OBJECTIVES: Eosinophilic esophagitis (EoE) is a chronic allergic, inflammatory condition of the esophagus that can lead to scarring. Successful treatment involves resolution of symptoms and inflammation; however, treatments that resolve inflammation aren’t always accompanied by symptom improvement. Additionally, most treatments lack regulatory approval for EoE, and treatment mode and side effects vary widely, leading to complex treatment decisions. We conducted a stated-preference study to quantify patient preferences for features of EoE treatments in both utility space and healthy-time space. Healthy-time equivalents are a patient-centric construct based on time-tradeoff data that measures patients’ valuation of treatment features, as well as clinical outcomes of health interventions using the same metric.

METHODS: Preferences were elicited from adults with EoE using an online discrete-choice experiment (DCE). Attributes included months without symptoms: 10, 5 or 2 months, chance of no inflammation after one year: 90, 60, or 40%, regulatory approval for EoE, and treatment type: proton pump inhibitor, swallowed topical steroid, or biologic. Data were analyzed with mixed-logit models in utility space to elicit relative importance weights (RI) and healthy-time space to elicit equivalent values in months without symptoms and associated 95% confidence intervals (CI).

RESULTS: On average, patients (N=212, mean age: 46.6 years (SD 14.5), 56.7% female) highly valued improving the chance of eliminating inflammation from 40% to 90% (RI:4.6, CI:3.5-5.7) and extending symptom-free time from 2 to 10 months (RI:2.7, CI:1.9-3.5). Regulatory approval (RI:0.6, CI:0.3-0.9) and treatment type (RI:0.8, CI:0.2-1.4) were less important. In terms of healthy time, 90% chance of no inflammation equated to 15.1 months without symptoms (CI:12.7-17.6) while regulatory approval and treatment type were equivalent to 2.0 (CI:0.9-3.0) and 2.3 (CI:0.6-4.1) months, respectively.

CONCLUSIONS: Mixed-logit models of DCE data estimated in utility and healthy-time space demonstrated the value to patients of EoE therapies that address both symptoms and inflammation.