A stated preference survey to explore patient preferences for novel preventive migraine treatments

Abstract

Objective: The objective of this study was to explore patient preference for attributes of calcitonin gene-related peptide (CGRP) inhibitors for the preventive treatment of migraine and to describe differences in treatment preferences between patients.

Background: CGRP inhibitors are a novel class of migraine drugs specifically developed for the preventive treatment of migraine. Clinicians should understand patient preferences for CGRP inhibitors to inform and support prescribing choices.

Methods: Patients with migraine in the US and Germany were recruited to participate in an online discrete choice experiment (DCE) survey, which presented hypothetical treatment choices using five attributes: mode of administration, side effects, migraine frequency, migraine severity, and consistency of treatment effectiveness. Attribute selection was informed by a literature review and semi-structured patient interviews (n = 35), and evaluated using patient cognitive debriefing interviews (n = 5).

Results: Of 680 who consented to participate, 506 participants completed the survey and were included in the study (US = 257; Germany = 249). Overall, participants placed highest importance (preference weight, beta = 1.65, p < 0.001) on the treatment's ability to reduce the severity of migraine (mild vs. unchanged severity), followed by consistent treatment effectiveness (beta = 1.13, p < 0.001), and higher chance of reduced migraine frequency (beta = 1.00, p < 0.001). Participants preferred an oral tablet every other day (beta = 1.00, p < 0.001) over quarterly infusion, quarterly injections (p = 0.019), or monthly injection (p < 0.001). Preference for all treatment attributes were heterogeneous, and the subgroup analyses found that participants naïve to CGRP monoclonal antibody treatments had a stronger preference for oral therapy compared to those with such experience (p = 0.006).

Conclusion: In this DCE assessing CGRP inhibitors attributes, the main driver of patient choice was treatment effectiveness, specifically reduced migraine severity, and consistent treatment effectiveness. Further, patients exhibited an overall preference for an oral tablet every other day over injectables. Patients' experience with previous treatments informs the value they place on treatment characteristics.

Keywords: calcitonin gene-related peptide inhibitors; discrete choice experiment; migraine; patient preference; preventive treatments.

FIGURE 1

Example choice task tailored to a participant who reported 10 migraine days per month in the last 3 months.

FIGURE 2

Results of mixed logit (MXL) model (N = 506). (A) Mean preference weights and 95% confidence interval (CI, error bar); positive mean estimates with 95% CI spanning a range of >0 suggest overall preference for attribute level over reference level (0). (B) Mean preference weights and standard deviation (SD, error bar) of the preference distribution. The SD shows the distribution of patient preferences. Except for the attribute level “10% risk of constipation,” the SDs of all levels were statistically significant, which suggests that patient preferences were heterogeneous. MMD, monthly migraine day.

FIGURE 3

Relative attribute importance (RAI) by subgroup. The horizonal black lines indicate the 95% confidence intervals of the estimated RAI subgroup scores (point); the dashed vertical black lines show the overall mean RAI scores. CGRP mAb, calcitonin gene‐related peptide monoclonal antibody; MIBS‐4, migraine interictal burden scale.