AIMS: This study assessed preferences for characteristics of oral antipsychotics among adults with bipolar I disorder (BD-I) and explored perceived tradeoffs between treatment efficacy and tolerability.
METHODS: A cross-sectional web-based discrete-choice experiment (DCE) survey collected preference data across five attributes of oral antipsychotics: efficacy (ie, improvement in symptom severity), weight gain over six months, sexual dysfunction, sedation, and akathisia. The survey was administered to US adults with a self-reported diagnosis of BD-I.
RESULTS: A total of 152 respondents completed the survey (mean age 40 years; 70% female; 78% White). Symptom improvement was the most important attribute, followed by less weight gain and no sexual dysfunction. Respondents preferred treatments associated with 0, 4, or 7 pounds of weight gain significantly more than a treatment associated with 11 pounds over six months. Respondents were willing to accept 7 to 9 pounds of weight gain over six months for the smallest improvement in symptom control (one incremental step of improvement of disease severity). In addition, respondents were willing to accept >25% risk of sedation for any improvement in symptoms assessed in the DCE.
CONCLUSION: Among respondents with BD-I, treatment efficacy was the most important attribute of oral antipsychotics, followed by less weight gain and no sexual dysfunction. Respondents were willing to accept some weight gain as a tradeoff for improved efficacy. As oral antipsychotics have different efficacy and tolerability profiles, it is important to understand the features patients value in a treatment and how they balance benefits and risks when choosing among treatments.
NOVELTY/UNIQUE DATA: This study provides novel insight of the characteristics of oral antipsychotics that patients find most important, as well as compromises they are willing to endure from a tolerability standpoint, in order to attain more efficacy.
