Comparing preferences of patients with rheumatic diseases, of experienced rheumatologists, nurses and pharmacists toward the treatment of rheumatic diseases with biological agents: Results from the cara study

Objectives: to estimate preferences of relevant treatment characteristics valued by the different subjects involved in the management of patients with rheumatic diseases. Methods: we involved patients with rheumatic diseases, rheumatologists, nurses and pharmacists with experience in the treatment with/provision of biological drugs of these patients. Through a Discrete-Choice-Experiment, the participants valued 16 possible scenarios in which pairs of similarly effective treatments were described with 6 characteristics including 2-4 possible levels each: (1) frequency of administration; (2) mode and place of administration; (3) hospitality, service, efficiency and courtesy of health personnel; (4) frequency of reactions at the site of drug administration; (5) generalized undesired/allergic reactions; (6) additional cost: since the Italian NHS pays treatment costs, we included possible additional cost as monthly healthcare taxes for all the citizens, to make available the treatment to all target patients. The direction and strength of preferences toward each characteristic level and the relative importance of each characteristic were estimated through a random-effects conditional logistic regression model. Results: 513 patients, 110 rheumatologists, 51 nurses and 46 pharmacists from 30 centres through Italy participated. Characteristics (3), (4) and (6) were the most important for every subgroup, while (1) was the least important for patients and rheumatologists, (2) the least important for the pharmacists, (2) and (5) the least important for the nurses. The four subgroups were consistent in preferences towards the specified levels of characteristics (1) and (3) to (6). However, as for characteristic (2), pharmacists preferred autonomous subcutaneous injection with syringe, nurses preferred assisted infusion at an infusional center close to patient's place, patients and rheumatologists preferred autonomous subcutaneous injection with pen. Conclusions: different subjects show different preferences for some treatment characteristics, which together with pure clinical aspects, can play an important role in the choice and consequent success of treatments.