Quantifying US healthcare provider preferences for the treatment of post-transplant cytomegalovirus infection using a discrete choice experiment.

BACKGROUND

Post-transplant cytomegalovirus (CMV) infection is associated with poor patient outcomes. Treatment decisions are complex, involving patient/transplant characteristics, risk factors, and trade-offs between treatment effectiveness and tolerability. This study assessed healthcare professional (HCP) preferences of CMV treatment attributes.

METHODS

A discrete choice experiment (DCE) survey was administered to US HCPs who treat post-transplant CMV in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. The DCE evaluated preferences across seven attributes using two patient vignettes per HCP. Subgroup analyses explored preferences across medical degrees and specialties.

RESULTS

Overall, 301 HCPs participated (specialties: SOT [n = 90], HSCT [n = 90], infectious disease [n = 90], pharmacy [n = 31]). When selecting a CMV treatment, HCPs often preferred better attributes over worse. For the overall population, "CMV viral clearance" was the most frequently prioritized attribute (relative attribute importance [RAI]: 26.4%), followed by "Risk of myelosuppression" (RAI: 17.3%), "Drug interactions" (RAI: 16.6%), "Mode of administration" (RAI: 15.5%), "Risk of nephrotoxicity" (RAI: 11.1%), "Risk of resistance" (RAI: 8.5%), and "Medication access" (RAI: 4.6%). Physicians prioritized greater CMV viral clearance and pharmacists prioritized myelosuppression risk compared with other medical degrees. Infectious disease specialists and pharmacists favored greater CMV viral clearance and lower myelosuppression risk compared with other specialties.

CONCLUSION

Results showed that HCPs consider many attributes when choosing CMV treatments but prioritize effective viral clearance. Differences in preferences were seen between medical degrees/specialities, likely due to the HCP's role in CMV treatment. These results highlight considerations in treating post-transplant CMV and could inform HCPs on how the community approaches decision-making.