Patient preferences for topical treatment of actinic keratoses: a discrete-choice experiment

D. Kopasker, A. Kwiatkowski, R. N. Matin, C. A. Harwood, F. Ismail, J. T. Lear, J. Thomson, Z. Hasan, G. N. Wali, A. Milligan, L. Crawford, I. Ahmed, H. Duffy, C. M. Proby, P. F. Allanson (Corresponding Author)

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Treatment of actinic keratoses (AK) is a potentially effective strategy for prevention of cutaneous squamous cell carcinoma (cSCC). However, the patient perspective on potential benefits of AK treatment in terms of skin cancer reduction has received little attention to date.
(1) To investigate patient preferences for AK topical treatments using a discrete choice experiment (DCE); (2) To evaluate patient willingness to trade between clinical benefit and medical burden.
The DCE was conducted as part of a study to establish the feasibility of a phase III RCT evaluating prevention of cSCC using currently available topical interventions. Preferences were elicited by asking patients to make a series of choices between treatment alternatives with different hypothetical combinations of attribute levels. Willingness to trade between treatment attributes was estimated using a flexible choice model that allows for the heterogeneity of patient preferences.
109 patients with AK completed the DCE. The majority of patients who expressed valid preferences were willing to accept some reduction in both prophylactic and cosmetic efficacy to reduce the burden of the treatment regimen, the severity of skin reaction and other adverse effects. Patients may reject treatment if the perceived therapeutic benefit is outweighed by the subjective burden of treatment.
Evidence of significant variation in the perceived utility of treatments across patients highlights the importance of taking individual patient preferences into account to improve AK treatment acceptability and adherence.
Original languageEnglish
Pages (from-to)902-909
Number of pages8
JournalBritish Journal of Dermatology
Issue number4
Early online date26 Jul 2018
Publication statusPublished - Apr 2019

Bibliographical note

Funding: This study was funded by the National Institute for Health Research (NIHR) Research for Patient Benefit programme (PB-PG-0110-21244), Department of Health, UK. The funder was not involved in the study design.

The authors gratefully acknowledge support from the Cancer Research UK Clinical Trials Unit, the UK Dermatology Clinical Trials Network, the NIHR Clinical Studies Group, and support for investigators from the British Skin Foundation and Cancer Research UK. We would also like to thank Martin Jones, Daniel Rigby and Ariel Bergmann for constructive comments on the design of the DCE.




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