Background/Purpose: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). Tofacitinib provides patients with a new oral alternative to biologic therapies; however, little is known about the patient preference of modern treatments for RA. Here, we determined patient preferences for attributes associated with therapies used in the treatment of RA.

Methods: A choice-based conjoint survey was mailed to 1400 randomly selected Humana adult (21-80 years old) members diagnosed with RA (continuously enrolled and had ≥2 medical claims with an ICD-9-CM diagnosis code of RA [714.0] between 5/1/2012 and 4/30/2013) and no prior use of a biologic indicated for RA. Attributes included route of administration (ROA); monthly out‑of-pocket cost; frequency of administration (FOA); ability to reduce daily joint pain and swelling; likelihood of serious side effects (SAE); improvement in the ability to perform daily tasks and activities; and medication burden (methotrexate co-administration). Mean attribute importance scores (AIS) were calculated after adjusting for various member demographics (e.g. age, gender, region, years since RA diagnosis). Mean AIS scores were used to rank order patient preferences for the attributes. An aggregate logit analysis was implemented to estimate average utilities & preference shares for two treatments – a twice daily oral and every other week self- injection. 

Results: A total of 380 commercially enrolled members (response rate of 27.1%) in Humana returned the survey (mean ± standard deviation [SD] age 54.9 ± 9.3 years, 9.7% had a history of joint surgery due to RA, 81.6% female). After an adjustment for demographic and clinical characteristics, commercial members’ ranking of attribute importance was as follows in decreasing order (mean AIS ± SD): ROA 34.08 ± 15.53; FOA 16.43 ± 6.82; SAE 12.01 ± 9.32; cost 10.12 ± 6.21; medication burden 9.75 ± 8.15; joint pain reduction 8.86 ± 3.82; and improvement in daily tasks 8.76 ± 4.70. Within the route of administration attribute, the oral formulation was the level with the highest part‑worth utility (preference score) compared with subcutaneous and intravenous routes of administration. Based on the part-worth utility, it was estimated that 62% of RA patients included in the sample would prefer oral therapy.

Conclusion: Route of administration is an important consideration for those diagnosed with RA and naïve to biologic therapy. Given the variety of RA therapies available, gaining a better understanding of the attributes considered important to patients in their treatment may help inform payer and prescriber decisions in selecting therapies that will lead to higher patient satisfaction and improved medication adherence.