Objective: To quantify patient preferences for on‐demand treatments among patients with Parkinson's disease (PD) and “OFF” episodes. Background: Patients with PD develop potentially disabling “OFF” episodes—periods when symptoms worsen or reemerge—that may be treated with on‐demand therapies.
Methods: Carbidopa/levodopa‐treated adults (age 18–75 years) from the US with self‐reported PD for ≥5 years or <5 years with “OFF” episodes 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 a random parameters logit model, and results were used to calculate the relative importance of treatment attributes and willingness to pay (WTP).
Results: Nearly all (98%) of the 300 respondents had “OFF” episodes. Among the attribute levels given, the least important was increasing the duration of “ON” from 1 to 2 hours. The most important attribute was avoiding a $90 cost (9.7× as important as duration of “ON”), then change in mode of administration from injection with site reactions to dissolvable sublingual film without mouth/lip sores (8.9× as important as duration of “ON”), followed by decreasing time to “ON” from 60 to 15 minutes (6.2× as important as duration of “ON”). Given a choice in mode of administration, dissolvable sublingual film with potential mouth/lip sores was preferred over inhalation with potential cough or mild respiratory infection (2.2× as important) or injection with potential site reactions (4.7× as important). Average WTP to move from an injection with site reactions (least preferred) to a dissolvable sublingual film without AEs (most preferred) was $83. Average WTP to decrease time to FULL “ON” from 60 to 15 minutes was $58.
Conclusions: Based on the attributes and levels given, patients with PD placed the most importance on avoiding high out‐of‐pocket costs and mode of administration when choosing an on‐demand treatment for “OFF” episodes. Time to FULL “ON” was also an important driver of choice.
