Multi-Criteria Decision Analysis using Physician Preferences from a Global Discrete Choice Experiment to Investigate the Selection of Preemptive Antiviral Treatments for Post-Hematopoietic Cell Transplant Cytomegalovirus Infection.

BACKGROUND: A discrete choice experiment (DCE) subsequently incorporated into a multi-criteria decision analysis (MCDA) was used to compare clinicians' trade-offs between the benefits and risks of preemptive anti-cytomegalovirus (CMV) treatments posthematopoietic cell transplant (HCT). METHODS: In the DCE, physicians completed forced-choice tasks comparing hypothetical treatments. We used logit models to estimate preference weights, relative attribute importance (RAI) score, and minimum acceptable benefit. The MCDA combined DCE-derived weighted attributes with clinical performance data to compare maribavir versus valganciclovir (using data from the AURORA study) and maribavir versus valganciclovir, ganciclovir, and foscarnet (using data from multiple sources). Analyses were conducted for 2 cohorts defined by baseline absolute neutrophil count (ANC) <1500/mm3 or ≥1500/mm3 at CMV reactivation. RESULTS: In the DCE, all 7 attributes significantly impacted physician (n = 377) treatment choices; the most important were administration route/monitoring (RAI score = 25.7%), nephrotoxicity risk (RAI score = 18.5%), grade 3-4 neutropenia risk (RAI score = 18.1%), and week 8 viremia clearance (RAI score = 16.0%). Neutropenia at CMV reactivation significantly reduced physicians' preference for treatments with a higher grade 3-4 neutropenia risk. In the MCDA, overall benefit-risk scores were higher for maribavir than valganciclovir in both ANC cohorts. Among the considered attributes, the largest positive contributor to the overall benefit-risk score was viremia clearance at week 8, and the largest negative contributor was grade 3-4 neutropenia risk. Maribavir had a higher overall benefit-risk score than ganciclovir and foscarnet in both ANC cohorts. CONCLUSIONS: Within this MCDA framework, maribavir was preferred over valganciclovir, ganciclovir, and foscarnet for preemptive treatment of CMV after HCT.