Background/Purpose: As Psoriatic Arthritis (PsA) treatment choices continue to expand, it is important to consider patient preferences for treatment modalities for PsA. Involving patients in treatment decisions can influence adherence and outcomes of therapy, which has a large impact on treatment outcomes.

Methods: A choice-based conjoint survey was mailed to 2,800 randomly selected patients enrolled in Humana Inc. Medicare and commercial plans (1,400 patients each). Patients were 18-80 years old and had been diagnosed with PsA (≥2 claims with a diagnosis code ICD-9-CM: 696.0 /ICD-10 CM: L40.5) between 1/1/2012 and 9/30/2016. Attributes for comparison included route of administration, frequency of administration, ability to reduce daily joint pain and swelling, likelihood of serious infections, improvement in the ability to perform daily tasks and activities, achieving clear or almost clear skin, and cost. Part-worth utilities (preference scores) and attribute importance scores (AIS) were estimated separately for patients enrolled in Medicare and commercial plans, using hierarchical Bayesian models after adjustment for demographic and clinical characteristics (age, sex, region, years since first PsA diagnosis, Deyo-Charlson comorbidity score, disease severity, and prior injectable/infusion experience). Mean AIS scores were used to rank order patient preferences for the attributes.

Results: A total of 468 patients (258 Medicare and 210 commercial; response rate of 16.7%) returned the survey (mean age ± standard deviation Medicare: 66.7 ± 7.6 years/Commercial: 51.4 ± 10.7 years; proportion female Medicare: 58.1%/Commercial: 56.2%). The top three attributes of importance for patients enrolled in Medicare plans were (in order) route of administration, cost, and then improvement in the ability to perform daily tasks and activities. The top three attributes of importance for patients enrolled in commercial plans were (in order) cost, route of administration, followed by frequency of administration (Figure 1). For both health plans, oral formulation was preferred relative to self-injection and intravenous routes of administration, and lower cost was preferred. For the commercial plans, less frequency of administration was preferred; for Medicare plans, more improvement in ability to perform daily tasks and activities was preferred.

Conclusion: Route of administration and cost are among the most important and common considerations for patients diagnosed with PsA and surveyed in this study. Gaining a better understanding of the attributes considered important to patients may help inform payer policies and prescriber selections regarding therapy that may lead to higher patient satisfaction, improved medication adherence, and ultimately treatment outcomes.

Figure 1.

Data are represented as mean, standard deviation.

For each plan, the sum of the average importance scores across attributes equaled 100.