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Oskoui M, Caller TA, Parsons JA, Servais L, Butterfield RJ, Bharadwaj J, Rose SC, Tolchin B, Puskala Hamel K, Silsbee HM, Dowling JJ. Delandistrogene Moxeparvovec Gene Therapy in Individuals With Duchenne Muscular Dystrophy: Evidence in Focus: Report of the AAN Guidelines Subcommittee. Neurology 2025; 104:e213604. [PMID: 40367405 DOI: 10.1212/wnl.0000000000213604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Accepted: 03/13/2025] [Indexed: 05/16/2025] Open
Abstract
This Evidence in Focus reviews the current evidence on the efficacy and adverse effects of delandistrogene moxeparvovec in patients with Duchenne muscular dystrophy (DMD) and presents clinical considerations regarding use. The author panel systematically reviewed available clinical trial data on delandistrogene moxeparvovec in patients with DMD. The risk of bias was evaluated using the American Academy of Neurology's 2017 therapeutic classification of evidence scheme. Safety information, regulatory decisions, and clinical context were also reviewed. Six clinical trials were identified, of which 4 had peer-reviewed data available. From the 4 studies with available data (2 Class I and 2 Class III), exposure data are available on 134 boys, of which 128 are ambulatory and aged ≥4 to <8 years. Both Class I studies failed to meet the primary functional motor outcome as assessed by change in the North Star Ambulatory Assessment score. Several secondary functional motor outcomes demonstrated improvement in the treatment group with small effect sizes, not meeting statistical significance from hierarchical analysis. Corticosteroid dose exposure was higher in the treatment group in the first 12 weeks after infusion, potentially contributing to measured differences between groups. Safety outcomes were similar across studies with multiple treatment-related adverse events, including peri-infusion effects, immune myositis and myocarditis, thrombocytopenia, and liver toxicity. One death has been reported in an individual who was treated with delandistrogene moxeparvovec outside of a trial. Despite not demonstrating efficacy in its primary outcome, delandistrogene moxeparvovec has been approved by the US Food and Drug Administration (FDA) for use in boys with DMD. This decision was supported by the relative safety of the product and secondary outcome measures data in the phase 3 clinical trial. As the drug may now be actively prescribed in the United States and other countries after FDA approval, providers should be aware of the limitations of the treatment and the need to monitor for immune-related side effects including myocarditis, liver injury, and thrombocytopenia, which may require expanded clinical infrastructure. Additional clinical trials and careful collection of real-world evidence from treated patients will be essential to establish short-term and long-term effectiveness and inform understanding of benefits and risks of delandistrogene moxeparvovec across the lifespan.
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Affiliation(s)
- Maryam Oskoui
- Departments of Pediatrics and Neurology & Neurosurgery, McGill University, Quebec, Canada
| | | | - Julie A Parsons
- Department of Child Neurology, Children's Hospital Colorado, Aurora
| | - Laurent Servais
- Department of Pediatrics, University of Oxford, United Kingdom
| | | | | | - Sean C Rose
- Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH
| | | | | | | | - James J Dowling
- Departments of Neurology and Genetics, University of Pennsylvania, Philadelphia
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Nouwens SPH, Marceta SM, Bui M, van Dijk DMAH, Groothuis-Oudshoorn CGM, Veldwijk J, van Til JA, de Bekker-Grob EW. The Evolving Landscape of Discrete Choice Experiments in Health Economics: A Systematic Review. PHARMACOECONOMICS 2025:10.1007/s40273-025-01495-y. [PMID: 40397369 DOI: 10.1007/s40273-025-01495-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2025] [Indexed: 05/22/2025]
Abstract
INTRODUCTION Stakeholder preference evaluations are increasingly emphasized in healthcare policy and health technology assessment. Discrete choice experiments (DCEs) are the most common method for quantifying preferences among patients, the public, and healthcare professionals. While prior reviews (1990-2017) have examined DCE trends, no comprehensive synthesis exists for studies published since 2018. This updated review (2018-2023) provides critical insights into evolving methodologies and global trends in health-related DCEs. METHODS A systematic search (2018-2023) of Medline, Embase, and Web of Science identified relevant studies. Studies were screened for inclusion and data were extracted, including details on DCE design and analysis. To enable trend comparisons, the search strategy and extraction items aligned with previous reviews. RESULTS Of 2663 identified papers, 1279 met the inclusion criteria, reflecting a significant rise in published DCEs over time. DCEs were conducted globally, with a remarkable increase in publications from Asia and Africa compared with previous reviews. Experimental designs and econometric models have advanced, continuing prior trends. Notably, most recent DCEs were administered online. DISCUSSION The rapid growth of DCE applications underscores their importance in health research. While the methodology is advancing rapidly, it is crucial that researchers provide full transparency in reporting their methods, particularly in detailing experimental designs and validity tests, which are too often overlooked. Key recommendations include improving reporting of experimental designs, applying validity tests, following good practices for presenting benefit-risk attributes, and adopting open science practices. Ensuring methodological rigor will maximize the impact and reproducibility of DCE research in health economics.
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Affiliation(s)
- Sven Petrus Henricus Nouwens
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands.
| | - Stella Maria Marceta
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | - Michael Bui
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Daisy Maria Alberta Hendrika van Dijk
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | | | - Jorien Veldwijk
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | - Janine Astrid van Til
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Esther Wilhelmina de Bekker-Grob
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
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Penfold RB, Yoo HI, Richards JE, Crossnohere NL, Johnson E, Pabiniak CJ, Renz AD, Campoamor NB, Simon GE, Bridges JFP. Acceptability of linking individual credit, financial, and public records data to healthcare records for suicide risk machine learning models. JAMIA Open 2024; 7:ooae113. [PMID: 39434890 PMCID: PMC11493183 DOI: 10.1093/jamiaopen/ooae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 07/03/2024] [Accepted: 10/08/2024] [Indexed: 10/23/2024] Open
Abstract
Objectives Individual-level information about negative life events (NLE) such as bankruptcy, foreclosure, divorce, and criminal arrest might improve the accuracy of machine learning models for suicide risk prediction. Individual-level NLE data is routinely collected by vendors such as Equifax. However, little is known about the acceptability of linking this NLE data to healthcare data. Our objective was to assess preferences for linking external NLE data to healthcare records for suicide prevention. Materials and Methods We conducted a discrete choice experiment (DCE) among Kaiser Permanente Washington (KPWA) members. Patient partners assisted in the design and pretesting of the DCE survey. The DCE included 12 choice tasks involving 4 data linking program attributes and 3 levels within each attribute. We estimated latent class conditional logit models to derive preference weights. Results There were 743 participants. Willingness to link data varied by type of information to be linked, demographic characteristics, and experience with NLE. Overall, 65.1% of people were willing to link data and 34.9% were more private. Trust in KPWA to safeguard data was the strongest predictor of willingness to link data. Discussion Most respondents supported linking NLE data for suicide prevention. Contrary to expectations, People of Color and people who reported experience with NLEs were more likely to be willing to link their data. Conclusions A majority of participants were willing to have their credit and public records data linked to healthcare records provided that conditions are in place to protect privacy and autonomy.
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Affiliation(s)
- Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101-1466, United States
| | - Hong Il Yoo
- Loughborough Business School, Loughborough University, Loughborough, Leicestershire LE11 3TU, United Kingdom
| | - Julie E Richards
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101-1466, United States
| | - Norah L Crossnohere
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101-1466, United States
| | - Chester J Pabiniak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101-1466, United States
| | - Anne D Renz
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101-1466, United States
| | - Nicola B Campoamor
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101-1466, United States
| | - John F P Bridges
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States
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Martin EG, Kuziek J, Rasiah J, Orr SL. Evaluating patient and family preferences for acute and preventive pediatric headache treatment. Headache 2024; 64:950-966. [PMID: 38828670 DOI: 10.1111/head.14739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/07/2024] [Accepted: 04/23/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To describe acute and preventive treatment preferences among youth with migraine and their parents/guardians, and to describe the degree of youth-parent/guardian preference agreement. BACKGROUND Headache disorders are common in youth, but little is known about patient and family preferences for headache treatments and outcomes. METHODS In this cross-sectional survey, a headache treatment preferences questionnaire was co-created with stakeholders, piloted, and distributed to consenting youth with migraine aged 9-18 years and parents/guardians at a tertiary care headache clinic in western Canada. Response data were summarized for youth and parents/guardians separately, and agreement rates within a youth-parent/guardian pair were compared to a hypothesized agreement rate of 80% for the primary questionnaire items. RESULTS Seventy-two youth and n = 94 parents/guardians participated, with n = 63 in youth-parent/guardian pairs. Freedom from pain and rapid relief, and reducing pain severity and headache frequency were top acute and preventive treatment priorities, respectively. More than 90% (69/72) agreed that ≥ 50% reduction in headache frequency was a good target. For both acute and preventive interventions, swallowed pill-based options were most often selected as the preferred first-line treatment, with neuromodulation selected as the preferred second-line treatment. The level of agreement within youth-parent/guardian pairs on preferred treatment modalities was lower than hypothesized for acute (63% [40/63], 95% confidence interval [CI] = 52-75%, χ2 = 10.73, p = 0.001) but not for preventive treatment (73% [46/63], 95% CI = 62-84%, χ2 = 1.92, p = 0.166). Regarding which treatment modalities were perceived as most effective, youth-parent agreement was lower than hypothesized for both acute (48% [30/63], 95% CI = 35-60%, χ2 = 41.29, p < 0.001) and preventive treatment (46% [29/63], 95% CI = 34-58%, χ2 = 45.43, p < 0.001). CONCLUSION Youth and family preferences aligned qualitatively, but sometimes diverged quantitatively, from typical clinical trial outcomes. The level of agreement within youth-parent/guardian pairs on treatment preferences and perceptions was low. Clinicians should consider both perspectives as they may be divergent.
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Affiliation(s)
- Elise G Martin
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Kuziek
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jananee Rasiah
- Alberta Strategy for Patient Oriented Research Support Unit, Patient Engagement Platform, Calgary, Alberta, Canada
- Faculty of Nursing, MacEwan University, Edmonton, Alberta, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | - Serena L Orr
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Fischer R, Furlong P, Kennedy A, Maynard K, Penrod M, Miller D, Laverty CG, Lowes LP, Kuntz NL, Shieh PB, Kondejewski J, Neumann PJ, Shafrin J, Willke RJ. Healthcare Stakeholder Perspectives on a Value Assessment Approach for Duchenne Muscular Dystrophy Therapies. J Multidiscip Healthc 2024; 17:4199-4212. [PMID: 39224484 PMCID: PMC11368110 DOI: 10.2147/jmdh.s458181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/15/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose Traditional value assessment frameworks are challenged in comprehensively assessing the societal value new therapies bring to individuals with rare, progressive, genetic, fatal, neuromuscular diseases such as Duchenne muscular dystrophy (DMD). The objective of this study was to identify how value assessment frameworks may need to be adapted to measure the value to society of DMD therapies. Patients and Methods Three stakeholder groups (6 patient advocates, 4 clinicians, 3 health economists; N = 13) participated in semi-structured interviews around the International Society for Pharmacoeconomics and Outcomes Research's Value Flower, which includes elements to consider within value assessments of healthcare technologies. Results All stakeholders agreed that traditional value assessment frameworks based on the quality-adjusted life year (QALY) are narrow and will undervalue new DMD therapies. All stakeholders expressed some level of concern that using the QALY as a key metric of value discriminates against patients with severe progressive diseases and disabilities. Some stakeholders saw value in using the QALY for cross-disease comparisons in resource-constrained environments if the methodology was appropriate. All stakeholders recommended considering additional elements of value in decision-making around new DMD therapies. These elements reflect: economic and humanistic costs incurred by patients, caregivers, and families with Duchenne, such as indirect out-of-pocket costs, lost productivity, and family spillovers; meaningful attributes for individuals with disabilities and high unmet need, such as severity of disease, value of hope, and real option value; and factors that contribute to improvements in population health, such as insurance value, equity, and scientific spillovers. Conclusion These findings highlight the need to expand traditional value assessment frameworks and take a holistic approach that incorporates the perspectives of individuals with Duchenne, caregivers, clinicians, and health economists when assessing the societal value of new DMD therapies. Broadening value assessment will prevent restricted or delayed access to therapies for individuals with Duchenne.
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Affiliation(s)
- Ryan Fischer
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Pat Furlong
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Annie Kennedy
- EveryLife Foundation for Rare Diseases, Washington, DC, USA
| | - Kelly Maynard
- Little Hercules Foundation, Dublin, OH, USA
- Duchenne Family Assistance Program, Detroit, MI, USA
| | - Marissa Penrod
- Duchenne Family Assistance Program, Detroit, MI, USA
- Team Joseph, West Bloomfield, MI, USA
| | | | - Chamindra G Laverty
- Department of Neuroscience, University of California San Diego, San Diego, CA, USA
| | - Linda P Lowes
- Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, the Ohio State University, Columbus, OH, USA
| | - Nancy L Kuntz
- Division of Neurology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Neurology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Perry B Shieh
- Department of Neurology and Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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Crossnohere NL, Campoamor NB, Camino E, Dresnick E, Martschenko DO, Rodrigues V, Apkon S, Hazlett A, Mittur D, Rodriguez PE, Bridges JFP, Armstrong N. Barriers to diverse clinical trial participation in Duchenne muscular dystrophy: Engaging Hispanic/Latina caregivers and health professionals. Orphanet J Rare Dis 2024; 19:207. [PMID: 38773664 PMCID: PMC11110421 DOI: 10.1186/s13023-024-03209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/05/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Despite the increasing availability of clinical trials in Duchenne muscular dystrophy, racial/ethnic minorities and other populations facing health disparities remain underrepresented in clinical trials evaluating products for Duchenne. We sought to understand the barriers faced by Hispanic/Latino families specifically and underrepresented groups more generally to clinical trial participation in Duchenne. METHODS We engaged two participant groups: Hispanic/Latino caregivers of children with Duchenne in the US, including Puerto Rico, and health professionals within the broader US Duchenne community. Caregiver interviews explored attitudes towards and experiences with clinical trials, while professional interviews explored barriers to clinical trial participation among socio-demographically underrepresented families (e.g., low income, rural, racial/ethnic minority, etc.). Interviews were analyzed aggregately and using a thematic analysis approach. An advisory group was engaged throughout the course of the study to inform design, conduct, and interpretation of findings generated from interviews. RESULTS Thirty interviews were conducted, including with 12 Hispanic/Latina caregivers and 18 professionals. We identified barriers to clinical trial participation at various stages of the enrollment process. In the initial identification of patients, barriers included lack of awareness about trials and clinical trial locations at clinics that were less likely to serve diverse patients. In the prescreening process, barriers included ineligibility, anticipated non-compliance in clinical trial protocols, and language discrimination. In screening, barriers included concerns about characteristics of the trial, as well as mistrust/lack of trust. In consent and recruitment, barriers included lack of timely decision support, logistical factors (distance, time, money), and lack of translated study materials. CONCLUSIONS Numerous barriers hinder participation in Duchenne clinical trials for Hispanic/Latino families and other populations experiencing health disparities. Addressing these barriers necessitates interventions across multiple stages of the clinical trial enrollment process. Recommendations to enhance participation opportunities include developing clinical trial decision support tools, translating prominent clinical trials educational resources such as ClinicalTrials.gov, fostering trusting family-provider relationships, engaging families in clinical trial design, and establishing ethical guidelines for pre-screening potentially non-compliant patients.
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Affiliation(s)
- Norah L Crossnohere
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Nicola B Campoamor
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Eric Camino
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Erin Dresnick
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | | | - Viana Rodrigues
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Susan Apkon
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Dhruv Mittur
- Patient partner, Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Priscilla E Rodriguez
- Diversity Inclusion Advocacy Manager, EveryLife Foundation for Rare Diseases, Washington, DC, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
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Johnston KM, Audhya IF, Dunne J, Feeny D, Neumann P, Malone DC, Szabo SM, Gooch KL. Comparing Preferences for Disease Profiles: A Discrete Choice Experiment from a US Societal Perspective. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:343-352. [PMID: 38253973 PMCID: PMC11021240 DOI: 10.1007/s40258-023-00869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVES There is increasing interest in expanding the elements of value to be considered when making health policy decisions. To help inform value frameworks, this study quantified preferences for disease attributes in a general public sample and examined which combination of attributes (disease profiles) are considered most important for research and treatment. METHODS A discrete choice experiment (DCE) was conducted in a US general population sample, recruited through online consumer panels. Respondents were asked to select one of a set of health conditions they believed to be most important, characterized by attributes defined by a previous qualitative study: onset age; cause of disease; life expectancy; caregiver requirement; symptom burden (characterized by the Health Utilities Index with varying levels of ambulation independence, dexterity limitations, and degree of pain and discomfort); and disease prevalence. A fractional factorial DCE design was implemented using R, and 60 choice sets were generated (separated into blocks of 10 per participant). Data were analyzed using a mixed-logit regression model, and results used to assess the likelihood of preferring disease profiles. Based on individual attribute preferences, overall preferences for disease profiles, including a profile aligned with Duchenne muscular dystrophy (DMD), were compared. RESULTS Fifty-two percent of respondents (n = 537) were female, and 70.6% were aged 18-54 years. Attributes considered most important were those related to life expectancy (odds ratio [OR], 95% confidence interval [CI] 1.88 [1.56-2.27] for a 50% reduction in remaining life expectancy vs no impact), and symptom burden (OR [95% CI] 1.84 [1.47-2.31] for severe vs mild burden). Greater importance was also found for pediatric onset, caregiver requirement, and diseases affecting more people. As an example of disease profile preferences, a DMD-like pediatric inherited disease with 50% reduction in life expectancy, extensive caregiver requirement, severe symptom burden, and 1:5000 prevalence had 2.37-fold higher odds of being selected as important versus an equivalent disease with adult onset and no life expectancy reduction. CONCLUSIONS Of disease attributes included in this DCE, respondents valued higher prevalence of disease, life expectancy and symptom burden as most important for prioritizing research and treatment. Based on expressed attribute preferences, a case study of an inherited pediatric disease involving substantial reductions to length and quality of life and requiring caregiver support has relatively high odds of being identified as important compared to diseases reflecting differing attribute profiles. These findings can help inform expansions of value frameworks by identifying important attributes from the societal perspective.
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Affiliation(s)
| | - Ivana F Audhya
- Sarepta Therapeutics, Inc., 215 First Street, Cambridge, MA, USA
| | - Jessica Dunne
- Broadstreet HEOR, 201-343 Railway St., Vancouver, BC, V6A 1A4, Canada
| | | | | | | | - Shelagh M Szabo
- Broadstreet HEOR, 201-343 Railway St., Vancouver, BC, V6A 1A4, Canada
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Kimberly L, Hunt C, Beaverson K, James E, Bateman-House A, McGowan R, DeSante-Bertkau J. The Lived Experience of Pediatric Gene Therapy: A Scoping Review. Hum Gene Ther 2023; 34:1180-1189. [PMID: 37964764 DOI: 10.1089/hum.2023.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Little is known about patients' and families' lived experiences of participating in pediatric gene therapy (GT) clinical trials. Currently, pediatric GT research targets a broad range of indications--including rare and ultra-rare diseases--which vary in severity and in the availability of alternative therapies. Pediatric GT differs meaningfully from adult GT because the decision to participate involves a dyad of both the child and parent or caregiver/s. It is critical to understand patients' and caregivers' perceptions and experiences of social, emotional, physical, and logistical burdens or benefits of participating in such trials, and how they weigh and prioritize these factors when deciding whether to participate. We conducted a scoping review of the current literature in this subject area with objectives to (1) provide an overview of existing literature, (2) identify gaps and areas for further research, and (3) better understand the lived impact of pediatric GT research on patients and their parents/caregivers. Four themes emerged, including (1) weighing risks and benefits (2) timing of GT trial participation, (3) value of clear communication, and (4) potential impact on quality of life. Notably, our sample surfaced articles about how patients/parents/caregivers were thinking about GT-their understanding of its safety, efficacy, and risks-rather than accounts of their experiences, which was our initial intention. Nevertheless, our findings offer useful insights to improve the informed consent process and promote a more patient- and family-centered approach. Moreover, our findings can contribute to patient advocacy organizations' efforts to develop educational materials tailored to patients' and families' expressed informational needs and perspectives, and can inform more patient- and family-centered policies from GT clinical trial sponsors.
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Affiliation(s)
- Laura Kimberly
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, New York, USA
- Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Cara Hunt
- Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Emma James
- Medical and Patient Affairs, Encoded Therapeutics, South San Francisco, California, USA
| | - Alison Bateman-House
- Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Richard McGowan
- Department of Epidemiology and Health Promotion, Health Sciences Library, NYU Grossman School of Medicine, New York, New York, USA
| | - Jennifer DeSante-Bertkau
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Crossnohere NL, Childerhose JE, Bose-Brill S. Increasing the Patient-Centeredness of Predictive Analytics Tools. THE PATIENT 2022; 15:615-617. [PMID: 36053486 DOI: 10.1007/s40271-022-00595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University, College of Medicine, 1800 Cannon Drive, Columbus, OH, 43210, USA.
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University, College of Medicine, Columbus, OH, USA.
| | - Janet E Childerhose
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University, College of Medicine, Columbus, OH, USA
- Division of Bioethics, Department of Anatomy and Biomedical Education, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University, College of Medicine, Columbus, OH, USA
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Unmet Therapeutic Needs of Non-Ambulatory Patients with Duchenne Muscular Dystrophy: A Mixed-Method Analysis. Ther Innov Regul Sci 2022; 56:572-586. [PMID: 35325439 PMCID: PMC8943787 DOI: 10.1007/s43441-022-00389-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/21/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Duchenne muscular dystrophy has been a launching pad for patient-focused drug development (PFDD). Yet, PFDD efforts have largely neglected non-ambulatory patients. To support PFDD efforts in this population, we primarily sought to understand the needs of non-ambulatory Duchenne patients and, secondarily, to examine these needs in the context of the PUL-PROM-a validated patient-reported outcome measure of upper limb functioning. METHODS Non-ambulatory Duchenne patients or their caregivers from eight countries answered open-ended survey questions about patients' needs related to their most significant symptoms and important benefits of new treatments. The PUL-PROM was used to evaluate patients' upper limb functioning and was compared to data collected on non-ambulatory stage and quality of life. We thematically analyzed open-ended data, descriptively analyzed close-ended data, and compared themes by non-ambulatory stage. RESULTS The study included 275 participants. Mean patient age was 24. Most patients were early-stage non-ambulatory (67%). Thematic analysis identified three congruent themes between significant symptoms and important benefits of new treatments: muscle functioning, especially upper limb function; body system functioning; and quality of life. Muscle functioning and body system functioning were endorsed more frequently in responses from early- and late-stage patients, respectively. Mean PUL-PROM total score was 22 with higher scores in early-stage patients (p ≤ 0.001). Upper limb function positively correlated with quality of life (r = 0.42, p ≤ 0.001). DISCUSSION Non-ambulatory Duchenne patients want new treatments that improve upper limb functioning and body system functioning, and not exclusively regaining ambulation. The PUL-PROM can be used as a patient-centric measure that accounts for the needs of later-stage Duchenne patients.
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Crossnohere NL, Armstrong N, Fischer R, Bridges JFP. Diagnostic experiences of Duchenne families and their preferences for newborn screening: A mixed-methods study. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2022; 190:169-177. [PMID: 35943031 PMCID: PMC9804254 DOI: 10.1002/ajmg.c.31992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/06/2022] [Accepted: 07/19/2022] [Indexed: 01/05/2023]
Abstract
Duchenne muscular dystrophy is the most common form of muscular dystrophy diagnosed in childhood but is not routinely screened for prenatally or at birth in the United States. We sought to characterize the diagnostic experiences of families and describe their preferences for newborn screening (NBS). We conducted a registry-based survey of families with Duchenne and Becker muscular dystrophy that included open- and closed-ended questions regarding the journey to a diagnosis, preferences for when to learn of a diagnosis, and how knowledge of a diagnosis would impact life decisions. Open-ended responses were analyzed thematically, and closed-ended responses were analyzed descriptively. Sixty-five families completed the survey. The average ages of first concern and diagnosis were 2 and 4 years, respectively. One-third of families (30%) indicated that they would prefer to receive a diagnosis in the newborn period irrespective of treatment options available, and nearly all of the remaining families (93%) indicated that they would want to learn about a diagnosis if there were treatments that worked well during the newborn period. All families (100%) indicated that a diagnosis in the newborn period would impact life decisions. We identified three overarching themes, which described the stages of the diagnostic journey, including having concerns about the child, seeking answers, and receiving the diagnosis. NBS can facilitate improved health outcomes through early access to care, and inform families on major health and nonhealth decisions. The preferences and experiences of families and other stakeholders should be considered when determining the potential value and benefit of expanding NBS programs.
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Affiliation(s)
- Norah L. Crossnohere
- Department of Biomedical InformaticsThe Ohio State University College of MedicineColumbusOhioUSA,Present address:
Department of Internal MedicineDivision of General Internal Medicine, The Ohio State University College of MedicineColumbusOhioUSA
| | - Niki Armstrong
- Parent Project Muscular DystrophyWashingtonDistrict of ColumbiaUSA
| | - Ryan Fischer
- Parent Project Muscular DystrophyWashingtonDistrict of ColumbiaUSA
| | - John F. P. Bridges
- Department of Biomedical InformaticsThe Ohio State University College of MedicineColumbusOhioUSA
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