Attribute preferences associated with gonadotropin-releasing hormone agonists/antagonists among women with endometriosis in the United States.

BACKGROUND

Endometriosis symptoms have multifaceted manifestations, and there are few approved nonsurgical treatment options. Gonadotropin-releasing hormone (GnRH) agonists/antagonists for endometriosis vary on efficacy, safety profile, and out-of-pocket (OOP) cost, among other features.

OBJECTIVES

This study quantified the importance that women with endometriosis in the United States (US) placed on pain and non-pain features that differ among these medications.

DESIGN

English-speaking, 18 to 50 years (premenopausal) US women with healthcare coverage for the past 3 years, who self-reported a laparoscopy-confirmed endometriosis diagnosis, were recruited via healthcare research panels to complete a cross-sectional survey.

METHODS

A discrete choice experiment (DCE) with a surgery opt-out option assessed preferences for eight GnRH agonist/antagonist attributes (reducing different types of pain, treatment administration, impact on daily activities, etc.). Best-worst scaling (BWS) assessed preferences for 11 non-pain medication attributes (dosage flexibility, short treatment onset, reversible side effects, etc.). Relative importance (RI) was estimated for each attribute.

RESULTS

Overall, 300 women were included (mean age 33.0 years; 76.7% White). Across DCE choice tasks, GnRH agonist/antagonist was chosen over surgery 46.7% of the time. Non-menstrual pelvic pain relief (RI = 23.1%), reducing monthly OOP cost (RI = 22.1%), and relief of dyspareunia (RI = 21.4%) and dysmenorrhea (RI = 12.9%) were most important for GnRH treatment choice. Among non-pain attributes in the BWS, short onset of treatment effect (RI = 13.1%), long-term safety (RI = 12.9%), and reducing fatigue (RI = 11.2%) were most important to women when choosing a pharmacologic endometriosis treatment.

CONCLUSION

Relieving the three types of endometriosis pain and reducing cost are the most important considerations for women when selecting GnRH agonist/antagonist treatment. Women with endometriosis strongly prefer a medication that can be safely taken for longer periods of time, takes effect within a few menstrual cycles, and can reduce endometriosis-related fatigue. Findings can inform discussions between patients and healthcare providers to better align endometriosis treatment decision-making with patients' individual needs and preferences.