliever therapy. The aim of this study was to determine the relative importance of attributes associated with these two asthma therapies in this subgroup of participants who indicated their preferred treatment in the PRACTICAL study.

    Methods At their final study visit, a subgroup of participants indicated their preferred treatment and completed a discrete choice experiment using the Potentially All Pairwise RanKings of all possible Alternatives method and 1000minds software. Treatment attributes and their levels were selected from measurable study outcomes, and included: treatment regimen, shortness of breath, steroid dose and likelihood of asthma flare-up.

    Results The final analysis dataset included 288 participants, 64% of whom preferred as-needed combination preventer and reliever. Of the attributes, no shortness of breath and lowest risk of asthma flare-up were ranked highest and second highest, respectively. However, the relative importance of the other two attributes varied by preferred therapy: treatment regimen was ranked higher by participants who preferred as-needed treatment than by participants who preferred maintenance treatment.

    Conclusions Knowledge of patient preferences for treatment attributes together with regimen characteristics can be used in shared decision-making regarding choice of treatment for patients with mild–moderate asthma.

    Trial registration number ACTRN12616000377437.

    • asthma
    • asthma pharmacology
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    Footnotes

    • Twitter @jamesfingleton

    • Collaborators Clinical Horizons (Tauranga, New Zealand): Andrew Corin, Liz Dronfield, Colin Helm, Tracy Paterson, Bhuwan Poudel; Culloden Research (Papamoa, New Zealand): Davitt Sheahan, Pamela Sheahan; Medical Research Institute of New Zealand and Lower Hutt After Hours Medical Centre (Wellington, New Zealand): Christina Baggott, Richard Beasley, Irene Braithwaite, Alexandra Eathorne, Stefan Ebmeier, James Fingleton, Daniela Hall, Jo Hardy, Matire Harwood, Mark Holliday, Claire Houghton, Saras Mane, John Martindale, Karen Oldfield, Janine Pilcher, Donah Sabbagh, Philippa Shirtcliffe, Jenny Sparks, Alexandra Vohlidkova, Mathew Williams; Optimal Clinical Trials Ltd (Auckland, New Zealand): Patrick Collins, Summer Hassan, Annika Lam, Claudette Lionnet, Barney Montgomery, Liz Smaill; RMC Medical Research (Dunedin, New Zealand): Elena Bayly-McCredie, Chris Millar-Coote, Dean Millar-Coote, Jim Reid, Anna Samuel; University of Otago, Dunedin: Robert J Hancox; University of Otago, Wellington: Mark Weatherall; Woolcock Institute of Medical Research (Sydney, Australia): Helen K Reddel.

    • Contributors CB, PH, RJH, RB, HKR and JF conceived the idea and designed the study. CB, JKH and JS collected the data. MH monitored the study and undertook data management. CB, JF and MW undertook data analysis. All authors had access to analyses of study data. CB and PH wrote the first draft of the manuscript, and all authors contributed to and approved the final version.

    • Funding The PRACTICAL study and the DCE were funded through a programme grant (15/573) provided by the Health Research Council of New Zealand to the study sponsor, the Medical Research Institute of New Zealand (MRINZ). MRINZ had overall responsibility for the study conduct, monitoring and data management.

    • Competing interests CB reports personal fees from AstraZeneca and Novartis. PH co-owns and cocreated the 1000minds software used in this study, which was created for the purpose of supporting elements of the methodology explained herein and which is made available to many academics (to date, more than 2000 researchers and students worldwide), including for the present study for free. RJH reports grants from AstraZeneca and Boehringer Ingelheim; and personal fees from Menarini. JKH reports personal fees from AstraZeneca. RB reports grants from Genentech, AstraZeneca, GlaxoSmithKline; and personal fees from AstraZeneca and Theravance. HKR reports grants from AstraZeneca and Novartis; personal fees from AstraZeneca, GlaxoSmithKline, Merck, Novartis, Teva, Mundipharma, and Boehringer Ingelheim; and is chair of the Global Initiative for Asthma scientific committee. JF reports grants from AstraZeneca, GlaxoSmithkline, and Genentech; and personal fees and non-financial support from AstraZeneca and Boehringer Ingleheim.

    • Patient consent for publication Not required.

    • Ethics approval The PRACTICAL study and the DCE were approved by the Northern B Health and Disability Ethics Committee (reference 15/NTB/178).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Deidentified individual participant DCE data from the PRACTICAL trial will be shared beginning two years after article publication with no end date. These data will be available to researchers who provide a methodologically sound proposal for the purposes of achieving specific aims outlined in that proposal. Proposals should be directed to Richard Beasley via email: richard.beasley@mrinz.ac.nz and will be reviewed by the PRACTICAL study management committee. Requests to access data to undertake hypothesis-driven research will not be unreasonably withheld. To gain access, data requesters will need to sign a data access agreement and to confirm that data will only be used for the agreed purpose for which access was granted.

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