Patient preferences for treatment of castration-resistant prostate cancer in Japan: a discrete-choice experiment.

BACKGROUND: Up to a fifth of patients diagnosed with prostate cancer (PC) will develop castration-resistant prostate cancer (CRPC), which has been associated with a poor prognosis. The aim of this study was to consider the patient perspective as part of the overall treatment decision-making process for CRPC, given that an alignment between patient preference and prescribing has been shown to benefit patient outcomes. This study examines preferences of patients with CRPC in Japan for treatment features associated with treatments like RA-223, abiraterone, and docetaxel and to examine the extent to which treatment preferences may vary between symptomatic and asymptomatic patients. METHODS: A two-phase research approach was implemented. In Phase 1, N = 8 patients with CRPC were recruited from a single hospital to complete a qualitative interview to provide feedback on the draft survey. In Phase 2, N = 134 patients with CRPC were recruited from five hospitals to complete a paper survey. The survey included 6 treatment choice questions, each asking patients to choose between two hypothetical treatments for their CRPC. Each treatment alternative was defined by the following attributes: length of overall survival (OS), time to a symptomatic skeletal event (SSE), method of administration, reduction in the risk of bone pain, treatment-associated risk of fatigue and lost work days. A hierarchical Bayesian logistic regression was used to estimate relative preference weights for each attribute level and mean relative importance. RESULTS: A total of N = 133 patients with CRPC completed the survey and were included in the final analysis. Patients had a mean age of 75.4 years (SD = 7.4) and had been diagnosed with PC a mean of 6.5 years prior (SD = 4.4). Over the attribute levels shown, fatigue (relative importance [RI] = 24.9 %, 95 % CI: 24.7 %, 25.1 %) was the most important attribute, followed by reduction in the risk of bone pain (RI = 23.2 %, 95 % CI: 23.0 %, 23.5 %), and OS (RI = 19.2 %, 95 % CI: 19.0 %, 19.4 %). Although symptomatic patients placed significantly more importance on delaying an SSE (p < .05), no other preference differences were observed. CONCLUSIONS: CRPC patients were more concerned about reduced quality of life from side effects of treatment rather than extension of survival, which may have implications for shared decision-making between patients and physicians.

Anti-vascular Endothelial Growth Factor Outpatient Treatment Patterns in Patients with Exudative Age-related Macular Degeneration from a Japanese Hospital Claims Database.

Purpose: To identify outpatient treatment patterns of patients with exudative age-related macular degeneration (AMD) who received approved anti-vascular endothelial growth factor (VEGF) therapy, using real-world data from hospitals in Japan. Methods: A hospital claims database was retrospectively reviewed for patients diagnosed with exudative AMD who were treated with anti-VEGF therapy in the outpatient setting between January 2010 and December 2012. Within a treatment period of at least 12 months, the frequency of anti-VEGF injections and AMD-related visits, and time intervals between AMD-related visits and anti-VEGF injections were captured for patients who had neither cataracts nor glaucoma. "Loading dose regimen" was defined as the first 2 or 3 monthly doses and "PRN maintenance regimen" (where PRN=pro re nata) was defined as the entire period of time after the loading doses had been administered. Results: Claims data were collected from a total of 219 patients from 13 of 126 hospitals: 217 treated with ranibizumab (8 received pegaptanib as well), 2 with aflibercept. Of these, 68 patients were treated for at least 12 months (all with ranibizumab PRN), and 29 had neither cataracts nor glaucoma and were included in the treatment pattern analysis. These 29 patients received a mean of 3.8 injections in the first 12 months and another 2.5 injections in the second 12 months of treatment. The average number of all outpatient visits was 16.1 in the first 12 months and 13.7 in the second 12 months, and an average of 11.6 days elapsed between injections and the previous outpatient monitoring visits using a PRN schedule. Conclusion: In a real-world setting in Japan, anti-VEGF PRN injections are administered less frequently than in clinical trials, and with time between monitoring and re-injection visits. Nonetheless, patients still visit the hospital frequently, which can significantly burden patients, caregivers, and healthcare providers.