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B. M. Wirostko, K. Beusterien MPH, J. Grinspan BA, T. Ciulla MD, J. Gonder MD, A. Pleil PhD; Patient Preferences in the Treatment of Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1592.
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Several treatments exist for diabetic retinopathy (DR), but data are lacking that compare them from a patient perspective. The objective of this study was to elicit patient preferences for various features (attributes) associated with anti-VEGF therapy, focal and scatter laser, and intravitreal steroids.
This was a cross-sectional adaptive conjoint survey administered to DR patients at 3 Canadian eye centers. The survey assessed 13 DR treatment attributes including the chance of improving vision (VA), short-term experience, and risks of adverse events (AEs). Each attribute had three descriptive levels (eg. probability of cataract: 0%, 30%, and 54%). Patients indicated preferences in pairwise comparisons. The analysis estimated the relative utilities for each attribute level. These utilities were summed for different target product profiles to determine the most preferred. Sensitivity analyses examined how changes to single or multiple attributes affected preferences.
The study sample included 161 patients [79 (49%) laser experience only, 5 (3%) injection experience only, 36 (22%) experience with both, and 41 (25%) treatment-naïve]. Patients valued attributes that were directly related to visual functioning, including the chance of improving VA and reduced chances of AEs contributing to further VA loss (eg. cataracts). Least important attributes were those not affecting vision (e.g., administration regimen). These findings translated into higher preferences for the product profile matching anti-VEGF versus the other options (≥ 75% preferred anti-VEGF in each subgroup). When the base case anti-VEGF attributes were changed to reflect least favorable levels, patients favored steroid therapy but not laser. Results did not differ by age, previous cataract experience, or diagnosis with DME versus PDR.
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