Understanding Treatment Preferences of Australian Patients Living with Treatment-Resistant Depression

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 centricit