Exploring Preferences and Priorities in Advanced Parkinson's Disease: A Discrete Choice Experiment

Area of Science:

• Neurology
• Pharmacology
• Patient-Reported Outcomes

Background:

• Advanced Parkinson's disease (aPD) management involves balancing efficacy, safety, and treatment modality.
• Motor fluctuations and worsening symptoms necessitate advanced therapies like infusions, gels, or deep brain stimulation.
• Assessing patient and caregiver preferences is crucial for treatment satisfaction, adherence, and quality of life.

Purpose of the Study:

• To investigate the treatment preferences of people with aPD (PwP) and their care partners (CPs).
• To identify key attributes influencing treatment choice in aPD.
• To understand trade-offs between different treatment characteristics.

Main Methods:

• A discrete choice experiment (DCE) was conducted with 304 participants (223 PwP, 81 CPs) from the USA, UK, and Germany.
• Participants evaluated hypothetical treatments based on attributes including ON time without dyskinesia, OFF time, side effect risks, route of administration (ROA), and regimen frequency.
• A random parameter logit model analyzed conditional relative importance (CRI) of attributes.

Main Results:

• Route of administration (ROA) was the most critical attribute (CRI 35.3%), followed by hours of ON time without troublesome dyskinesia (ONwoTD) (CRI 26.4%).
• Non-surgical treatments were strongly preferred, with oral pills being the most favored, followed by subcutaneous infusions.
• Other attributes like side effect risks and OFF time had similar, lower importance.

Conclusions:

• PwP prioritize treatment efficacy (ONwoTD) and route of administration (ROA) when selecting therapies for advanced Parkinson's disease.
• Non-surgical and oral treatment options are highly preferred by patients.
• Incorporating patient preferences into clinical decision-making can improve treatment selection and adherence.