Patients' Preferences for Parkinson's Disease Pharmacotherapy: An Online Discrete Choice Experiment

Background: There are many pharmacological treatment options beyond levodopa for Parkinson's disease (PD), with a variety of drug classes and formulations available. To achieve patient-centered care, clinicians must consider patients' backgrounds and preferences when selecting medications. Objectives: To investigate medication preferences regarding efficacy, safety, dosage/formulation, and cost in Japanese PD patients. Methods: Adults (18-90 years) from the Japan Parkinson's Disease Association receiving PD medication were eligible. An online survey was conducted, involving a discrete choice experiment, which set five medication characteristics including improvement of bothersome symptoms, risk of dyskinesia, risk of side effects other than dyskinesia, dosage/formulation, and monthly out-of-pocket cost. A questionnaire about the value of efficacy and safety of PD medications was also included. Results: In the full analysis set (N = 207), the mean age was 65.2 years, 53.1% were female, and 62.8% had wearing-off. The most impotrant characteristics of PD medications for patients were the risk of dyskinesia, improvement of bothersome symptoms, and risk of side effects other than dyskinesia. Latent class analysis identified three groups with different preferences who have varied backgrounds, such as disease severity. The three most important symptoms patients wanted to improve were moving difficulty/slow movement (79.7%), body stiffness (43.5%), and pain (42.0%). The three most important side effects patients wanted to avoid were dyskinesia (54.6%), hallucinations/visual hallucinations (19.3%), and constipation (11.6%). Conclusion: PD patients placed the highest importance on the risk of dyskinesia for PD medications and also efficacy. To achieve patient-centered care, clinicians should consider patients' backgrounds and preferences when selecting medications.