What trade-offs are patients willing to make when selecting between novel preventive treatments for migraine? Evidence from a Discrete Choice Experiment
CL Whichello1, Antje Tockhorn-Heidenreich2, Matt Quaife1, Myrto Trapali1, Tommi Tervonen1, Lars Viktrup2, April Naegeli2
1Evidera, 2Eli Lilly and Company
Objective:
To quantify the trade-offs people with episodic migraine (EM) are willing to make between the attributes of calcitonin gene-related peptide monoclonal antibodies and gepants for the prevention of migraine.
Background:
The introduction of new treatments for migraine prevention, such as CGRP-mAbs injectables and lately oral gepants, means that current and future treatment options differ in administration mode, efficacy, and the adverse event profile. Understanding patients’ treatment preferences can help improve how needs of patients with migraine are addressed.
Design/Methods:
An online discrete choice experiment (DCE) among people with self-reported EM diagnosis in the US elicited treatment preferences based on: a) treatment administration; b) chance of ≥50% reduction in monthly migraine headache days; c) onset time; d) impact of migraines on daily activities; and e) reduction in the number of days with acute medication use. Relative attribute importance (RAI) scores and maximum acceptable attribute trade-offs were obtained from a mixed logit model.
Results:
A total of 301 patients, mean age (standard deviation) of 45 (13) years completed the DCE. Patients were mostly female (63%), and mostly experienced with migraine preventive treatments (70%). The chance of achieving ≥50% response was the largest driver of treatment preferences (RAI: 38%), followed by onset time (RAI:20%). Treatment administration was the least important attribute (RAI: 8%). Despite differences in RAI, patients were willing to trade-off all attributes when making decisions. For example, on average, patients were willing to take a self-injectable treatment instead of a novel oral for an additional 7% chance in achieving ≥50% response.
Conclusions:
Preferences of patients with EM are driven by a range of treatment aspects, with chance of achieving ≥50% reduction in MHD being most important to them and administration being least important to them. The findings suggest that a patient-centric treatment strategy jointly considers and weighs all treatment aspects.