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Patient preferences for access to over-the-counter medications for allergic eye symptoms: A discrete choice
Michael P Douglas1, Ruben Vargas1, Laura Formosa2
1University of California San Francisco, San Francisco, CA.
Background:
Allergic conjunctivitis affects approximately 40% of the U.S.
Population:
While 90% self-manage with over-the-counter (OTC) medications, little is known about patient preferences for different treatment access pathways.
Objectives:
To quantify patient preferences for three allergic conjunctivitis treatment approaches: (1) OTC self-selection, (2) pharmacy-advised OTC selection, and (3) physician-prescribed treatment.
Methods:
We conducted a discrete choice experiment (DCE) with 1,656 U.S. adults using a previously validated choice-based conjoint tool. The survey included seven attributes (speed of access, first treatment decision, accuracy, ease of administration, cost, duration of relief, side effects) with 2-3 levels each. Respondents completed 10 random choice pairs and 3 fixed scenarios. We used random parameters logistic regression to estimate preference weights and conducted latent class analysis to identify preference segments.
Results:
Treatment accuracy (26.1% relative importance) and cost (24.6%) were the primary decision drivers. Respondents showed strong preferences for best treatment accuracy (β=1.8) while strongly avoiding high costs (β=-1.7 for $50) and high side effect risk (β=-1.3 for 40% stinging). Notably, respondents preferred avoiding physician-prescribed treatment (β=-0.34) and showed slight preference for pharmacy-advised OTC (β=0.11). In direct comparisons, 68% chose pharmacy-advised OTC over physician prescription, and 56% chose pharmacy-advised over self-selected OTC. Higher-income individuals showed stronger accuracy preferences and less tolerance for delays. Latent class analysis identified four distinct segments: side effect avoiders, cost-conscious consumers, accuracy seekers, and duration prioritizers.
Conclusions:
Patients strongly prefer OTC approaches with pharmacy support over physician-prescribed treatments for allergic conjunctivitis. Treatment accuracy and cost are co-primary drivers, though preferences are heterogeneous. These findings support continued Rx-to-OTC switches while emphasizing the value of pharmacy counseling and clear product labeling.
