Factors associated with treatment escalation among MS specialists and general neurologists: Results from an International cojoint study

G Saposnik; S Andhavarapu; Ó Fernández; H J Kim; H Wiendl; M Foss; F Zuo; E K Havrdová; E Celius; F Caceres; M Magyari; R Bermel; A Costa; M Terzaghi; T Kalincik; V Popescu; M P Amato; X Montalban; J Oh

doi:10.1016/j.msard.2021.103404

Factors associated with treatment escalation among MS specialists and general neurologists: Results from an International cojoint study

Mult Scler Relat Disord. 2022 Feb:58:103404. doi: 10.1016/j.msard.2021.103404. Epub 2021 Nov 16.

Authors

G Saposnik¹, S Andhavarapu², Ó Fernández³, H J Kim⁴, H Wiendl⁵, M Foss⁶, F Zuo⁷, E K Havrdová⁸, E Celius⁹, F Caceres¹⁰, M Magyari¹¹, R Bermel¹², A Costa¹³, M Terzaghi¹⁴, T Kalincik¹⁵, V Popescu¹⁶, M P Amato¹⁷, X Montalban¹⁸, J Oh¹⁹

Affiliations

¹ Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 55 Queen St E, Toronto, Ontario M5C 1R6, Canada; Director and Founder, NeuroEconSolutions© (www.neuroeconsolutions.com), Toronto, Canada; Clinical Outcomes and Decision Neuroscience Unit, St Michael's Hospital, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada. Electronic address: gustavo.saposnik@unityhealth.to.
² Clinical Outcomes and Decision Neuroscience Unit, St Michael's Hospital, University of Toronto, Toronto, Canada.
³ Department of Pharmacology, Faculty of Medicine, University of Malaga, Institute of Biomedical Research of Malaga, Regional University Hospital of Malaga, Spain.
⁴ Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea.
⁵ Department of Neurology, Institute of Translational Neurology, University of Münster, Germany.
⁶ Bootstrap Analytics, Calgary, Canada.
⁷ Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada.
⁸ Department of Neurology, First Medical Faculty, Center for Clinical Neuroscience, Charles University, Prague, Czech Republic.
⁹ Department of Neurology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
¹⁰ Institute of Restorative Neurosciences, Buenos Aires, Argentina.
¹¹ Danish Multiple Sclerosis Center, University Hospital Rigshospitalet, Copenhagen, Denmark.
¹² Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States.
¹³ Neurology Department, Faculty of Medicine University of Porto, Centro Hospitalar Universitário São João, Portugal.
¹⁴ Clinical Outcomes and Decision Neuroscience Unit, St Michael's Hospital, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada.
¹⁵ Department of Medicine, MS Centre, Royal Melbourne Hospital Core Unit, University of Melbourne, Melborne, Australia.
¹⁶ University MS Centre, Noorderhart Hospital, Pelt, Belgium; Hasselt University, Hasselt, Belgium.
¹⁷ Department of Neurofarba, IRCCS Fondazione Don Carlo Gnocchi, University of Florence, Florence, Italy.
¹⁸ Department of Neurology, Hospital Vall d´Hebron, Centre d'Esclerosi Mútiple de Catalunya, Universitat Autonoma de Barcelona, Spain.
¹⁹ Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 55 Queen St E, Toronto, Ontario M5C 1R6, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada.

PMID: 35216786
DOI: 10.1016/j.msard.2021.103404

Abstract

Background: Previous studies in multiple sclerosis (MS) showed that therapeutic inertia (TI) affects 60-90% of neurologists and up to 25% of daily treatment decisions. The objective of this study was to determine the most common factors and attribute levels associated with decisions to treatment escalation in an international study in MS care.

Methods: 300 neurologists with MS expertise from 20 countries were invited to participate. Participants were presented with 12 pairs of simulated MS patient profiles described by 13 clinically relevant factors. We used disaggregated discrete choice experiments to estimate the weight of factors and attributes affecting physicians' decisions when considering treatment selection. Participants were asked to select the ideal candidate for treatment escalation from modest to higher-efficacy therapies.

Results: Overall, 229 neurologists completed the study (completion rate: 76.3%). The top 3 weighted factors associated with treatment escalation were: previous relapses (20%), baseline expanded disability status scale [EDSS] (18%), and MRI activity (13%). Patient demographics and desire for pregnancy had a modest influence (≤ 3%). We observed differences in the weight of factors associated with treatment escalation between MS specialists and non-MS specialists.

Conclusions: Our results provide critical information on factors influencing neurologists' treatment decisions and should be applied to continuing medical education strategies.

Keywords: Decision making; Disease-modifying therapy; Multiple sclerosis; Neuroeconomics; Risk; Therapeutic inertia.

MeSH terms

Female
Humans
Multiple Sclerosis* / drug therapy
Multiple Sclerosis* / therapy
Neurologists*
Pregnancy
Recurrence
Specialization