OBJECTIVES: Patients vary in preferences for health outcomes, risks, and treatments. However, patient preferences are not typically considered in health technology assessment (HTA) decision-making. Using plaque psoriasis as a case study, we aimed to provide an in-depth understanding of how preferences are shaped and co-constructed, by exploring real-world preference heterogeneity subgroups for psoriasis treatments.

METHODS: Between September 2023 and June 2024, 20 Canadians with moderate-to-severe psoriasis engaged in one-to-one, semi-structured interviews. Interviews were audio-recorded, transcribed, and coded in NVIVO using the constant comparison technique. Development of key themes and sub-themes was done iteratively, aiming to explain the factors underlying reported preferences for psoriasis treatment attributes.

RESULTS: Participant ages ranged from 25-66 years; 13 were female; 5 had moderate-to-severe symptoms; 8 had received injectable biologics. All participants valued treatment effectiveness, although for some avoiding side effects was a primary concern. Preferences for other treatment aspects varied. Participants using injectables (n=8) attribute their excellent psoriasis control to biologics, and noted alignment with preferences. However, participants favoring minimally-invasive treatments or with needle phobias prefer to avoid injectables. Similar underlying preference drivers could result in different reported preferences. While everyone wanted a ‘convenient’ treatment, some considered a daily pill ideal and others a monthly injection; according to what fits best into one’s current lifestyle. While acceptance of their chronic health condition was a commonly discussed theme, some operationalized this as preferences for more intensive treatments (minimizing psoriasis impact), versus less intensive regimens (minimizing treatment burden). Some participants reported being unable to afford co-payments for treatments they would prefer to take. Preferences varied according to psoriasis severity and life stage.

CONCLUSIONS: Heterogeneity in patient preferences for aspects of psoriasis impact and treatment translate into markedly different preferences for specific psoriasis therapies. Considering preference heterogeneity will be important in expanding decision-making frameworks to ensure patient voices are considered within HTA.