Caregivers’ Preference for Antipsychotic Medication for Youth Less Than 18 Years-Old: A Discrete Choice Experiment Pilot

Yu-Hua Fu,1 Laura M Bozzi,1 Beverly Butler,2 Susan dosReis1,3 1Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore, School of Pharmacy, Baltimore, MD, USA; 2Swats, LLC, Manchester, MD, USA; 3PAVE Center, University of Maryland Baltimore, School of Pharmacy, Baltimore, MD, USACorrespondence: Susan dosReis, Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, 220 North Arch Street, 12th Floor, Baltimore, MD, 21201, USA, Email [email protected]: Antipsychotics are often prescribed for youth with complex mental health conditions but carry risks of metabolic adverse effects. Caregivers play a key role in weighing the potential benefit of treating the underlying mental health condition with the potential risk of side effects.Objective: To evaluate caregivers’ preferences for the benefits and risks of antipsychotic medication for their child and to assess how these preferences relate to treatment acceptability.Methods: We recruited 26 caregivers of youth < 18 years-old across the greater Baltimore region to pilot test a discrete choice experiment (DCE). The DCE included nine choice tasks, each with three profiles and six attributes per profile, with three for the risks (weight gain, diabetes, cholesterol) and three for the benefits (self-harm episodes, aggressive behavior, hospitalizations) of antipsychotics. For each choice task, participants first selected the most acceptable profile; second, indicated if they would use their chosen profile. Conditional logit models estimated part-worth utilities. We calculated the relative attribute importance and assessed trade-offs between attributes. Summing the part-worth utilities for attributes within each DCE profile, we identified profiles with the largest utility and assessed the acceptance of the profile chosen.Results: Participants were, on average, 44 years-old; 76% were biological mothers. Nearly half of the youth (46%) had prior psychiatric hospitalization, 70% had aggression towards property, and 90% had aggression towards others. Reduction in hospitalizations (34%), days with aggressive behavior (22%), and self-harm episodes (15%) achieved greater relative importance than diabetes risk (14%), weight gain (11%), and high cholesterol (4%). Participants accepted 2.21 hospitalizations per year to reduce diabetes risk from four-fold to two-fold. Sixty-five percent of the profiles selected were those participants would use.Conclusion: Prioritizing outcomes over the antipsychotic metabolic adverse effects underscores the importance of eliciting caregiver preferences for the benefits and risks of medication.Plain Language Summary: This preference survey study asked caregivers of a child who may have been treated with an antipsychotic medication to consider the benefits and risks of the medication. Six attributes of the medication that caregivers considered included the benefits of reductions in hospitalizations, aggressive behavior, and self-harm along with the risks of weight gain, diabetes, and high cholesterol. The most important attributes when choosing an antipsychotic medication for their child were hospitalizations and the number of days without aggressive behavior, suggesting caregivers are willing to accept the adverse effects of antipsychotic medications to achieve these outcomes.Keywords: antipsychotic, child mental health, discrete choice experiment, caregiver preference, benefit–risk