Trade-offs between the benefits and risks of drug treatment for psoriasis: a discrete choice experiment with UK dermatologists

Background The choice of drug treatment for an individual patient is a complex matter. In the case of psoriasis there is a range of treatments available, with varying degrees of efficacy and risk of adverse events. Objectives To examine the extent to which the attributes of a treatment affect dermatologists' choice of drug therapy and explore the magnitude and nature of the trade-offs between the risks and benefits of treatment. Methods A postal questionnaire was sent to members of the British Association of Dermatologists (BAD). The questionnaire used a discrete choice experiment (DCE) to elicit dermatologists' preferences for the treatment of psoriasis. In all, 227 dermatologists completed the questionnaire. The results indicated that time to moderate improvement, time to relapse, risk of hypertension, liver damage, skin cancer and skin irritation were all important factors affecting dermatologists' choice of treatment. Comparing the coefficients for the different side-effects indicated that the dermatologists considered the risk of liver damage to be the most important side-effect, followed by the risk of skin cancer. The time to achieve a moderate (50%) improvement in psoriasis was prioritized over the time to relapse. Conclusions This study has provided novel insight into the trade-offs that dermatologists face when selecting treatment for psoriasis patients. Future research should explore the extent to which dermatologists' preferences for treatment match those of psoriasis sufferers.