ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Therapeutic and Management Preferences and Goals of Adults with Asthma: A Discrete Choice Experiment
Session Title
TP15 - TP015 UPDATES IN ADHERENCE AND TREATMENT OF LUNG DISEASE
Abstract
A1642 - Therapeutic and Management Preferences and Goals of Adults with Asthma: A Discrete Choice Experiment
Author Block: E. Israel1, M. George2, C. Gillette3, I. A. Gilbert4, H. Gandhi4, T. Tervonen5, Z. Balantac6, C. Thomas7, N. Krucien7, N. Farooqui8; 1Brigham and Womens Hospital, Boston, MA, United States, 2Columbia University School of Nursing, New York, NY, United States, 3Wake Forest School of Medicine, Winston-Salem, NC, United States, 4AstraZeneca, Wilmington, DE, United States, 5Evidera, London, United Kingdom, 6Evidera, San Francisco, CA, United States, 7Evidera, Ivry-sur-Seine, France, 8Allergy Partners, Fishers, IN, United States.
Rationale: Understanding patients’ goals for asthma care can inform shared decision-making between healthcare providers (HCPs) and patients. This study examined preferences of adults with asthma for therapeutic and management attributes and trade-offs they would be willing to make between them. Methods: An online discrete choice experiment (DCE) where respondents repeatedly chose between hypothetical treatment options was conducted in US adults with asthma. Treatment attributes (Figure) were selected based on literature review and patient focus groups. Multinomial logit models were used to estimate marginal utilities describing the relative value of changing from a reference to a non-reference level. Willingness to make trade-offs between attributes was quantified by calculating marginal rates of substitution. Results: 1184 adults with asthma completed the DCE (60% female; mean[SD] age 49.2[15.0] years, 37% well-controlled, 68% GINA step-therapy 1-2). Participants most valued reducing number of attacks requiring an urgent HCP visit (outpatient clinic, emergency department, or hospital) from 3 to 0/year and reducing exacerbations requiring oral corticosteroids (OCS) from 6 to 0/year (Figure). Less value was placed on reducing need for a rescue inhaler from daily to 0/day. A higher value was placed on reducing the risk of short- (oral thrush) vs long-term (diabetes) side-effects of asthma therapies. The least valued change in management was going from medication adjustments determined solely by a HCP to one where a patient could self-adjust without contacting their provider. Multinomial logit models found that to avoid 1 attack/year needing an urgent HCP visit, participants were willing to accept treatment attributes consisting of an increase of up to a 6.5% risk of diabetes within 5 years, up to 2.3 exacerbations/year requiring OCS, a 13.4% yearly risk of oral thrush, and 4.8 lbs of weight gain. To be treated with a single inhaler used as needed for symptoms instead of two inhalers of the same device type for rescue and maintenance, patients were willing to accept an increase in the yearly risk of thrush of up to 5.8%. Patients were also willing to increase their use of rescue medication from none to daily in exchange for a 2.8/year decrease in OCS bursts. Conclusion: With respect to preferences and goals for treatments and management, adults with asthma most valued reducing attacks requiring urgent HCP visits, very large reductions in exacerbations treated with OCS, and reducing the yearly risk of thrush. When educating patients, HCPs may want to focus on these goals to improve shared decision-making.
Author Block: E. Israel1, M. George2, C. Gillette3, I. A. Gilbert4, H. Gandhi4, T. Tervonen5, Z. Balantac6, C. Thomas7, N. Krucien7, N. Farooqui8; 1Brigham and Womens Hospital, Boston, MA, United States, 2Columbia University School of Nursing, New York, NY, United States, 3Wake Forest School of Medicine, Winston-Salem, NC, United States, 4AstraZeneca, Wilmington, DE, United States, 5Evidera, London, United Kingdom, 6Evidera, San Francisco, CA, United States, 7Evidera, Ivry-sur-Seine, France, 8Allergy Partners, Fishers, IN, United States.
Rationale: Understanding patients’ goals for asthma care can inform shared decision-making between healthcare providers (HCPs) and patients. This study examined preferences of adults with asthma for therapeutic and management attributes and trade-offs they would be willing to make between them. Methods: An online discrete choice experiment (DCE) where respondents repeatedly chose between hypothetical treatment options was conducted in US adults with asthma. Treatment attributes (Figure) were selected based on literature review and patient focus groups. Multinomial logit models were used to estimate marginal utilities describing the relative value of changing from a reference to a non-reference level. Willingness to make trade-offs between attributes was quantified by calculating marginal rates of substitution. Results: 1184 adults with asthma completed the DCE (60% female; mean[SD] age 49.2[15.0] years, 37% well-controlled, 68% GINA step-therapy 1-2). Participants most valued reducing number of attacks requiring an urgent HCP visit (outpatient clinic, emergency department, or hospital) from 3 to 0/year and reducing exacerbations requiring oral corticosteroids (OCS) from 6 to 0/year (Figure). Less value was placed on reducing need for a rescue inhaler from daily to 0/day. A higher value was placed on reducing the risk of short- (oral thrush) vs long-term (diabetes) side-effects of asthma therapies. The least valued change in management was going from medication adjustments determined solely by a HCP to one where a patient could self-adjust without contacting their provider. Multinomial logit models found that to avoid 1 attack/year needing an urgent HCP visit, participants were willing to accept treatment attributes consisting of an increase of up to a 6.5% risk of diabetes within 5 years, up to 2.3 exacerbations/year requiring OCS, a 13.4% yearly risk of oral thrush, and 4.8 lbs of weight gain. To be treated with a single inhaler used as needed for symptoms instead of two inhalers of the same device type for rescue and maintenance, patients were willing to accept an increase in the yearly risk of thrush of up to 5.8%. Patients were also willing to increase their use of rescue medication from none to daily in exchange for a 2.8/year decrease in OCS bursts. Conclusion: With respect to preferences and goals for treatments and management, adults with asthma most valued reducing attacks requiring urgent HCP visits, very large reductions in exacerbations treated with OCS, and reducing the yearly risk of thrush. When educating patients, HCPs may want to focus on these goals to improve shared decision-making.
