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Diagnostic pathway and treatment preferences for systemic lupus erythematosus: a physician-based discrete choice experiment
M. Piga1, L. Quartuccio2, F. Atzeni3, A. Doria4, G. Emmi5, F. Franceschini6, M. Gerosa7, M. Mosca8, P. Pasqualetti9, G.D. Sebastiani10, F. Conti11, M. Govoni12
- Rheumatology Unit, Department of Medical Sciences and Public Health, University and AOU Cagliari, Monserrato, Italy.
- Division of Rheumatology, Department of Medicine (DAME), ASUFC, University of Udine, Italy.
- Department of Clinical and Experimental Medicine, University of Messina, Italy.
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy.
- Department of Medical, Surgery and Health Sciences, University of Trieste, and Clinical Medicine and Rheumatology Unit, Cattinara University Hospital, Trieste, Italy; and Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Melbourne, Australia.
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Italy.
- Rheumatology Unit, University of Milan, ASST Gaetano Pini CTO, Milan, Italy.
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
- Section of Medical Statistics, Department of Public Health and Infectious Disease, Sapienza University of Rome, Italy. patrizio.pasqualetti@uniroma1.it
- Rheumatology Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy.
- Lupus Clinic - Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Italy.
CER17651
2025 Vol.43, N°1
PI 0048, PF 0052
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PMID: 39263803 [PubMed]
Received: 07/03/2024
Accepted : 05/07/2024
In Press: 10/09/2024
Published: 23/01/2025
Abstract
OBJECTIVES:
To assess physicians’ preferences on diagnostic pathways and treatment priorities for systemic lupus erythematosus (SLE) using a discrete choice experiment (DCE).
METHODS:
A board of 11 SLE experts and a DCE expert statistician defined informative profiles of diagnostic pathways, pharmacological therapies, and two distinct profiles of mild-moderate and severe SLE. An independent panel of 115 clinicians involved in SLE management was invited to participate. Parameter estimates from the model were interpreted as relative preference weights (PWs). The mean PWs were used to calculate each attribute’s relative importance (RI).
RESULTS:
95 clinicians (57% females, 71% rheumatologists) completed the DCEs. The DCEs could not identify a hierarchy of importance among diagnostic pathway attributes. Nevertheless, “referral time to a rheumatologist” was considered more important for mild-moderate (RI=25%) and severe (RI=20%) SLE. Among the therapeutic attributes, the effect on organ damage progression after 12 months showed the highest preference for mild-moderate (RI=35%) and severe (RI=41%) SLE patients, followed by reduction in disease activity levels (max RI=19%) and glucocorticoid dose (max RI=13%) after six months. Reducing prednisone dose below 5 mg/day scored higher utility levels for mild-moderate (PW=66.1) than severe (PW=14.2) SLE. Administration route, action rapidity, patient-global assessment, and serious infection risk showed lesser relevance (RI 7–8%). No distinctions were found among subgroups categorised by the clinicians’ areas of expertise.
CONCLUSIONS:
These DCEs highlight a high degree of awareness among lupus-treating physicians, with no differences across medical specialties, of the unmet need for early diagnosis and prevention of damage accrual in SLE management.
