(143) Patient and physician preferences in epilepsy monotherapy in a real-world study (VOTE): evidence from discrete choice experiments

Rationale: The importance of patient-centered decision-making is increasingly recognized. There is limited experience in capturing patient preference information as part of observational studies. This study was conducted to gain insights into patients’ and physicians’ preferences for risks and benefits in terms of efficacy and side effects in epilepsy monotherapy with antiepileptic drugs (AED).

Methods: Prospective, observational study (EP0076; VOTE) in patients with focal seizures who required a change in their AED monotherapy. Patients completed a discrete choice experiment (DCE) survey on a tablet in clinic before and after consultation. The survey was experimentally designed and pretested. Physicians completed a similar survey for up to three patients per physician after the consultation. The DCE consisted of a series of 12 choices between two hypothetical treatments defined by seven attributes with three-four levels: chance of becoming seizure-free, chance of developing clinical depression, personality changes, trouble thinking clearly, dizziness, bodyweight change in 6 months, and sleepiness/tiredness. Data were analyzed using a conditional multinomial logit or random-parameters logit model. The conditional relative importance of each attribute was calculated.

Results: Three hundred ten patients (mean [SD] age: 46.8 [18.3] years; 52.3% female) were enrolled from eight European countries, of whom 305 completed the survey before consultation and 273 completed the survey before and after consultation. Patients had a mean (SD) epilepsy duration of 11.2 (12.6) years and median (range) focal seizure frequency/28 days of 0.6 (0.0, 112.0).  Most common reasons for change in AED regimen were insufficient efficacy (48.4%) and adverse drug reaction (31.9%). 49 physicians completed a survey for 94 patients. Prior to consultation, patients preferred a higher chance of seizure freedom, lower risk of clinical depression, and less severe side effects (Figure 1A). Avoiding moderate-to-severe trouble thinking clearly was more important than avoiding a 10% chance of clinical depression. After consultation, the patients’ relative importance weights were generally qualitatively similar (Figure 1B). Physicians placed more weight on efficacy and personality changes than on chance of depression or other side effects (Figure 2A). For patients, the most important attributes before consultation were seizure freedom and trouble thinking clearly; in physicians, the most important attributes after the consultation were seizure freedom, followed by personality changes (Figure 2B). For both patients and physicians, bodyweight change was least important.

Conclusions: In this study, patients’ most important treatment attributes for AED monotherapy before and after consultation were higher chance of seizure freedom and avoiding negative impact on cognition in terms of trouble thinking clearly. Physicians placed more weight on personality changes than other side effects.

Funding: Please list any funding that was received in support of this abstract.:

Funding: UCB Pharma-sponsored.