Patient preferences for preventive migraine treatments among Canadian adults: A discrete choice experiment

Objective: To evaluate preferences for key attributes of injected or infused preventive migraine treatments and assess heterogeneity in preferences among Canadian participants with migraine. Background: Current treatment options for migraine prevention differ in their attributes, including mode of administration, efficacy, and dosing frequency; preferences for such attributes can vary among patients. With the advent of new therapies, evidence demonstrating patient preferences for injected or infused preventive migraine treatments is necessary. Methods: Canadian adults self-reporting a diagnosis of migraine completed a cross-sectional, internet-based survey that included a discrete choice experiment. Participants were presented with attributes of preventive migraine treatments, including speed of onset, durability of efficacy, mode of administration, administration setting, and dosing frequency. Latent class analysis (LCA) was used to identify subgroups of patients who differed in their treatment preferences. Results: In total, 200 participants completed the survey. Participants' treatment preferences were most sensitive to improvements in the durability of effectiveness from "wears off 2 weeks before next dose" to "does not wear off before the next dose" (absolute difference in weights=|-0.95 to 1.07|=2.02) and improvements from "cranial injections" to "intravenous infusions" (|-1.04 to 0.58|=1.62); participants equally preferred self-injection and intravenous infusion from a health-care provider (mean weight=0.58 and 0.47, respectively) as a route of administration over cranial injections (mean weight=-1.04). Three subgroups were identified with LCA: group one (n=103) prioritized fast-acting and durable therapies, group two (n=54) expressed aversion to cranial injections, and group three (n=43) favored treatments administered in a health-care provider setting. Conclusions: In this sample of Canadian adults with migraine, we showed that durability of effectiveness and mode of administration are key attributes influencing patient preferences for preventive migraine treatments; however, certain groups of patients may differ in their treatment priorities. Our results highlight the need for patient-provider discussions regarding treatment attributes and consideration of patients' preferences when selecting a preventive migraine treatment. Plain Language Summary We do not have information about whether Canadian patients prefer injected or infused migraine treatments to prevent migraine attacks. In this study, Canadian patients with migraine were given a survey and asked to choose a treatment based on treatment-related factors such as how long until the treatment helps, how often they need the treatment, how long it lasts, how it is given, and where it is given. The study found that how long it lasts and how it is given were very important for patients; however, the importance of preventive migraine treatment-related factors differed among unique groups of patients.