Patient preferences for the treatment of Bowen disease.

Abstract

Background: Discrete choice experiments (DCEs) are increasingly used to understand and quantify patient preferences for a variety of treatments, services or screening in order to analyse the choices patients make when faced with different alternatives.

Objectives: The aim of this DCE was to examine patient preferences for the treatment of Bowen disease.

Methods: A DCE was conducted alongside a randomized controlled noninferiority trial comparing the effectiveness of surgical excision, methyl aminolaevulinate photodynamic therapy (MAL-PDT) and 5-fluorouracil (5-FU) cream as treatments for Bowen disease. Preferences were elicited by presenting patients with choice tasks between surgical excision, MAL-PDT and 5-FU cream with the following attributes: effectiveness, cosmetic outcome, side-effects, treatment duration and process. A mixed logit model was used to account for the panel nature of the data (repeated choices for each respondent) and heterogeneity in preference.

Results: A total of 215 patients completed the DCE. Patients have a clear preference for excision and noninvasive therapies were less valued, as indicated by the large and negative label effect. Both moderate and good-to-excellent cosmetic outcomes were accepted and preferred to poor cosmetic outcomes for all treatments. In addition, none or mild-to-moderate side-effects were considered acceptable and preferred to severe side-effects.

Conclusions: Patients show a clear preference for surgical excision, and of the two noninvasive treatments, 5-FU cream is preferred to MAL-PDT. Treatment choice is also determined by attributes such as effectiveness, cosmetic outcome and side-effects. In the context of shared decision making for Bowen disease, it is important to discuss the elements of treatment that patients value to ensure that an informed decision is made.