Chinese Patient Preferences and Trade-Offs for Therapy-Related Attributes of Anti-Vascular Endothelial Growth Factor Agents in Diabetic Macular Edema and Neovascular Age-Related Macular Degeneration: A Discrete Choice Experiment.

BACKGROUND AND

objectiveAnti-vascular endothelial growth factor agents are the first-line treatment for macular edema associated with neovascularization or increased vascular permeability, yet patient adherence remains suboptimal. This study aimed to quantify how patient preferences for therapy-related attributes of anti-vascular endothelial growth factor agents influence trade-offs among effectiveness, safety, required injection regimen, and cost.

methodsA face-to-face survey-based discrete choice experiment was conducted across six Chinese cities from October 2023 to April 2024 among adults with diabetic macular edema or neovascular age-related macular degeneration. Two separate discrete choice experiment sets were developed based on literature review, focus groups, best-worst scaling, and reference to package inserts and clinical trial data. Each patient was asked to choose a preferred alternative from each of the ten choice sets. Mixed logit models estimated patient preference weights for each attribute level, relative attribute importance, and trade-offs between benefits, risks, injection regimens, and cost. Latent class models explored preference heterogeneity.

resultsA total of 355 participants who passed quality checks, most preferred anti-vascular endothelial growth factor agents with longer or more flexible maintenance-phase injection intervals, greater macular edema reduction, improved visual acuity, lower risk of serious adverse events, and lower cost. For patients with diabetic macular edema, injection frequency was the most important attribute. They were willing to pay an additional ¥5045.26 ($708.60) to extend injection intervals from monthly to treat-and-extend regimen, or accept a 12.97% increased risk, or forgo a 21.76% macular edema reduction, or a 14.76% visual acuity improvement. For patients with neovascular age-related macular degeneration, visual acuity improvement was the most important. They were willing to pay ¥16,586.29 ($2329.54) to improve visual acuity from 20% to 43%, or accept a 17.30% increased risk, or forgo an 18.64% macular edema reduction, or an 11.88% visual acuity improvement. Patients with diabetic macular edema with senior high school education or above, or with cross-region treatment history, placed greater emphasis on visual acuity improvement, while those with more than three prior injections prioritized lower injection frequency.

conclusionsEliciting individual preferences can support ophthalmologists in making patient-centered recommendations during shared decision making. Understanding trade-offs across different patients is also valuable for pharmaceutical companies and payers. Future research should further explore the balance between cost, risk, and potential benefits that patients are willing to accept.