576427
letter2015
CMSXXX10.1177/1203475415576427Journal of Cutaneous Medicine and SurgeryLetter to the Editor
Letter to the Editor
Is Safety Psoriasis Patients’ Overriding Concern?
Journal of Cutaneous Medicine and Surgery 2015, Vol. 19(3) 201–202 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1203475415576427 jcms.sagepub.com
To the Editor: With expanding psoriasis treatment options, patients face increasingly complex treatment decisions. We created an algorithm that incorporates treatment characteristics and patient preferences to assist patients in finding treatments that best fit their needs.1,2 We anticipated that safety concerns would be a major factor driving treatment decisions.2 We report that our model overestimated patients’ concern for safety. The algorithm concept assumed that patients vary in how much importance they ascribe to the various characteristics of psoriasis treatments. We created a list of psoriasis medications and, for each medication, assigned intrinsic values to 11 characteristics based on published clinical trials. Patients rated how important each of the 11 characteristics was to them and ranked the characteristics in order of importance. The intrinsic value (VMi), patient’s importance scores (Pi), and characteristic ranking values (Ri) were multiplied and then summed to generate scores for each medication (Figure 1). The top three scoring treatments were discussed with patients using a treatment overview tool that described the characteristics of each treatment. SM = ∑11 i =1 VMi * Pi * Ri Feedback was gathered after the recommendations to assess how they felt about the proposed therapies. This research was approved by the Wake Forest University Health Sciences Institutional Review Board. Beta testing of the algorithm was performed on 8 patients, with 5 of the 8 patients given recommendations for phototherapy. Feedback from 1 patient, who had previously tried phototherapy, included preference for biologic treatments over phototherapy despite potential safety concerns. Another patient reported that although phototherapy was a safer option, it was too inconvenient to travel into the office numerous times per week and that a home option should be included. One patient declined phototherapy because of satisfaction with current therapy. The preferences we observed were inconsistent with the notion that safety is the dominant factor in the treatment decisions patients make. While patients clearly value safety when considered in isolation, their choice of treatment may not be driven primarily by safety concerns. For example,
Figure 1. This figure, while a simplification of the algorithmic process, demonstrates the basic methods applied in a patient scenario. Step 1: Intrinsic values obtained from the literature are assigned to each medication for each characteristic. Higher numbers indicate a stronger association. Step 2: Patients rank how important each characteristic is separately (1 = not important, 2 = somewhat important, 3 = very important). Step 3: Patients rank the characteristics in order of importance. Higher values indicate higher importance. Step 4: Matrices are multiplied to determined weighted scores for each treatment. The therapies with the highest 3 final scores are then recommended.
when office-based phototherapy is recommended, patients often decline due to convenience issues and choose less safe alternative options.3
202
Journal of Cutaneous Medicine and Surgery 19(3)
When absolute risks are low, it is not illogical for other issues to outweigh the importance of relative difference in safety. People regularly make decisions on factors other than safety, even if they feel safety is critical. For example, given the low absolute risks of air travel, travelers may completely ignore the relative safety differences between airlines when planning flights, choosing instead on the basis of getting to where they want to go, the cost of the flights, and the convenience of the airport. While safety is an important consideration, safety may not be paramount to patients’ decisions or therefore to what doctors should recommend for achieving control over psoriasis. Getting patients to where they want to go may be more important. Jaclyn N. Hess Farah A. Moustafa K. Jade Kindley Karen E. Huang Steven R. Feldman Wake Forest School of Medicine, Winston-Salem, NC, USA [email protected] Authors’ Note The preliminary data for this research was presented at the 2014 AAD Conference in Denver, CO.
Declaration of Conflicting Interests The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The Center for Dermatology Research is supported by an
unrestricted educational grant from Galderma Laboratories, L.P. Dr Feldman is a speaker for Janssen and Taro. He is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, and Leo Pharma Inc. Dr Feldman has received grants from Galderma, Janssen, Abbott Labs, Amgen, Stiefel/GlaxoSmithKline, Celgene, and Anacor. He is a consultant for Amgen, Baxter, Caremark, Gerson Lehrman Group, Guidepoint Global, Hanall Pharmaceutical Co Ltd, Kikaku, Lilly, Merck & Co Inc, Merz Pharmaceuticals, Mylan, Novartis Pharmaceuticals, Pfizer Inc, Qurient, Suncare Research, and Xenoport. He is on an advisory board for Pfizer Inc. Dr Feldman is the founder and holds stock in Causa Research and holds stock and is majority owner in Medical Quality Enhancement Corporation. He receives royalties from UpToDate and Xlibris. All other authors have no conflicts to disclose.
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
Institutional Review Board Status Approval for this research was received by the Wake Forest Baptist University Health Sciences Institutional Review Board.
References 1. Torbica A, Fattore G, Ayala F. Eliciting preferences to inform patient-centred policies: the case of psoriasis. Pharma coeconomics. 2014;32:209-223. 2. Seston EM, Ashcroft DM, Griffiths CE. Balancing the benefits and risks of drug treatment: a stated-preference, discrete choice experiment with patients with psoriasis. Arch Dermatol. 2007;143:1175-1179. 3. Schaarschmidt ML, Umar N, Schmieder A, et al. Patient preferences for psoriasis treatments: impact of treatment experience. J Eur Acad Dermatol Venereol. 2013;27:187-198.
letter2015
CMSXXX10.1177/1203475415576427Journal of Cutaneous Medicine and SurgeryLetter to the Editor
Letter to the Editor
Is Safety Psoriasis Patients’ Overriding Concern?
Journal of Cutaneous Medicine and Surgery 2015, Vol. 19(3) 201–202 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1203475415576427 jcms.sagepub.com
To the Editor: With expanding psoriasis treatment options, patients face increasingly complex treatment decisions. We created an algorithm that incorporates treatment characteristics and patient preferences to assist patients in finding treatments that best fit their needs.1,2 We anticipated that safety concerns would be a major factor driving treatment decisions.2 We report that our model overestimated patients’ concern for safety. The algorithm concept assumed that patients vary in how much importance they ascribe to the various characteristics of psoriasis treatments. We created a list of psoriasis medications and, for each medication, assigned intrinsic values to 11 characteristics based on published clinical trials. Patients rated how important each of the 11 characteristics was to them and ranked the characteristics in order of importance. The intrinsic value (VMi), patient’s importance scores (Pi), and characteristic ranking values (Ri) were multiplied and then summed to generate scores for each medication (Figure 1). The top three scoring treatments were discussed with patients using a treatment overview tool that described the characteristics of each treatment. SM = ∑11 i =1 VMi * Pi * Ri Feedback was gathered after the recommendations to assess how they felt about the proposed therapies. This research was approved by the Wake Forest University Health Sciences Institutional Review Board. Beta testing of the algorithm was performed on 8 patients, with 5 of the 8 patients given recommendations for phototherapy. Feedback from 1 patient, who had previously tried phototherapy, included preference for biologic treatments over phototherapy despite potential safety concerns. Another patient reported that although phototherapy was a safer option, it was too inconvenient to travel into the office numerous times per week and that a home option should be included. One patient declined phototherapy because of satisfaction with current therapy. The preferences we observed were inconsistent with the notion that safety is the dominant factor in the treatment decisions patients make. While patients clearly value safety when considered in isolation, their choice of treatment may not be driven primarily by safety concerns. For example,
Figure 1. This figure, while a simplification of the algorithmic process, demonstrates the basic methods applied in a patient scenario. Step 1: Intrinsic values obtained from the literature are assigned to each medication for each characteristic. Higher numbers indicate a stronger association. Step 2: Patients rank how important each characteristic is separately (1 = not important, 2 = somewhat important, 3 = very important). Step 3: Patients rank the characteristics in order of importance. Higher values indicate higher importance. Step 4: Matrices are multiplied to determined weighted scores for each treatment. The therapies with the highest 3 final scores are then recommended.
when office-based phototherapy is recommended, patients often decline due to convenience issues and choose less safe alternative options.3
202
Journal of Cutaneous Medicine and Surgery 19(3)
When absolute risks are low, it is not illogical for other issues to outweigh the importance of relative difference in safety. People regularly make decisions on factors other than safety, even if they feel safety is critical. For example, given the low absolute risks of air travel, travelers may completely ignore the relative safety differences between airlines when planning flights, choosing instead on the basis of getting to where they want to go, the cost of the flights, and the convenience of the airport. While safety is an important consideration, safety may not be paramount to patients’ decisions or therefore to what doctors should recommend for achieving control over psoriasis. Getting patients to where they want to go may be more important. Jaclyn N. Hess Farah A. Moustafa K. Jade Kindley Karen E. Huang Steven R. Feldman Wake Forest School of Medicine, Winston-Salem, NC, USA [email protected] Authors’ Note The preliminary data for this research was presented at the 2014 AAD Conference in Denver, CO.
Declaration of Conflicting Interests The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The Center for Dermatology Research is supported by an
unrestricted educational grant from Galderma Laboratories, L.P. Dr Feldman is a speaker for Janssen and Taro. He is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, and Leo Pharma Inc. Dr Feldman has received grants from Galderma, Janssen, Abbott Labs, Amgen, Stiefel/GlaxoSmithKline, Celgene, and Anacor. He is a consultant for Amgen, Baxter, Caremark, Gerson Lehrman Group, Guidepoint Global, Hanall Pharmaceutical Co Ltd, Kikaku, Lilly, Merck & Co Inc, Merz Pharmaceuticals, Mylan, Novartis Pharmaceuticals, Pfizer Inc, Qurient, Suncare Research, and Xenoport. He is on an advisory board for Pfizer Inc. Dr Feldman is the founder and holds stock in Causa Research and holds stock and is majority owner in Medical Quality Enhancement Corporation. He receives royalties from UpToDate and Xlibris. All other authors have no conflicts to disclose.
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
Institutional Review Board Status Approval for this research was received by the Wake Forest Baptist University Health Sciences Institutional Review Board.
References 1. Torbica A, Fattore G, Ayala F. Eliciting preferences to inform patient-centred policies: the case of psoriasis. Pharma coeconomics. 2014;32:209-223. 2. Seston EM, Ashcroft DM, Griffiths CE. Balancing the benefits and risks of drug treatment: a stated-preference, discrete choice experiment with patients with psoriasis. Arch Dermatol. 2007;143:1175-1179. 3. Schaarschmidt ML, Umar N, Schmieder A, et al. Patient preferences for psoriasis treatments: impact of treatment experience. J Eur Acad Dermatol Venereol. 2013;27:187-198.
