Patient preferences for topical treatment of actinic keratoses

a discrete-choice experiment

D. Kopasker, A. Kwiatkowski, R. N. Matin, C. A. Harwood, F. Ismail, J. T. Lear, J. Thomson, Z. Hasan, G. N. Wali, A. Milligan, L. Crawford, I. Ahmed, H. Duffy, C. M. Proby, P. F. Allanson (Corresponding Author)

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background
Treatment of actinic keratoses (AK) is a potentially effective strategy for prevention of cutaneous squamous cell carcinoma (cSCC). However, the patient perspective on potential benefits of AK treatment in terms of skin cancer reduction has received little attention to date.
Objectives
(1) To investigate patient preferences for AK topical treatments using a discrete choice experiment (DCE); (2) To evaluate patient willingness to trade between clinical benefit and medical burden.
Methods
The DCE was conducted as part of a study to establish the feasibility of a phase III RCT evaluating prevention of cSCC using currently available topical interventions. Preferences were elicited by asking patients to make a series of choices between treatment alternatives with different hypothetical combinations of attribute levels. Willingness to trade between treatment attributes was estimated using a flexible choice model that allows for the heterogeneity of patient preferences.
Results
109 patients with AK completed the DCE. The majority of patients who expressed valid preferences were willing to accept some reduction in both prophylactic and cosmetic efficacy to reduce the burden of the treatment regimen, the severity of skin reaction and other adverse effects. Patients may reject treatment if the perceived therapeutic benefit is outweighed by the subjective burden of treatment.
Conclusions
Evidence of significant variation in the perceived utility of treatments across patients highlights the importance of taking individual patient preferences into account to improve AK treatment acceptability and adherence.
Original languageEnglish
Pages (from-to)902-909
Number of pages8
JournalBritish Journal of Dermatology
Volume180
Issue number4
Early online date26 Jul 2018
DOIs
Publication statusPublished - Apr 2019

Fingerprint

Actinic Keratosis
Patient Preference
Therapeutics
Skin
Squamous Cell Carcinoma
Skin Neoplasms
Cosmetics

Keywords

  • CREAM
  • PHOTODYNAMIC THERAPY
  • SKIN-CANCER
  • SQUAMOUS-CELL CARCINOMA
  • TRANSPLANT RECIPIENTS

ASJC Scopus subject areas

  • Dermatology

Cite this

Kopasker, D., Kwiatkowski, A., Matin, R. N., Harwood, C. A., Ismail, F., Lear, J. T., ... Allanson, P. F. (2019). Patient preferences for topical treatment of actinic keratoses: a discrete-choice experiment. British Journal of Dermatology, 180(4), 902-909. https://doi.org/10.1111/bjd.16801

Patient preferences for topical treatment of actinic keratoses : a discrete-choice experiment. / Kopasker, D.; Kwiatkowski, A.; Matin, R. N.; Harwood, C. A.; Ismail, F.; Lear, J. T.; Thomson, J.; Hasan, Z.; Wali, G. N.; Milligan, A.; Crawford, L.; Ahmed, I.; Duffy, H.; Proby, C. M.; Allanson, P. F. (Corresponding Author).

In: British Journal of Dermatology, Vol. 180, No. 4, 04.2019, p. 902-909.

Research output: Contribution to journalArticle

Kopasker, D, Kwiatkowski, A, Matin, RN, Harwood, CA, Ismail, F, Lear, JT, Thomson, J, Hasan, Z, Wali, GN, Milligan, A, Crawford, L, Ahmed, I, Duffy, H, Proby, CM & Allanson, PF 2019, 'Patient preferences for topical treatment of actinic keratoses: a discrete-choice experiment', British Journal of Dermatology, vol. 180, no. 4, pp. 902-909. https://doi.org/10.1111/bjd.16801
Kopasker, D. ; Kwiatkowski, A. ; Matin, R. N. ; Harwood, C. A. ; Ismail, F. ; Lear, J. T. ; Thomson, J. ; Hasan, Z. ; Wali, G. N. ; Milligan, A. ; Crawford, L. ; Ahmed, I. ; Duffy, H. ; Proby, C. M. ; Allanson, P. F. / Patient preferences for topical treatment of actinic keratoses : a discrete-choice experiment. In: British Journal of Dermatology. 2019 ; Vol. 180, No. 4. pp. 902-909.
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abstract = "BackgroundTreatment of actinic keratoses (AK) is a potentially effective strategy for prevention of cutaneous squamous cell carcinoma (cSCC). However, the patient perspective on potential benefits of AK treatment in terms of skin cancer reduction has received little attention to date.Objectives(1) To investigate patient preferences for AK topical treatments using a discrete choice experiment (DCE); (2) To evaluate patient willingness to trade between clinical benefit and medical burden.MethodsThe DCE was conducted as part of a study to establish the feasibility of a phase III RCT evaluating prevention of cSCC using currently available topical interventions. Preferences were elicited by asking patients to make a series of choices between treatment alternatives with different hypothetical combinations of attribute levels. Willingness to trade between treatment attributes was estimated using a flexible choice model that allows for the heterogeneity of patient preferences.Results109 patients with AK completed the DCE. The majority of patients who expressed valid preferences were willing to accept some reduction in both prophylactic and cosmetic efficacy to reduce the burden of the treatment regimen, the severity of skin reaction and other adverse effects. Patients may reject treatment if the perceived therapeutic benefit is outweighed by the subjective burden of treatment.ConclusionsEvidence of significant variation in the perceived utility of treatments across patients highlights the importance of taking individual patient preferences into account to improve AK treatment acceptability and adherence.",
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note = "Funding: This study was funded by the National Institute for Health Research (NIHR) Research for Patient Benefit programme (PB-PG-0110-21244), Department of Health, UK. The funder was not involved in the study design. Acknowledgments: The authors gratefully acknowledge support from the Cancer Research UK Clinical Trials Unit, the UK Dermatology Clinical Trials Network, the NIHR Clinical Studies Group, and support for investigators from the British Skin Foundation and Cancer Research UK. We would also like to thank Martin Jones, Daniel Rigby and Ariel Bergmann for constructive comments on the design of the DCE.",
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AU - Kwiatkowski, A.

AU - Matin, R. N.

AU - Harwood, C. A.

AU - Ismail, F.

AU - Lear, J. T.

AU - Thomson, J.

AU - Hasan, Z.

AU - Wali, G. N.

AU - Milligan, A.

AU - Crawford, L.

AU - Ahmed, I.

AU - Duffy, H.

AU - Proby, C. M.

AU - Allanson, P. F.

N1 - Funding: This study was funded by the National Institute for Health Research (NIHR) Research for Patient Benefit programme (PB-PG-0110-21244), Department of Health, UK. The funder was not involved in the study design. Acknowledgments: The authors gratefully acknowledge support from the Cancer Research UK Clinical Trials Unit, the UK Dermatology Clinical Trials Network, the NIHR Clinical Studies Group, and support for investigators from the British Skin Foundation and Cancer Research UK. We would also like to thank Martin Jones, Daniel Rigby and Ariel Bergmann for constructive comments on the design of the DCE.

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N2 - BackgroundTreatment of actinic keratoses (AK) is a potentially effective strategy for prevention of cutaneous squamous cell carcinoma (cSCC). However, the patient perspective on potential benefits of AK treatment in terms of skin cancer reduction has received little attention to date.Objectives(1) To investigate patient preferences for AK topical treatments using a discrete choice experiment (DCE); (2) To evaluate patient willingness to trade between clinical benefit and medical burden.MethodsThe DCE was conducted as part of a study to establish the feasibility of a phase III RCT evaluating prevention of cSCC using currently available topical interventions. Preferences were elicited by asking patients to make a series of choices between treatment alternatives with different hypothetical combinations of attribute levels. Willingness to trade between treatment attributes was estimated using a flexible choice model that allows for the heterogeneity of patient preferences.Results109 patients with AK completed the DCE. The majority of patients who expressed valid preferences were willing to accept some reduction in both prophylactic and cosmetic efficacy to reduce the burden of the treatment regimen, the severity of skin reaction and other adverse effects. Patients may reject treatment if the perceived therapeutic benefit is outweighed by the subjective burden of treatment.ConclusionsEvidence of significant variation in the perceived utility of treatments across patients highlights the importance of taking individual patient preferences into account to improve AK treatment acceptability and adherence.

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