US general population food allergy treatment preferences: a discrete choice experiment

Abstract

Objective: To quantify treatment preferences for food allergy management options (oral immunotherapy, biologic therapy, and allergen avoidance), overall and by sociodemographic strata.

Methods: A US general population (≥13 years) discrete choice experiment (DCE) was conducted, including the Intolerance of Uncertainty-12 Scale and clinical/demographic questions. Conditional logistic regression analyses were conducted overall and by sociodemographic factors. DCE results were presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Participants (n = 294) mean (standard deviation) age was 47 (19.7) years; 48.6% were male. A 1% reduction in risk of having an exposure resulting in a moderate-to-severe reaction was statistically significantly associated with treatment preference (OR: 1.10; CI:1.04-1.16; p < 0.01). Features significantly associated with reduced preference included: a 1% increase in risk of treatment-related, severe anaphylaxis (0.85; 0.74-0.97; p=0.02); a 1% increase in risk of gastrointestinal symptoms (0.99; 0.99-0.99; p < 0.01); daily treatment (vs. every 2-4 weeks; 0.81; 0.72-0.91; p < 0.01); in-clinic administration (vs. at-home; 0.76; 0.66-0.87; p < 0.01); subcutaneous administration (vs. oral; 0.69; 0.61-0.78; p < 0.01); three-hour post-treatment physical activity limitation (0.84; 0.77-0.93; p < 0.01); and one-year life expectancy reduction (0.87; 0.85-0.89; p < 0.01). Rural dwellers favoured at-home use and no activity limits; lower-income respondents preferred convenience (oral, less frequent, and at-home administration). Teens strongly preferred being bite-safe (vs. fully allergic; 2.75; 1.09-6.90; p = 0.03).

Conclusion: When making food allergy management decisions, US general population respondents had strong preferences for features related to safety and convenience; however, the magnitude of preferences varied by sociodemographic factors. These findings may be pertinent for population-level health decision makers.

Keywords: Food allergy; biologic therapy; discrete choice experiment; general population; immunotherapy; surveys and questionnaires; treatment preferences.