To elicit preferences of people with advanced Parkinson’s (PwaP) and care partners (CP), exploring the relative importance of treatment characteristics, and benefits-risks tradeoffs.

Several treatments are available for PwaP who do not achieve sufficient control of their symptoms using oral medications alone. Because of differences in efficacy, safety and route of administration (ROA) across these treatments, assessing preferences is valuable. 

A discrete-choice experiment was administered to 304 PwaP and CP in the US (n=110 and 38, respectively), UK (n=31 and 15), and Germany (n=82 and 28). Respondents chose between varying pairs of hypothetical treatments, defined by differing levels of 7 attributes: daily hours of ON time without troublesome dyskinesia (ONwoTD), frequency of early morning OFF time, risk of mild-to-moderate skin reaction, risk of severe side effects requiring hospitalization, ROA, pill regimen, and device maintenance frequency. Random-parameter logit model estimates were used to calculate Attribute Relative importance (RI, reported rescaled between 0 and 100), and maximum acceptable risks.

The average age of PwaP was 65.7 years (Standard deviation [SD]=8.6), duration of Parkinson’s diagnosis was 10.0 years (SD=4.2), and self-reported OFF time was 4.0 hours/day (SD=2.4). ROA was considered the most important attribute (RI=35.3), followed by hours of ONwoTD (RI=26.4). Other attributes had lower RI and were not statistically different from each other. Transition from an infusion device requiring surgery to an infusion device without surgery (subcutaneous delivery) was the most impactful improvement between adjacent levels. Respondents were willing to accept the highest risks of safety events if it meant switching from a surgical-based to a subcutaneous ROA or gaining increased ONwoTD from 3 to 6 hours.

PwaP and CP prioritize treatment ROA (subcutaneous over surgical options) and efficacy (increased hours of ONwoTD). These findings underscore the importance of considering these factors in treatment discussions between PwaP, CP, and their healthcare provider.