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Cook, Nigel ; Geier, Andreas ; Schmid, Andreas ; Hirschfield, Gideon ; Kautz, Achim ; Schattenberg, Jörn M. ; Balp, Maria-Magdalena:
Assessing physician preferences on future therapeutic options and diagnostic practices in Non-Alcoholic Steatohepatitis.
In: JHEP Reports.
Bd. 2
(2020)
Heft 2
.
- 100081.
ISSN 2589-5559
DOI: https://doi.org/10.1016/j.jhepr.2020.100081
Abstract
Background
There is currently no data on physician preferences regarding future therapies for non-alcoholic steatohepatitis (NASH); this study explores these preferences and characteristics that are relevant to physician decision-making when choosing a potential therapy for a NASH patient. The results were compared with those from a similar patient preference survey which was conducted in parallel.
Method
Initial exploratory 30-minute telephone interviews were conducted to inform the design of a 15-minute quantitative online specialist physicians survey containing direct questions and the preference survey. This was based on a Best-Worst Scaling (BWS) experiment to assess the relative importance of different treatment characteristics (attributes), followed by several paired comparison questions to understand the preference for 5 hypothetical product profiles.
Results
The answers come from 121 physicians from Canada n=31, Germany n=30, the UK n=30 and the USA n=30). The primary driving element in NASH treatment decision-making was efficacy (49.23%), defined as “hypothetical product impact on liver status” and “slowing of progression to cirrhosis”. Physicians reported the common use of non-invasive NASH diagnostic tests and 81% reported performing liver biopsy. In 57% of cases, physicians reported that “concerns related to the available diagnostic methods” limits the number of patients with biopsy-confirmed NASH. Conclusions This first physician preference study reveals that efficacy will be the main driver for physicians in selecting future NASH drugs. The findings also confirm the widespread use of non-invasive diagnostic tests and the reluctance to perform confirmatory liver biopsy despite guideline recommendations mainly due to limited therapeutic options and patient refusal.