Patient preferences for treatment of Bowen's disease

BACKGROUND: Discrete choice experiments (DCEs) are increasingly used to understand and quantify patient preferences for a variety of treatments, services or screening in order to analyse the choices patients make when faced with different alternatives. The aim of this DCE was to examine patient preferences for the treatment of Bowen's disease. METHODS: A DCE was conducted alongside a randomised controlled non-inferiority trial comparing the effectiveness of surgical excision, MAL-PDT, and 5-fluorouracil cream as treatments for Bowen's disease. Preferences were elicited by presenting patients with choice tasks between surgical excision, MAL-PDT, and 5-fluorouracil cream with the following attributes: effectiveness, cosmetic outcome, side effects, treatment duration and process. A mixed logit model was used to account for the panel nature of the data (repeated choices for each respondents) and heterogeneity in preference. RESULTS: A total of 215 patients completed the DCE. Patients have a clear preference for excision and non-invasive therapies were less valued, as indicated by the large and negative label effect.Both moderate and good to excellent cosmetic outcomes were accepted and preferred to poor cosmetic outcomes for all treatments. In addition, none or mild to moderate side effects were considered acceptable and preferred to severe side effects. CONCLUSION: Patients show a clear preference for surgical excision, and of the two non-invasive treatments, 5-fluorouracil cream is preferred to MAL-PDT. Treatment choice is also determined by attributes such as effectiveness, cosmetic outcome and side effects. In the context of shared decision making for Bowen's disease, it is important to discuss the elements of treatment that patients value to ensure that an informed decision is made.