Contributions
Abstract: P749
Type: Poster
Abstract Category: Therapy - disease modifying - Others
Introduction: Clinical and radiological progression is the standard criterion used for decisions to increase therapy in patients with multiple sclerosis (MS). Therapeutic inertia (TI) is defined as lack of treatment escalation when there is clinical-radiological evidence of disease progression. Limited information is currently available on physicians" factors influencing TI in MS.
Objectives: To evaluate physicians" factors associated with TI in the management of MS by applying principles from behavioral economics.
Design: A web-based study comprising 96 neurologists with expertise in MS care throughout Spain was conducted. Participants answered questions regarding the management of 20 case-scenarios commonly encountered in clinical practice and completed 3 surveys and 4 experimental paradigms from behavioral economics. Surveys and experiments included standardized tests to measure aversion to risk and ambiguity, physicians" reactions to uncertainty, and questions related to risk preferences in different domains. Ambiguity aversion is a preference for known risks over unknown risks.
We used different MS score criteria (e.g. clinical+radiological, EMA, Prosperini"s scheme) to take into account physicians" differences in escalating therapy. Multivariable analysis was adjusted for age, sex and specialty status reported as OR; 95%CI.
Results: 96 participants completed the survey. TI was present in at least one case-scenario in 68.8% of participants. Similar results were observed for definitions of TI only based on radiological progression. TI was observed in 29.2% of participants when applying the EMA criteria. TI was less common among MS experts (OR 0.29; 0.11-0.73). Low tolerance to uncertainty was associated with higher prevalence of TI (85.4% vs. 56.4%; adjusted OR 4.48, 1.52-13.1). Aversion to ambiguity was associated with TI
(82% vs 52%; adjusted OR 4.2; 1.1-16.1).
Conclusions: TI is a common phenomenon affecting 6 out of 10 physicians caring for MS patients. Physicians" factors including aversion to ambiguity, tolerance to uncertainty, and MS expertise were associated with lower prevalence of TI.
Disclosure: The study was sponsored by the Sociedad Española de Neurologia (SEN) and funded by an operating grant from Roche Farma Spain.
D Prefasi and J Maurino are employees of Roche Farma Spain.
G Saposnik, R Raptis, D Selchen, CC Ruff, PN Tobler: nothing to disclose.
Abstract: P749
Type: Poster
Abstract Category: Therapy - disease modifying - Others
Introduction: Clinical and radiological progression is the standard criterion used for decisions to increase therapy in patients with multiple sclerosis (MS). Therapeutic inertia (TI) is defined as lack of treatment escalation when there is clinical-radiological evidence of disease progression. Limited information is currently available on physicians" factors influencing TI in MS.
Objectives: To evaluate physicians" factors associated with TI in the management of MS by applying principles from behavioral economics.
Design: A web-based study comprising 96 neurologists with expertise in MS care throughout Spain was conducted. Participants answered questions regarding the management of 20 case-scenarios commonly encountered in clinical practice and completed 3 surveys and 4 experimental paradigms from behavioral economics. Surveys and experiments included standardized tests to measure aversion to risk and ambiguity, physicians" reactions to uncertainty, and questions related to risk preferences in different domains. Ambiguity aversion is a preference for known risks over unknown risks.
We used different MS score criteria (e.g. clinical+radiological, EMA, Prosperini"s scheme) to take into account physicians" differences in escalating therapy. Multivariable analysis was adjusted for age, sex and specialty status reported as OR; 95%CI.
Results: 96 participants completed the survey. TI was present in at least one case-scenario in 68.8% of participants. Similar results were observed for definitions of TI only based on radiological progression. TI was observed in 29.2% of participants when applying the EMA criteria. TI was less common among MS experts (OR 0.29; 0.11-0.73). Low tolerance to uncertainty was associated with higher prevalence of TI (85.4% vs. 56.4%; adjusted OR 4.48, 1.52-13.1). Aversion to ambiguity was associated with TI
(82% vs 52%; adjusted OR 4.2; 1.1-16.1).
Conclusions: TI is a common phenomenon affecting 6 out of 10 physicians caring for MS patients. Physicians" factors including aversion to ambiguity, tolerance to uncertainty, and MS expertise were associated with lower prevalence of TI.
Disclosure: The study was sponsored by the Sociedad Española de Neurologia (SEN) and funded by an operating grant from Roche Farma Spain.
D Prefasi and J Maurino are employees of Roche Farma Spain.
G Saposnik, R Raptis, D Selchen, CC Ruff, PN Tobler: nothing to disclose.