An evaluation of patients' preferences for osteoporosis medications and their attributes: the PREFER-International study.

Background: Patients' preferences for medications may be important in determining their compliance with therapy, particularly in the case of an asymptomatic chronic disease such as osteoporosis. Although preferences for certain attributes of osteoporosis medications, including dosing frequency and tolerability, can be evaluated in short-term clinical trials, years of use may be necessary for differences in effectiveness in reducing fracture risk to emerge.

Objectives: The primary aim of this study was to evaluate the relative importance of various attributes in determining patients' preferences for osteoporosis medications. Its secondary aim was to investigate patients' preferences for either of 2 hypothetical osteoporosis medications with different profiles.

Methods: The Preference for Effective Regimens (PREFER)-International study was a cross-sectional survey of postmenopausal women with osteoporosis in France, Germany, Mexico, Spain, and the United Kingdom. Participants were recruited by their physicians in the 4 European countries and were identified by trained interviewers going door to door in Mexico. Participants were administered a questionnaire in which they were asked to rate and rank the importance of 7 medication attributes in determining their preferences for prescription osteoporosis medications. The attributes were side effects, out-of-pocket costs, effectiveness in improving bone health and preventing fractures, dosing frequency, formulation, administration procedure, and length of time on the market. They were also asked to indicate their preference for 2 hypothetical osteoporosis medications whose profiles differed in terms of efficacy (medication A reduced the risk of spine and hip fracture; medication B reduced spine fracture only), time on the market (10 years vs recently introduced), dosing frequency (weekly vs monthly), and dosing procedure (30- vs 60-minute wait after dosing).

Results: Of 3000 patients interviewed, 1500 were receiving prescription treatment for osteoporosis. Across the rankings and ratings, effectiveness in reducing the risk of fracture emerged as the most important factor in determining patients' preferences for prescription osteoporosis medications, followed by side effects. Out-of-pocket costs, dosing frequency, formulation, time on the market, and dosing procedure were less important considerations among respondents from most countries. The majority (78%) of patients indicated a preference for medication A over medication B.

Conclusion: Effectiveness in reducing fracture risk was cited as the primary reason for patients' preference for prescription osteoporosis medications among postmenopausal women with osteoporosis from 4 European countries and Mexico.