Assessing physician preferences on future therapeutic options and diagnostic practices in non-alcoholic steatohepatitis

Nigel Cook; Andreas Geier; Andreas Schmid; Gideon Hirschfield; Achim Kautz; Jörn M Schattenberg; Maria-Magdalena Balp

doi:10.1016/j.jhepr.2020.100081

Assessing physician preferences on future therapeutic options and diagnostic practices in non-alcoholic steatohepatitis

JHEP Rep. 2020 Feb 1;2(2):100081. doi: 10.1016/j.jhepr.2020.100081. eCollection 2020 Apr.

Authors

Nigel Cook¹, Andreas Geier², Andreas Schmid³, Gideon Hirschfield⁴, Achim Kautz⁵, Jörn M Schattenberg⁶, Maria-Magdalena Balp¹

Affiliations

¹ Novartis Pharma AG, Basel, Switzerland.
² Division of Hepatology, University Hospital Würzburg, Würzburg, Germany.
³ Health Management, School of Law and Economics, University of Bayreuth, Bayreuth, Germany.
⁴ Toronto Centre for Liver Disease, University Health Network and University of Toronto, Toronto, Canada.
⁵ Leberhilfe Projekt gUG, Dülken Straße 9, 51143 Köln, Germany.
⁶ Metabolic Liver Research Program, I. Department of Medicine, University Medical Center Mainz, Langenbeckstrasse 1, 55116 Mainz, Germany.

Abstract

Background & aims: 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 patient with NASH. 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 a 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" limit 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.

Lay summary: This study explores physician preferences in relation to future therapies for non-alcoholic steatohepatitis (NASH) and characteristics that are relevant to physician decision-making when choosing a potential therapy for a patient with NASH. The results of a short online survey completed by 121 specialist physicians determined that the primary factor that influences treatment decision-making is efficacy, and that a wide range of non-invasive techniques are used to diagnose NASH, while confirmatory liver biopsy is not performed by all physicians despite guideline recommendations.

Keywords: ACBC, adaptive choice-based conjoint; BWS, best-worst scaling; Best-worst scaling; GPs, general practitioners; HB, hierarchical Bayesian; HTA, health technology assessment; Hb1Ac, glycated haemoglobin; NAFLD; NASH; NASH, non-alcoholic steatohepatitis; Non-invasive diagnostics; PCPs, primary care physicians; SC, steering committee; liver biopsy; liver disease; non-alcoholic fatty liver disease; type 2 diabetes mellitus.