Conjoint Analysis of Preferred Features of a Hypothetical First Dose Observation Program Among Patients and Neurologists before Fingolimod Initiation in Multiple Sclerosis

Background: First dose observation (FDO) is required for all multiple sclerosis (MS) patients initiating fingolimod treatment. Conjoint analysis was used to deduce participant preferences for FDO program features. 

Objectives: Identify preferences of MS patients and neurologists for FDO program attributes.

Methods: Patients were recruited from PatientsLikeMe, an online community of patients with chronic illnesses. Patients were diagnosed with relapsing remitting MS, ≥18 years old, U.S. resident, fingolimod-naive, and logged on to PatientsLikeMe ≥1 time (past 90 days). US board certified neurologists (3 to 35 years post-residency) were recruited from WebMD physician network. 

Both patients and neurologists were asked to select their preferred option among hypothetical FDO programs, each with a combination of levels of tested attributes. The reference scenario was the least preferred levels for all attribute. Respondents’ preferences were analyzed using Hierarchical Bayes estimation.

Results: The study included 254 patients (median age 52 years, 83% female) and 225 neurologists (18% MS specialists). Among patients, increasing available locations from one (medical facility only) to two (medical facility, physician’s office) and three (medical facility, physician’s office, patient’s home), the preferences increased by 23% and 36%, respectively. Patient preference also increased if the patient was familiar with the medical care team (45%), time was reduced from 16 to 12 hours (22%) or 8 hours (39%), scheduling changed from very difficult to somewhat difficult (56%) or not at all difficult (74%), reports were automatically sent to the treating physician (69%) and the facility was able to manage medical complications without need to transfer (64%). 

Neurologists had increased preference when available locations increased from one to two (34%); however, unlike patients, neurologists’ preference did not increase with the addition of the third location (patient’s home). Neurologist preference increased if administrative burden was reduced from high to minimal (83%), reports were automatically sent to the treating physician (42%), and the facility was able to manage medical complications without need to transfer (62%).

Conclusions: Although some differences were apparent, patients and neurologists valued choice and convenience. Understanding preferences among patients and neurologists may provide guidance for appropriate selection and optimization of current FDO programs.