OBJECTIVES: Quantify patient preferences for outcomes of treatments for endometriosis-associated pain and patients’ tolerance for treatment-related risks of side effects.
DESIGN: Online discrete choice experiment (DCE) survey
MATERIALS AND METHODS: Respondents with a self-reported physician diagnosis of endometriosis and moderate or severe dysmenorrhea (DYS) and nonmenstrual pelvic pain (NMPP) completed an online DCE survey. Each of a series of choice questions had a pair of hypothetical treatments for endometriosis-associated pain characterized by 7 attributes with varying levels: improvements from severe DYS (to moderate, mild, or no pain), severe NMPP (to moderate, mild, or no pain), and severe dyspareunia (DYSP) (to moderate or mild pain, or no improvement); mode of administration (oral or injectable); treatment-related risks of pregnancy-related problems like miscarriage or birth defects (unknown, 0%, 2%, 7%), bone fracture later in life (in addition to age-related risk) (unknown, 0%, 2%, 5%, 10%), and moderate to severe hot flashes (0%, 30%, 50%, 65%, 85%). A mixed logit model was used to quantify preferences and conditional relative importance of each attribute (the difference between the preference weights for the most and least preferred levels of the same attribute). Subgroup analysis explored how preferences varied with respondent characteristics.
RESULTS: Two hundred fifty women from the Endometriosis Association and a web panel completed the survey. Average respondent age was 34 years, 34% were interested in becoming pregnant, 47% had a personal or family history of bone problems, and 51% had experienced moderate to severe hot flashes. The relative importance of attributes, in order of decreasing importance, were risk of moderate to severe hot flashes; improvements in DYSP, NMPP, and DYS; risk of pregnancy-related problems; mode of administration; and risk of bone fracture (Table 1). Treatment preferences varied with experience with moderate to severe hot flashes. None of the preference weights corresponding to levels of bone fracture risk studied were statistically significantly different from the others.
CONCLUSIONS: Women with endometriosis differentiate between types of endometriosis-associated pain, placing the greatest weight on improvements in DYSP, followed by NMPP and DYS. The risk of bone fracture did not drive preferences.
