Who knows best, patients or physicians? Clearly, physicians have medical knowledge that patients do not. On the other hand, patients have their own preferences balancing treatment safety, efficacy, convenience and other factors. Further, physicians may be more familiar with older less effective treatments compared to newer more effective treatments.
One interesting question is how health outcomes would look if current prescribing practices changed to ones based on patient preferences. Along with my co-authors Emma van Eijndhoven, Michelle Brauer, Rebecca Kee, Joanna MacEwan, Lisa Mucha, Schiffon Wong, and Adeline Durand, we attempt to answer this question using a case study in relapsing-remitting multiple sclerosis. van Eijndhoven et al. (2020) use patient preference from a discrete choice experiment and measure health and economic outcomes using a cohort-based Markov model. Using this approach, we find the following:
Compared to current prescribing practices, when UK patients with RRMS were treated following patient preferences, health outcomes were improved. This population was expected to experience 501,690 relapses and gain 1,003,263 discounted QALYs over 50 years under patient-centered prescribing practices compared to 538,417 relapses and 958,792 discounted QALYs under current practices (-6.8% and +4.6%, respectively). Additionally, less disability progression was observed when prescribed treatment was based on patient preferences. In a scenario analysis where only oral treatments were considered, the results were similar, although the magnitude of benefit was smaller. Number of relapses was most sensitive to how the annualized relapse rate was modeled; disability progression was most sensitive to mortality rate assumptions.