Treatment Preferences of Physicians of Pediatric Patients with Attention-Deficit/Hyperactivity Disorder in the United States and Canada: A Discrete Choice Experiment.

INTRODUCTION: Evidence on how treatment attributes, especially adverse events, influence preferences of physicians treating pediatric patients with attention-deficit/hyperactivity disorder (ADHD) is scant. This discrete choice experiment aimed to address this evidence gap. METHODS: A web-based survey was completed by physicians treating pediatric patients with ADHD in the United States (US) and Canada recruited from a market research firm's panel (12/2024-01/2025). Treatment attributes evaluated included efficacy (improvement in ADHD symptoms) and safety (irritability, upper abdominal pain, insomnia, somnolence, decreased appetite, vomiting), identified from clinical inputs and published data. Physicians' preferences and willingness to trade-off were estimated using conditional logistic regression. Attributes' relative importance was assessed. Subgroups were stratified by physician subspecialty and by patients' age group. RESULTS: The sample included 404 physicians in the US and 402 in Canada (50.2% and 49.8% psychiatrists, respectively). US physicians were on average willing to trade 0.42, 0.36, 0.34, 0.32, and 0.22 percentage points of improvement in ADHD symptoms to achieve a 1-percentage-point reduction in the risk of irritability, upper abdominal pain, insomnia, somnolence, and decreased appetite, respectively, with similar ranges for Canadian physicians (0.22-0.38). In the US, the relative importance of efficacy and that of all safety-related attributes assessed was both 50.0%, whereas, in Canada, this was 53.7% and 46.3%, respectively. In both countries, the most important safety-related attributes were the risks of insomnia (US: 14.5%; Canada: 12.5%), somnolence (US: 13.7%; Canada: 11.0%), and decreased appetite (US: 10.6%; Canada: 11.4%). Psychiatrists placed greater relative importance on efficacy compared to primary care physicians/pediatricians. Findings were consistent when physicians considered treating children and adolescents. CONCLUSION: US and Canadian physicians valued efficacy and safety similarly when considering pediatric ADHD treatments, with some differences by subspecialty. Understanding drivers of physician preferences and how they may diverge from that of parents/caregivers may facilitate informed discussions and effective shared decision-making.