Preferences and Priorities for Relapsed Multiple Myeloma Treatments Among Patients and Caregivers in the United States

Abstract

Introduction/background: This study aimed to describe patient and caregiver preferences for treatments of relapsed or refractory multiple myeloma (MM).

Materials and methods: A survey including discrete-choice experiment (DCE) and best-worst scaling (BWS) exercises was conducted among US patients with relapsed or refractory MM and their caregivers. The DCE included six attributes with varying levels including progression-free survival (PFS), toxicity, and mode and frequency of administration. In addition, the impact of treatment cost was assessed using a fixed-choice question. The BWS exercise included 18 items (modes and frequency of administration, additional treatment convenience, and toxicity items). The survey was administered online to patients recruited from the Multiple Myeloma Research Foundation CoMMpass study (NCT01454297).

Results: The final samples consisted of 94 patients and 32 caregivers. Avoiding severe nerve damage was most important to patients, followed by longer PFS. Caregivers considered PFS to be the most important attribute. We estimate that a third or more of patients were cost-sensitive, meaning their treatment preference was altered based on cost implications. Caregivers were not cost-sensitive. The three most bothersome treatment features in the BWS exercise were risk of kidney failure, lowering white blood cell counts, and weakening the immune system.

Conclusion: Patients with relapsed or refractory MM and their caregivers consider many factors including efficacy, toxicity, mode/frequency of administration, and cost in their decisions regarding treatment options. The study provides a basis for future Research on patient and caregiver treatment preferences, which could be incorporated into shared decision-making with physicians.

Keywords: caregiver; discrete choice experiment; multiple myeloma; patient; preference.

Conflict of interest statement

Daniel Auclair reports grants from Takeda, during the conduct of the study performed at MMRF; he is now an AstraZeneca employee. Carol Mansfield and Brennan Mange are salaried employees of RTI Health Solutions which was contracted by Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical International Co. to assist in the analysis and writing. Craig E Cole reports personal fees and/or grants from Oncopeptides, Sanofi, and GlaxoSmithKline, outside the submitted work. Jonathan L Kaufman reports grants and/or personal fees from Janssen, Amgen, AbbVie, Roche, Sutro, TG therapeutics, Incyte, BMS, and Tecnofarma, outside the submitted work. Jeffrey A Zonder reports personal fees and/or grants from Janssen, Takeda, Regeneron, Amgen, Intellia, Eidos, Alnylam, Oncopeptides, BMS, and Caelum, outside the submitted work. Mehul Dalal is a salaried employee of Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical International Co. Joseph R Mikhael has received honoraria from Amgen, BMS, GSK, Karyopharm, Celgene, Janssen, Sanofi, and Takeda Pharmaceuticals. David S Siegel has received honoraria from Amgen, BMS, GSK, Celgene, Janssen, Karyopharm and Takeda Pharmaceuticals. The authors report no other conflicts of interest in this work.

© 2022 Auclair et al.

Figures

Figure 1

Example questions from the patient survey. (A) Example DCE question with fixed-profile choice question from the patient survey. (B) Example best-worst scaling question from the patient survey.

Figure 2

Conditional relative importance of a change in each attribute from the least-preferred level to the most-preferred level. (A) Patients. (B) Caregivers.