Using Discrete Choice Experiment to Elicit Treatment Preferences for Acute Allergic Reactions in Sweden: The Case of Patients with Swallowing Problems

OBJECTIVES: Timely access to treatment is important in case of acute allergic reactions (AAR). At present, glucocorticoid tablets are used as additional treatment to oral antihistamines and adrenaline injections. A new formulation for AAR, an oral fast dissolving film containing the glucocorticoid dexamethasone to be placed on the tongue, may facilitate the administration as it does not need to be dissolved in water, which may be particularly welcomed for patients with difficulties swallowing their medication. The objective was to assess the potential unmet need of people with AAR and estimate their willingness to pay (WTP) for attributes related to cortisone treatment. Separate subgroup analyses were conducted for individuals with problems swallowing their allergy medication.

METHODS: A web-based survey including a discrete-choice-experiment (DCE) was sent to a sample from the Swedish population (≥ 18 years) with experience of glucocorticoid treatment for AAR. DCE-attributes were administration mode, time to symptom relief, and price. The WTP was derived using each attribute’s coefficient in a logistic regression analysis.

RESULTS: Out of the respondents (N=426), 24% reported difficulties swallowing allergy medication in case of an AAR. Respondents with swallowing problems differed significantly in several ways; they were more worried about getting an AAR (32% vs 16%), more insecure with their current medication (32% vs 16%), had to a greater extent experienced an AAR that left them fearing for their lives (66% vs 36%), and had more visits to emergency departments. All attributes in the DCE regression were significant predictors for the treatment choice (p<0.001). The incremental WTP for an oral film compared to tablets was 757 and 568 SEK in respondents with and without swallowing problems, respectively.

CONCLUSIONS: The findings show a general unmet need in people risking ARR. The higher WTP for an oral dissolving cortisone film in people with swallowing problems mirrors their higher unmet need.