What do patients really think of oral steroids for asthma attacks? A discrete choice experiment (ID 526)

Howell I, Noble J, Morgan C, Howell A, Logan J, Miller S, Chaudhuri R, Russell R, Bafadhel M, Beasley R, Pavord ID, Buckell J

Nuffield Department of Medicine, University of Oxford

Abstract

Introduction

Oral corticosteroids (OCS) are guideline treatment for all asthma attacks based on trials showing reduced relapse and hospitalisation rates and faster symptom resolution. These trials may overestimate treatment effect of mild attacks as they pre-date widespread inhaled corticosteroid use. Cumulative OCS exposure is associated with side effects including diabetes, osteoporosis, and cardiovascular disease.
Aims
To define patients’ and healthcare professionals’ (HCPs) preferences for clinical outcomes and side effects of OCS treatment for asthma attacks.

Methods

A discrete choice experiment (DCE) on patients and HCPs in the UK and New Zealand. Participants chose from 12 hypothetical pairs comprising OCS treatment benefits and risks. The DCE design was informed by the clinical literature, a focus group, and pilot testing. Choice models analysed preferences of the sample.

Results

824 patients and 171 HCPs completed the DCE. The strongest preference of patients and HCPs was to avoid side effects of OCS. (Figure 1). Patients with poorly controlled asthma accepted more side effects in exchange for less relapse.

Conclusions

Patients and HCPs strongly value treatment of asthma attacks that avoids OCS side effects. In return, they are willing to trade-off substantial treatment benefits. Our data supports the concept of biomarker-directed trials of asthma attack treatment to minimise OCS exposure.

Funding: NIHR Biomedical Research Centre grant.

Conflicts of interest: None

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