Patient preferences for topical treatment of actinic keratoses: a discrete‐choice experiment. (26th July 2018)

• Record Type: Journal Article
• Authors: Kopasker, D.; Kwiatkowski, A.; Matin, R.N.; Harwood, C.A.; Ismail, F.; Lear, J.T.; Thomson, J.; Hasan, Z.; Wali, G.N.; Milligan, A.; Crawford, L.; Ahmed, I.; Duffy, H.; Proby, C.M.; Allanson, P.F.
• Is Part Of: British journal of dermatology. Volume 180:Number 4(2019)
• Page Start: 902
• Page End: 909
• Publication Date: 2018-07-26
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.16801
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: The treatment of actinic keratosis (AK) is a potentially effective strategy for the prevention of cutaneous squamous cell carcinoma (cSCC). However, the patient perspective on potential benefits of AK treatment in terms of skin cancer reduction has received little attention to date. Objectives: (i) To investigate patient preferences for topical treatments for AK using a discrete‐choice experiment (DCE); (ii) to evaluate patient willingness to trade between clinical benefit and medical burden. Methods: The DCE was conducted as part of a study to establish the feasibility of a phase III randomized controlled trial evaluating the prevention of cSCC using currently available topical interventions. Preferences were elicited by asking patients to make a series of choices between treatment alternatives with different hypothetical combinations of attribute levels. Willingness to trade between treatment attributes was estimated using a flexible‐choice model that allows for the heterogeneity of patient preferences. Results: A total of 109 patients with AK completed the DCE. The majority of patients who expressed valid preferences were willing to accept some reduction in both prophylactic and cosmetic efficacy to reduce the burden of the treatment regimen, the severity of skin reaction and other adverse effects. Patients may reject treatment if the perceived therapeutic benefit is outweighed by the subjective burden of treatment. Conclusions: Evidence of significant variation in the perceived utility of treatments across patients highlights the importance of taking individual patient preferences into account to improve AK treatment acceptability and adherence. Abstract : What's already known about this topic? There are multiple therapies of varying efficacy licensed for the treatment of actinic keratosis (AK), but none yet proven to reduce skin cancer incidence. The treatment of AK is a potential strategy for skin cancer prevention, but is feasible only if patients are willing to consent and adhere to therapy. All AK treatments carry a therapeutic burden including pain, local skin inflammation and inconvenience of regimen. Discrete‐choice experiments (DCE) are used increasingly to elicit patient preferences and thereby improve adherence to treatment. What does this study add? This is the first study to investigate patient willingness to undergo AK treatment using a DCE. The majority of patients are able to discriminate between treatment characteristics and many of these patients are willing to make trade‐offs between attributes. Patients are prepared to accept some reduction in efficacy in order to reduce treatment burden. Knowledge of patient preferences will help to optimize the design of treatment protocols given that no currently available treatment for AK is clearly superior in terms of both greater clinical benefit and reduced medical burden. Linked Editorial: de Berker. Br J Dermatol 2019; 180 :691–692 . Respond to this article Plain language summary available online