OBJECTIVES: This study assessed preferences for attributes of oral antipsychotics among adults with schizophrenia (SZ) or bipolar I disorder (BD-I) and explored potential tradeoffs patients may make between efficacy and tolerability.

METHODS: A cross-sectional web-based discrete choice experiment (DCE) survey collected preference data from US adults with a self-reported diagnosis of SZ or BD-I across 5 attributes associated with oral antipsychotic treatment: efficacy (ie, symptom improvement), weight gain over 6 months, sexual dysfunction, sedation, and akathisia.

RESULTS: A total of 144 respondents with SZ (mean age 41 years, 50% female, 69% White) and 152 respondents with BD-I (mean age 40 years, 70% female, 78% White) completed the survey. Symptom improvement was the most important treatment attribute for respondents with SZ or BD-I. Weight gain and sexual dysfunction were 2 side effects that respondents most wanted to avoid. Respondents preferred treatments associated with 0, 4, or 7 lb of weight gain over 6 months significantly more than those associated with 11 lb of weight gain. Respondents were willing to accept 7 to 9 lb of weight gain over 6 months for the smallest improvement in symptom control (1 incremental step of improvement of disease severity). In addition, respondents were willing to accept >25% risk of sedation for any level of symptom improvement.

CONCLUSIONS: In this survey, treatment efficacy was the most important attribute of oral antipsychotics among respondents with SZ or BD-I; weight gain and sexual dysfunction were 2 side effects patients most wanted to avoid. Respondents with SZ or BD-I were willing to accept a limited amount of weight gain as a side effect for better efficacy. As oral antipsychotics have different efficacy and tolerability profiles, it is important to understand the features that patients value in a treatment and how they balance benefits and risks when choosing among treatments.