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. 2024 Sep 10;24(1):605.
doi: 10.1186/s12888-024-06034-1.

Preferences for attributes of oral antipsychotic treatments: results from a discrete-choice experiment in respondents with schizophrenia or bipolar I disorder

Michael J Doane  1 , Marco Boeri  2   3 , Caroline Vass  4   5 , Cooper Bussberg  6 , Hemangi R Panchmatia  7 , Leslie Citrome  8 , Martha Sajatovic  9
Affiliations

Preferences for attributes of oral antipsychotic treatments: results from a discrete-choice experiment in respondents with schizophrenia or bipolar I disorder

Michael J Doane et al. BMC Psychiatry. .

Abstract

Background: Antipsychotic medications are effective treatments for schizophrenia (SZ) and bipolar I disorder (BD-I), but when presented with different treatment options, there are tradeoffs that individuals make between clinical improvement and adverse effects. As new options become available, understanding the attributes of antipsychotic medications that are valued and the tradeoffs that individuals consider when choosing among them is important.

Methods: A discrete-choice experiment (DCE) was administered online to elicit preferences across 5 attributes of oral antipsychotics: treatment efficacy (i.e., improvement in symptom severity), weight gain over 6 months, sexual dysfunction, sedation, and akathisia. Eligible respondents were aged 18-64 years with a self-reported clinician diagnosis of SZ or BD-I.

Results: In total, 144 respondents with SZ and 152 with BD-I completed the DCE. Of those with SZ, 50% identified themselves as female and 69.4% as White, with a mean (SD) age of 41.0 (10.1) years. Of those with BD-I, most identified themselves as female (69.7%) and as White (77.6%), with a mean (SD) age of 40.0 (10.7) years. In both cohorts, respondents preferred oral antipsychotics with better efficacy, less weight gain, no sexual dysfunction or akathisia, and lower risk of sedation. Treatment efficacy was the most important attribute, with a conditional relative importance (CRI) of 31.4% for respondents with SZ and 31.0% for those with BD-I. Weight gain (CRI = 21.3% and 23.1%, respectively) and sexual dysfunction (CRI = 23.4% and 19.2%, respectively) were adverse effects in this study that respondents most wanted to avoid. Respondents with SZ were willing to accept 9.8 lb of weight gain or > 25% risk of sedation for symptom improvement; those with BD-I were willing to accept 8.5 lb of weight gain or a > 25% risk of sedation.

Conclusions: In this DCE, treatment efficacy was the most important attribute of oral antipsychotic medications among respondents with SZ and BD-I. Weight gain and sexual dysfunction were the adverse effects respondents most wanted to avoid; however, both cohorts were willing to accept some weight gain or sedation to obtain better efficacy. These results highlight features that patients value in antipsychotic medications and how they balance benefits and risks when choosing among treatments.

Keywords: Discrete-choice experiment; Patient preference; Sedation; Treatment efficacy; Weight gain.

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Conflict of interest statement

MJD and HRP are or were employees of Alkermes, Inc., at the time of the study and may own stock/options in the company. MB, CV, and CB are or were employees of RTI Health Solutions, a not-for-profit research institute that received funding from Alkermes, Inc., to conduct this study and collect the data used for this publication. LC consulted with Alkermes on this research and has served as a consultant for AbbVie/Allergan, Acadia, Adamas, Angelini, Astellas, Avanir, Axsome, Biogen, BioXcel, Boehringer Ingelheim, Cadent Therapeutics, Cerevel, Clinilabs, COMPASS, Delpor, Eisai, Enteris BioPharma, HLS Therapeutics, Idorsia, INmune Bio, Impel, Intra-Cellular Therapies, Janssen, Karuna, Lundbeck, Luye, Lyndra, MapLight, Marvin, MedAvante-ProPhase, Merck, Mitsubishi-Tanabe Pharma, Neumora, Neurocrine, Neurelis, Noema, Novartis, Noven, Otsuka, Ovid, Praxis, Recordati, Relmada, Reviva, Sage, Sumitomo/Sunovion, Supernus, Teva, University of Arizona, Vanda, and Wells Fargo, and one-off ad hoc consulting for individuals/entities conducting marketing, commercial, or scientific scoping research; and speaker for AbbVie/Allergan, Acadia, Alkermes, Angelini, Axsome, BioXcel, Eisai, Idorsia, Intra-Cellular Therapies, Janssen, Lundbeck, Neurocrine, Noven, Otsuka, Recordati, Sage, Sunovion, Takeda, and Teva and CME activities organized by medical education companies such as Medscape, NACCME, NEI, Vindico, and universities and professional organizations/societies; owns stocks (small number of shares of common stock) in Bristol-Myers Squibb, Eli Lilly, J&J, Merck, and Pfizer purchased >10 years ago and has stock options for Reviva; and has received royalties/publishing income from Elsevier (topic editor, Psychiatry, Clinical Therapeutics), Springer Healthcare (book), Taylor & Francis (editor-in-chief, Current Medical Research and Opinion, 2022-date), UpToDate (reviewer), and Wiley (editor-in-chief, International Journal of Clinical Practice, through end of 2019). MS consulted with Alkermes on this research and has served as a consultant to Janssen, Lundbeck, Neurelis, Otsuka, and Teva; has received research grants (within 3 years) from the US Centers for Disease Control and Prevention, International Society for Bipolar Disorders, National Institutes of Health, and Patient-Centered Outcomes Research Institute; has received royalties from Johns Hopkins University Press, Oxford Press, Springer Press, and UpToDate; and has prepared CME activities for the American Academy of Child and Adolescent Psychiatry, American Epilepsy Society, American Physician Institute (CMEtoGO), Clinical Care Options, Neurocrine, and Psychopharmacology Institute.

Figures

Fig. 1
Fig. 1
Example choice set
Fig. 2
Fig. 2
Preferences for attributes of oral antipsychotic medications for respondents with schizophreniaa aPreference coefficient estimates are presented along with their 95% confidence intervals, with higher estimates for a given level associated with a greater preference for that level. The vertical distance between any 2 levels of an attribute represents the change in utility; larger differences indicate that respondents viewed the change as having a relatively greater effect on overall utility. Attributes are presented in the order in which they appeared in the discrete-choice experiment questions
Fig. 3
Fig. 3
Relative importance of oral antipsychotic medication attributes for respondents with schizophreniaa aConditional relative importance (CRI) is interpreted as the proportion of utility gained by improving each attribute from the least-preferred to the most-preferred level, relative to the maximum utility gained by improving all attributes. Each CRI was calculated by subtracting the preference coefficient estimate of the least-preferred level from that of the most-preferred level. Differences were summed across attributes and rescaled to 100. Each CRI is presented as a percentage of this total along with its 95% confidence interval. Attributes are presented in the order in which they appeared in the discrete-choice experiment questions
Fig. 4
Fig. 4
Preferences for attributes of oral antipsychotic medications for respondents with bipolar I disordera aPreference coefficient estimates are presented along with their 95% confidence intervals, with higher estimates for a given level associated with a greater preference for that level. The vertical distance between any 2 levels of an attribute represents the change in utility; larger differences indicate that respondents viewed the change as having a relatively greater effect on overall utility. Attributes are presented in the order in which they appeared in the discrete-choice experiment questions
Fig. 5
Fig. 5
Relative importance of oral antipsychotic medication attributes for respondents with bipolar I disordera aConditional relative importance (CRI) is interpreted as the proportion of utility gained by improving each attribute from the least-preferred to the most-preferred level, relative to the maximum utility gained by improving all attributes. Each CRI was calculated by subtracting the preference coefficient estimate of the least-preferred level from that of the most-preferred level. Differences were summed across attributes and rescaled to 100. Each CRI is presented as a percentage of this total along with its 95% confidence interval. Attributes are presented in the order in which they appeared in the discrete-choice experiment questions
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