Comorbidities significantly impact patients’ preferences for psoriasis treatments

• Published in: Journal of the American Academy of Dermatology 2012-09, Vol.67 (3), p.363-372
• Main Authors: Schmieder, Astrid, MD, Schaarschmidt, Marthe-Lisa, Umar, Nasir, MSc, Terris, Darcy D., PhD, Goebeler, Matthias, MD, Goerdt, Sergij, MD, Peitsch, Wiebke K., MD
• Format: Article
• Language: English
• Subjects: adherence; Adolescent; Adult; Aged; Aged, 80 and over; Arthritis, Psoriatic - epidemiology; Attitude to Health; Biological and medical sciences; cardiovascular disease; Cardiovascular Diseases - epidemiology; Comorbidity; conjoint analysis; depression; Depression - epidemiology; Dermatology; diabetes; Diabetes Mellitus - epidemiology; Female; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Multivariate Analysis; Patient Compliance; preferences; psoriasis; Psoriasis - epidemiology; Psoriasis - therapy; Psoriasis. Parapsoriasis. Lichen; psoriatic arthritis; Young Adult
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2011.08.023

Background Non-adherence rates are high among patients with psoriasis, partly because of discordance between recommended treatments and individual preferences. Objectives Our aim was to assess the impact of comorbidities on patients’ preferences for psoriasis treatments. Methods A computer-based conjoint analysis experiment was conducted to analyze preferences of patients with psoriasis (N = 163) for treatment outcome attributes (probability, magnitude and duration of benefit; probability, severity and reversibility of side effects) and process attributes (treatment location, frequency, duration, delivery method, individual cost). The impact of comorbidities (psoriatic arthritis, cardiovascular disease, diabetes, and depression) on relative importance scores of each attribute was assessed by analyses of variance, post hoc test, and multivariate regression analysis. Results Among the participants included (58.9% males, mean age 49.3 yrs), 27% suffered from psoriatic arthritis, 13.5% from cardiovascular disease, 8% from diabetes, and 12.9% from depression. Preferences for treatment attributes varied significantly depending on comorbidities. Participants with psoriatic arthritis cared most about the probability of benefit (β 0.166; P  = .037), whereas those participants with cardiovascular disease were highly concerned about the probability of side effects (β 0.179; P  = .046). For participants with depression, treatment duration (β 0.163; P  = .047), and individual cost ( P  = .023) were highly important. Limitations Only patients with moderate and severe psoriasis treated at a university medical center were included. Conclusions Integrating patients’ preferences into shared decision-making may facilitate treatment adherence and optimize outcomes. Addressing patients’ comorbidities, particularly depression, may be a currently neglected opportunity to improve care.