OBJECTIVES: Quantify patient preferences for on-demand treatments for Parkinson's disease (PD)-related "OFF" episodes (ie, symptom reappearance/worsening).
METHODS: US adults (18-75 years) with self-reported PD for 25 years or <5 years with "OFF" episodes on levodopa were recruited for an online discrete-choice experiment survey. Respondents selected between pairs of experimentally designed profiles for hypothetical on-demand "OFF" treatments that varied by mode of administration (with and without mode-specific adverse events [AEs]), time to FULL "ON," duration of "ON," and out-of-pocket cost for 30 doses. Data were analyzed by random-parameters logit model and results used to calculate relative importance of treatment attributes and willingness to pay (WTP).
RESULTS: Among 300 respondents, 98% had "OFF" episodes. Over the attribute levels presented, increasing duration of "ON" from 1 to 2 hours was least important. Avoiding $90 cost was most important (9.7 times as important as duration of "ON") followed by change in mode from injection with site reactions to dissolvable sublingual film without AEs (8.9 times as important as duration of "ON") and decreasing time to "ON" from 60 to 15 minutes (6.2 times as important as duration of "ON"). Given a choice of mode, dissolvable sublingual film with potential mouth sores was preferred vs inhalation with potential cough or mild respiratory infection (2.2 times as important) or injection with potential site reactions (4.7 times as important). Average WTP to move from injection with site reactions (least preferred) to dissolvable sublingual film without AEs (most preferred) was $83 and was $58 to decrease time to FULL "ON" from 60 to 15 minutes.
CONCLUSIONS: Based on attributes and levels presented, patients with PD placed most importance on avoidance of high out-of-pocket cost and mode of administration when choosing an on-demand treatment for "OFF" episodes. Time to FULL "ON" was also an important driver of choice.
