Measuring Treatment Preferences for Patients with Pulmonary Arterial Hypertension (PAH); A Discrete Choice Analysis to Identify Scale Heterogeneity

OBJECTIVES: The study aimed to investigate the relative importance of various features of a pulmonary arterial hypertension (PAH) treatment regimen using a Best-Worst Scaling (BWS) Case 3. An additional aim was to assess variation of choice consistency (scale heterogeneity) by groups of interest.

METHODS: Data were collected from PAH patients in Germany through an online survey conducted from March to June 2022, with the help of a patient association. Treatment features were 3-year survival rate, unplanned PAH-related hospitalization within 3 years, physical activity limitations after 3 years, digestive symptoms, pain, and headache in the first 6 months. A conditional logit model (CL) was applied to examine the main effects and heteroscedastic conditional logit (HCL) models were used to assess scale heterogeneity. Goodness of fit was evaluated using the Akaike information criterion (AIC) and Bayesian information criterion (BIC).

RESULTS: Eighty-three patients completed the survey (76% female). Physical activity limitations after 3 years and 3-year survival rate were the most important attributes. Unplanned PAH hospitalization over 3 years and short-term adverse events were relatively less important. HCL models showed evidence of scale heterogeneity and outperformed CL models on AIC and BIC. Low scale parameters suggest that participants exhibited high variance and made less consistent choices. Error variance increased with response time <12 minutes, marked limitation of physical activity, the need for daily assistance due to PAH, and older age (>45 years).

CONCLUSIONS: When establishing personalized treatment plans for PAH, it is crucial to consider patient preferences regarding physical activity limitations after 3 years and 3-year survival. Differences in scale/choice consistency suggest that some groups have more difficulty in making treatment decisions. Therefore, these groups may benefit from more comprehensive discussion with their treating physician.