Development and Validation of SCACOMS, a Composite Scale for Assessing Disease Progression and Treatment Effects in Spinocerebellar Ataxia.

Spinocerebellar ataxias (SCA) are rare inherited neurodegenerative disorders characterized by a progressive impairment of gait, balance, limb coordination, and speech. There is currently no composite scale that includes multiple aspects of the SCA experience to assess disease progression and treatment effects. Applying the method of partial least squares (PLS) regression, we developed the Spinocerebellar Ataxia Composite Scale (SCACOMS) from two SCA natural history datasets (NCT01060371, NCT02440763). PLS regression selected items based on their ability to detect clinical decline, with optimized weights based on the item's degree of progression. Following model validation, SCACOMS was leveraged to examine disease progression and treatment effects in a 48-week SCA clinical trial cohort (NCT03701399). Items from the Clinical Global Impression-Global Improvement Scale (CGI-I), the Friedreich Ataxia Rating Scale (FARS) - functional stage, and the Modified Functional Scale for the Assessment and Rating of Ataxia (f-SARA) were objectively selected with weightings based on their sensitivity to clinical decline. The resulting SCACOMS exhibited improved sensitivity to disease progression and greater treatment effects (compared to the original scales from which they were derived) in a 48-week clinical trial of a novel therapeutic agent. The trial analyses also provided a SCACOMS-derived estimate of the temporal delay in SCA disease progression. SCACOMS is a useful composite measure, effectively capturing disease progression and highlighting treatment effects in patients with SCA. SCACOMS will be a powerful tool in future studies given its sensitivity to clinical decline and ability to detect a meaningful clinical impact of disease-modifying treatments.

A prospective study of mental wellbeing, quality of life, human-animal attachment, and grief among foster caregivers at animal shelters.

Foster care programs at animal shelters have emerged as an important tool for promoting animal welfare and supporting shelter life-saving efforts. Preliminary evidence suggests that foster caregiving may also be health-promoting for humans. The goals of this study were to investigate the experiences of foster caregivers at animal shelters based on measures of positive and negative affect, quality of life, and grief, and to describe human-animal attachment among foster populations. Between March 2022 and 2023, 131 foster caregivers from five shelters in the United States completed three online surveys before, during and after providing foster care to a shelter animal. Positive affect decreased significantly from baseline to post-foster (F = 5.71, p<0.01), particularly among dog caregivers (F = 6.17, p<0.01). Negative affect remained unchanged (F = 0.47, p = 0.63). Foster caregivers perceived their foster animal provided companionship, affection and emotional support, although dog foster caregivers reported significantly higher emotional (U = 313.50, p<0.01) and social/physical quality of life (t = 4.42, p<0.01) than cat foster caregivers. Caregivers reported low mean avoidant and anxious attachment, suggesting they were able to develop secure bonds with their foster animals. Retention of fosters was also strong, with 86% of caregivers reporting they were likely to provide foster care in the future. Our findings suggest that fostering at animal shelters may serve as a One Health intervention to offer companionship, affection and emotional support to human caregivers while promoting animal welfare. However, these benefits did not translate to improvements in caregiver mental wellbeing, so caution should be applied when considering foster caregiving as a potential mental health promotion tool.

Cost-effectiveness of rimegepant oral lyophilisate compared to best supportive care for the acute treatment of migraine in the UK.

AIMS: Migraine is the most common disabling headache disorder and is characterized by recurrent throbbing head pain and symptoms of photophobia, phonophobia, nausea, and vomiting. Rimegepant 75 mg, an oral lyophilisate calcitonin gene-related peptide antagonist, is the first treatment approved for both the acute and preventative treatment of migraine, and the first acute therapy approved in over 20-years. The objective was to assess the cost-utility of rimegepant compared with best supportive care (BSC) in the UK, for the acute treatment of migraine in the adults with inadequate symptom relief after taking at least 2 triptans, or for whom triptans are contraindicated or not tolerated. MATERIALS AND METHODS: A de novo model was developed to estimate incremental costs and quality-adjusted life years (QALYs), structured as a decision tree followed by Markov model. Patients received rimegepant or BSC for a migraine attack and were assessed for response (pain relief at 2-h). Responders and non-responders followed different pain trajectories over 48-h cycles. Non-responders discontinued treatment while responders continued treatment for subsequent attacks, with a proportion discontinuing over time. Data sources included a post-hoc pooled analysis of the phase 3 acute rimegepant trials (NCT03235479, NCT03237845, NCT03461757), and a long-term safety study (NCT03266588). The analysis was conducted from the perspective of the UK National Health Service and Personal Social Services over a 20-year time horizon. RESULTS: Rimegepant resulted in an incremental cost-utility ratio (ICUR) of £10,309 per QALY gained vs BSC, which is cost-effectiveness at a willingness to pay threshold of £30,000/QALY. Rimegepant generated +0.44 incremental QALYs and higher incremental lifetime costs (£4,492). Improved QALYs for rimegepant were a result of less time spent with severe and moderate headache pain. CONCLUSION: This study highlights the economic value of rimegepant which was found to be cost-effective for the acute treatment of migraine in adults unsuitable for triptans.

Is dog walking suitable for physical activity promotion? Investigating the exercise intensity of on-leash dog walking.

Background: Approximately a quarter of the global population is physically inactive, increasing the prevalence of chronic health conditions such as cardiovascular disease. Clearly, a population shift is needed to increase physical activity participation. Given almost half of American and Australian households have at least one dog, dog walking has the potential to increase physical activity. The objective of this study was to characterize the exercise intensity of dog walking using physiological measures to determine whether it achieved a threshold for health-enhancement. Method: From February 2020 to September 2022, dog owners (aged > 18 years, without impediment to walking) who resided in metropolitan Sydney participated in an on-leash dog walk for a minimum of 20 minutes, while wearing a heart rate monitor and carrying a phone to track cadence, route and duration. Results: Forty-three participants were recruited (aged 34.26 ± 16 years). Data from measures of %heart rate reserve (38 ± 10.8 %HRR), %heart rate max (61 ± 7.2 %HRmax) and average cadence (45 ± 8.4steps/min) classified dog-walking as light intensity. However, when using average walking speed (4.29 ± 0.8 km/hr) and metabolic equivalents (3.53 ± 0.6METs), the walk was classified as moderate intensity. Conclusion: Overall, depending on the intensity measure used, dog walking was positioned in the upper range of light intensity and the lower range of moderate intensity. Although dog walking at a certain intensity may be difficult to prescribe as strategy for meeting current moderate-to-vigorous focused physical activity recommendations, it should be recognised as a beneficial activity that may reach moderate intensity on some occasions.

The suitability and acceptability of a co-designed prototype psychoeducational activity book for autistic children aged five-eleven years.

Background and aims: Evidence suggests that autistic children and young people (CAYP) can benefit from age-appropriate psychoeducation. Co-design is a methodology that iteratively involves end users and stakeholders in producing an intervention which may increase engagement and impact. Few age-appropriate co-designed psychoeducation resources for autistic CAYP exist. Therefore, a paper-based resource was co-designed for autistic CAYP who attend mainstream primary education. The resource aims to educate CAYP about their autism and provide strategies to support them to live well with their autism. Methods: This paper describes the evaluation of the prototype resource through online workshops with 12 families and input from four specialist clinicians. The suitability and acceptability of the resource was explored, and sketch notes were taken for respondent validity and engagement purposes. Results: A reflexive thematic analysis identified six themes and two subthemes: (1) content appropriateness (subtheme: strategies and unpredictability); (2) relating to content, (3) feelings and emotions, (4) terminology (subtheme: literal thinking); (5) positivity, and (6) communication aid. Suggested improvements were also identified. Results suggest the resource is suitable and acceptable. Conclusions: Future intervention development research may consider individual differences of autistic CAYP and the co-design of resources for other age groups of neurodiverse populations.

A 15-year review of characteristics and outcomes of patients leaving against medical advice.

PURPOSE: Discharging against medical advice can have significant, detrimental effects on burn patient outcomes as well as higher hospital readmission rates and healthcare expenditures. The goal of this study is to identify characteristics of patients who left against medical advice and suggest solutions to mitigate these factors. Data were collected at our American Burn Association verified Burn Unit over a 15-year period. RESULTS: Between 2007 and 2022, 37 patients were identified as having left against medical advice from the burn unit. The average patient age was 37 years old with 64.9% being male, and 70.2% were identified as having a substance abuse history. The majority (51.4%) had Medicaid or State health insurance, 29.7% had no insurance, and 18.9% had private insurance. The mechanism of injury was most commonly frostbite (43.2%). The majority sustained < 1% total body surface area injuries. Most (83.7%) had social work and/or case management involved during their admission, and all (100%) had their involvement if the length of admission was greater than one day. Over half (59.5%) returned to the ED within 2 weeks with complications. CONCLUSIONS: This study found that patients discharging against medical advice from the burn unit suffered from smaller injuries, often due to cold related injuries. These patients had comorbid substance abuse or psychiatric histories, and the majority had Medicaid or state health insurance. Recruiting interdisciplinary care members, including social work, psychiatry, and addiction medicine, early may help these patients by encouraging completion of their hospital care and setting up crucial follow-up care.

A 10-Year Retrospective Review of Playground-Associated Craniofacial Injuries in the Pediatric Patient Population.

This retrospective study utilized the National Electronic Injury Surveillance System (NEISS) database to identify pediatric emergency department (ED) patients with playground-associated craniofacial injuries between January 2012 and December 2021. A total of 25 414 patients were identified. The majority of injuries occurred in preschool and elementary school-age children (90.3%) and patients were more commonly boys (59.3%). Injuries most often involved the head/scalp (52.4%), face (30.4%), and mouth (11.9%). Infant (32.7%) and teen (40.0%) injuries most commonly involved swings, whereas preschool (23.1%) and elementary school (28.1%) injuries were mostly associated with slides and climbers, respectively. Most patients were treated in the ED and discharged to home (96.5%), a small portion required hospitalization (1.6%), and one death was reported. Although the majority of the injuries were relatively minor and resulted in same-day discharges, these injuries can result in serious physical harm, emotional stress, and unexpected financial burdens. Proper education and supervision regarding safe play is important to prevent these injuries.

Availability and Readability Level of Online Patient Education Materials Provided by Cleft Lip and Palate Teams.

OBJECTIVES: Evaluate the readability of online English and Spanish cleft lip and palate patient education materials. DESIGN: Review of free online materials. SETTING: English and Spanish language online patient education materials on cleft lip and palate were collected from American Cleft Palate-Craniofacial Association (ACPA) approved teams. PARTICIPANTS: American Cleft Palate-Craniofacial Association (ACPA) approved teams. INTERVENTIONS: English materials were analyzed using the Flesch-Kincaid, SMOG, and Coleman-Liau readability calculators. Spanish materials were analyzed using the Fry Graph, Fernandez Huerta, and INFLESZ calculators. A one-way analysis of variance (ANOVA) was used to test for variability between the readability tools. OUTCOMES: Readability levels were examined for both sets of materials. RESULTS: 171 (90.5%) teams provided English language materials online, with an average readability score calculated as 10.5 ± 2.9 (10th-11th grade). A total of 44 (23.2%) teams listed Spanish language materials online, with average readability score of 7.9 ± 1.2 (8th grade). ANOVA demonstrated statistically significant variability between the readability assessment tools (P < .01). CONCLUSION: Online cleft lip and palate patient education material provided by ACPA craniofacial teams were more available in English than in Spanish. Both sets of materials demonstrated readability levels above the recommended 6th-7th grade. Refining readability is associated with lowered healthcare costs and increased patient satisfaction.

Understanding the Motivations of Foster Caregivers at Animal Shelters.

Foster care programs in animal shelters have been shown to benefit animals and shelters, but little is known about what motivates foster caregivers to volunteer. This cross-sectional study explored the motivations and expectations of 131 foster caregivers from five shelters within the United States who completed a pre-foster survey between March 2022 and March 2023. The most common motivations were animal- or community-based, such as the desire to provide an animal with love or do something positive for the community. Ordinal logistic regression models were used to investigate associations between caregivers' motivations and their prior foster experience, pet ownership history, age, gender, and foster animal species. The 18- to 29-year-old caregivers were most likely to expect companionship (OR 5.18, 95% CI 1.79-15.04), emotional support (OR 4.25, 95% CI 1.40-12.89), and to meet other community members through fostering (OR 5.04, 95% CI 1.85-13.74). Male caregivers were less likely to foster for emotional support than females (OR 0.12, 95% CI 0.03-0.48), while dog caregivers (OR 2.23, 95% CI 1.04-4.76) and non-pet-owners (OR 2.66, 95% CI 1.17-6.05) had greater odds of expecting companionship. This study highlights the importance of animal- and community-related benefits for foster caregivers and provides useful direction for shelters wanting to increase recruitment to expand their foster care programs.

Readability Analysis of Online Breast Cancer Surgery Patient Education Materials from National Cancer Institute-Designated Cancer Centers Compared with Top Internet Search Results.

BACKGROUND: The National Institutes of Health (NIH) recommends patient education materials reflect the average reading grade level of the US population. Due to the importance of shared decision-making in breast cancer surgery, this study evaluates the reading level of patient education materials from National Cancer Institute-designated cancer centers (NCI-DCC) compared with top Internet search results. METHODS: Online materials from NCI-DCC and top Internet search results on breast cancer, staging, surgical options, and pre- and postoperative expectations were analyzed using three validated readability algorithms: Simplified Measure of Gobbledygook Readability Formula, Coleman-Liau index, and Flesch-Kincaid grade level. Mean readability was compared across source groups and information subcategories using an unpaired t-test with statistical significance set at p < 0.05. Mean readability was compared using a one-way analysis of variance. RESULTS: Mean readability scores from NCI-DCC and Internet groups ranged from a 9th-12th grade level, significantly above the NIH recommended reading level of 6th-7th grade. There was no significant difference between reading levels from the two sources. The discrepancy between actual and recommended reading level was most pronounced for "surgical options" at a 10th-12th grade level from both sources. CONCLUSIONS: Patient education materials on breast cancer from both NCI-DCC and top Internet search results were written several reading grade levels higher than the NIH recommendation. Materials should be revised to enhance patient comprehension of breast cancer surgical treatment and guide patients in this important decision-making process to ultimately improve health outcomes.

An 11-Year Review of Lactobacillus Bacteremia at a Pediatric Tertiary Care Center.

OBJECTIVES: To inform clinical decisions on the use of probiotics in a pediatric inpatient setting, we sought to determine the number of cases of Lactobacillus bacteremia as well as associated patient characteristics in a tertiary-care pediatric hospital over an 11-year period. METHODS: Cases of Lactobacillus bacteremia among admitted patients were identified through positive blood culture reports. The clinical chart for each case was reviewed for presenting symptoms and risk factors such as probiotic use, presence of a central venous catheter, immunocompromised state, impaired intestinal function, and age below 3 months. Concurrent total inpatient probiotic administration was assessed. RESULTS: Over an 11-year period, 8 cases of Lactobacillus bacteremia were identified among 127 845 hospital admissions. All cases were associated with systemic signs of infection. Lactobacillus bacteremia patients most frequently had underlying impaired intestinal function and a central venous catheter. Three cases had a history of probiotic use. The peak number of annual cases did not coincide with the peak number of inpatients who received probiotics. CONCLUSIONS: Lactobacillus bacteremia is uncommon and did not correlate with doses of probiotics-administered in the hospital. However, certain populations may be at higher risk and require extra consideration in clinical decision-making regarding use of probiotics.

Pyridine based dual binding site aromatase (CYP19A1) inhibitors.

Aromatase (CYP19A1) inhibitors are the mainstay therapeutics for the treatment of hormone dependant breast cancer, which accounts for approximately 70% of all breast cancer cases. However, increased resistance to the clinically used aromatase inhibitors, including letrozole and anastrazole, and off target effects, necessitates the development of aromatase inhibitors with improved drug profiles. The development of extended 4th generation pyridine based aromatase inhibitors with dual binding (haem and access channel) is therefore of interest and here we describe the design, synthesis and computational studies. Cytotoxicity and selectivity studies identified the pyridine derivative (4-bromophenyl)(6-(but-2-yn-1-yloxy)benzofuran-2-yl)(pyridin-3-yl)methanol (10c) as optimal with CYP19A1 IC50 0.83 nM (c.f. letrozole IC50 0.70 nM), and an excellent cytotoxicity and selectivity profile. Interestingly, computational studies for the 6-O-butynyloxy (10) and 6-O-pentynyloxy (11) derivatives identified an alternative access channel lined by Phe221, Trp224, Gln225 and Leu477, providing further insight into the potential binding mode and interactions of the non-steroidal aromatase inhibitors.

A Comprehensive Assessment of Cleft Lip and Palate Websites and Patient Education Information.

OBJECTIVE: The objective of this study is to evaluate online educational resources on cleft lip and palate teams. DESIGN: A Cross-Sectional Study. SETTING: An International, Multi-Institutional Study. PARTICIPANTS: All American Cleft Palate and Craniofacial Association-approved teams with websites. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Websites were assessed for patient education and support content. Affiliation between presence of materials and U.S. Newsweek Top 100 Hospitals was also assessed. RESULTS: 187 teams were included. Presence of educational videos were available in 29.4% of websites, educational infographics in 18.2%, written materials in 66.8%, perioperative instructions in 19.3%, diagnosis information in 34.8% and treatment information in 63.1%. Information on team members were available on 77.0% of websites, resources in languages other than English in 38.5%, and support group resources in 25.7%. Cleft lip and palate diagnosis information was significantly associated with geographic region, with the largest impact from the West region (P = .03). There was a significant difference between teams affiliated with U.S. Newsweek Top 100 hospitals: Top 100 hospitals had a higher presence of educational infographics, perioperative instructions, definitions, diagnosis, and treatment (P < .01). There was no significant difference between presence of educational videos (P = .37). CONCLUSION: While many websites had basic educational materials, very few included detailed information on peri-operative planning, as well as additional forms of information including videos, infographics, and non-English languages. Providing comprehensive patient education materials online is an important supplement for patients with cleft lip and palate and should be prioritized by cleft teams.

Health State Utility Mapping of Rimegepant for the Preventive Treatment of Migraine: Double-Blind Treatment Phase and Open Label Extension (BHV3000-305).

INTRODUCTION: The objectives of this study were to (1) report long-term health-related quality of life (HRQoL) outcomes among patients using rimegepant preventatively in BHV3000-305 (NCT03732638) open-label extension (OLE) and (2) map Migraine-Specific Quality of Life questionnaire version 2.1 (MSQv2) to EQ-5D-3L utility values over the double-blind treatment (DBT; 0-12 weeks) and the OLE (13-64 weeks) to assess the influence of treatment on these values. METHODS: This was a post hoc analysis using data from a rimegepant study for the prevention of migraine (BHV3000-305). Adult patients with migraine took either rimegepant 75 mg or placebo every other day (EOD) during the DBT phase. All patients received rimegepant during the OLE. MSQv2 was measured at baseline, weeks 12, 24, and 64. A validated algorithm was used to map MSQv2 scores to EQ-5D utilities. RESULTS: Baseline data were available for 347 patients treated with placebo and 348 treated with rimegepant in the DBT period, who continued to the OLE. Baseline EQ-5D utilities were similar between trial arms: 0.598 for placebo and 0.614 for rimegepant. EQ-5D improved from baseline to week 12 and utilities increased by + 0.09 for placebo and + 0.10 for rimegepant (p value = 0.011). By 24 weeks, at which point patients who were originally randomized to placebo had received rimegepant 75 mg EOD for 12 weeks, HRQoL measures (MSQv2 and EQ-5D) were similar across groups, demonstrating rapid onset of treatment effect. This HRQoL improvement was durable out to 64 weeks. CONCLUSION: Compared to placebo, treatment with rimegepant 75 mg was associated with greater improvement in EQ-5D utilities during the 12-week DBT phase. Patients originally randomized to placebo experienced a similar improvement in EQ-5D utilities after switching to rimegepant during the OLE, demonstrating that benefits are realized within 12 weeks of active treatment. This preventive effect was durable out to 64 weeks and was associated with an additional increase in HRQoL over time. TRIAL REGISTRATION: NCT03732638.

A Survey of Veterinary Student and Veterinarian Perceptions of Shelter Medicine Employment.

Shelter medicine appears to be popular among prospective veterinarians, but there is a shortage of veterinarians entering the field to fill available positions. The reasons for this discordance are not well understand. This study describes veterinary students' interest in shelter medicine, their perceptions of common duties, and their perceptions of employment attributes in shelter medicine, compared with those of current veterinarians. The sample included 146 first-year students, 155 final-year students, and 221 veterinarians who self-completed an online survey between September 2020 and March 2021. We found high levels of interest in shelter medicine, with 40% of first- and 43% of final-year students indicating they were likely to consider working in shelter medicine. Outreach clinics (84% of first-year students, 86% of final-year students), access-to-care clinics (82%, 83%), and loan forgiveness programs (75%, 64%) encouraged many veterinary students to consider working in shelter medicine. The risk of compassion fatigue, burnout, and stress (70%, 68%); weekend work (51%, 59%); euthanasia decision making (49%, 47%); euthanasia (43%, 41%); and expected salaries of shelter veterinarians (39%, 37%) acted as deterrents. Kruskal-Wallis H tests revealed students reported more positive ratings than veterinarians for most shelter medicine duties and employment characteristics, with moderate to strong consensus within groups. Little difference appeared between first- and final-year students. This study highlights target areas for animal shelters to boost recruitment of newly graduated veterinarians. Increasing veterinary students' exposure to shelter medicine throughout their veterinary training may also help address their concerns regarding euthanasia, salary, and quality of care.

Improving Adherence to Evidence-based Practice for Uncomplicated UTI in a Pediatric Emergency Department.

Introduction: Uncomplicated urinary tract infections (uUTIs) are among the more common pediatric bacterial infections. Despite their prevalence, significant variability exists in the treatment duration and antibiotic selection for uUTI. Our first aim was to improve adherence to a three-day course of antibiotic treatment for uUTI in children over 24 months old. Our second aim was to increase the selection of cephalexin in this population. Methods: We conducted a single-center quality improvement study from March 2021 to March 2022. One thousand four hundred thirty-five patients were included across our baseline and intervention periods. We created an order set with embedded discharge prescriptions and followed this with education and provider feedback. The outcome measures for this study were percent of children receiving 3 days of antibiotic treatment and percent of children prescribed cephalexin. In addition, we tracked order set use as a process measure, and 7-day emergency department revisit as a balancing measure. Results: Rates of 3-day prescriptions for uUTI demonstrated special cause variation with an increase from 3% to 44%. Prescription rates of cephalexin for uUTI demonstrated special cause variation with an increase from 49% to 74%. The process measure of order set use improved from 0% to 49% after implementation. No change occurred in 7-day emergency department revisits. Conclusion: We demonstrated improved use of shorter course therapy for uUTI with a first-generation cephalosporin throughout this project without adverse events. We leveraged an order set with embedded discharge prescriptions to achieve our goals.

One Size Does Not Fit All; Patient Preference for Breast Reconstruction.

Background: A myriad of patient education modalities for breast reconstruction exist, although the optimal tools for patient education remain undetermined. The aim of this study is to determine patient preferences for breast reconstruction education modalities based on demographic variables. Methods: A prospective observational study at a tertiary care university health system was conducted between November 2020 and May 2021. A questionnaire was administered to breast reconstruction patients to collect information on demographics, research sources used before the initial appointment, and preferred education modalities. Differences based on age were analyzed using an independent samples t test, whereas a Fisher exact test was used to analyze differences based on ethnicity and education level. Statistical significance was defined as P < .05. Results: The most preferred patient education tools overall were books/written materials and videos. Younger patients were significantly more likely than older patients to have referenced additional physician sources (P = .0174) and to seek out information on the institution's website (P = .0465). Those with a college degree were significantly more likely to have performed research prior to the initial appointment (P = .0206). White patients were significantly more likely than nonwhite patients to talk to friends/family as a research source (P = .0150). Conclusions: Regardless of age, education, or ethnicity, most patients prefer books/written materials and video presentations for education on breast reconstruction. Providers should strive to include written and video options to meet the needs of this diverse patient population.

A stated preference survey to explore patient preferences for novel preventive migraine treatments.

OBJECTIVE: The objective of this study was to explore patient preference for attributes of calcitonin gene-related peptide (CGRP) inhibitors for the preventive treatment of migraine and to describe differences in treatment preferences between patients. BACKGROUND: CGRP inhibitors are a novel class of migraine drugs specifically developed for the preventive treatment of migraine. Clinicians should understand patient preferences for CGRP inhibitors to inform and support prescribing choices. METHODS: Patients with migraine in the US and Germany were recruited to participate in an online discrete choice experiment (DCE) survey, which presented hypothetical treatment choices using five attributes: mode of administration, side effects, migraine frequency, migraine severity, and consistency of treatment effectiveness. Attribute selection was informed by a literature review and semi-structured patient interviews (n = 35), and evaluated using patient cognitive debriefing interviews (n = 5). RESULTS: Of 680 who consented to participate, 506 participants completed the survey and were included in the study (US = 257; Germany = 249). Overall, participants placed highest importance (preference weight, beta = 1.65, p < 0.001) on the treatment's ability to reduce the severity of migraine (mild vs. unchanged severity), followed by consistent treatment effectiveness (beta = 1.13, p < 0.001), and higher chance of reduced migraine frequency (beta = 1.00, p < 0.001). Participants preferred an oral tablet every other day (beta = 1.00, p < 0.001) over quarterly infusion, quarterly injections (p = 0.019), or monthly injection (p < 0.001). Preference for all treatment attributes were heterogeneous, and the subgroup analyses found that participants naïve to CGRP monoclonal antibody treatments had a stronger preference for oral therapy compared to those with such experience (p = 0.006). CONCLUSION: In this DCE assessing CGRP inhibitors attributes, the main driver of patient choice was treatment effectiveness, specifically reduced migraine severity, and consistent treatment effectiveness. Further, patients exhibited an overall preference for an oral tablet every other day over injectables. Patients' experience with previous treatments informs the value they place on treatment characteristics.