Toenail Onychomycosis with or without Diabetes in Canada: Patient Treatment Preferences and Health State Utilities

Alexis T Mickle; Greta Lozano-Ortega; Veronique Gaudet; Evan Popoff; Martin Barbeau; Steve Mathieu

doi:10.2147/PPA.S450215

Toenail Onychomycosis with or without Diabetes in Canada: Patient Treatment Preferences and Health State Utilities

Patient Prefer Adherence. 2024 Feb 22:18:475-486. doi: 10.2147/PPA.S450215. eCollection 2024.

Authors

Alexis T Mickle¹, Greta Lozano-Ortega¹, Veronique Gaudet², Evan Popoff¹, Martin Barbeau², Steve Mathieu³

Affiliations

¹ Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada.
² Market Access and Government Affairs, Bausch Health, Canada Inc., Laval, Québec, Canada.
³ Service de Dermatologie, Centre hospitalier de l'Université de Québec-Université Laval, Québec, Québec, Canada.

Abstract

Background: Toenail onychomycosis affects approximately 6.7% of Canadians. Symptoms include nail discolouration/disfiguration and pain; psychosocial impacts contribute to reduced health-related quality-of-life. Comorbid diabetes increases the risk of complications and exacerbates burden. Treatment may include topical therapy and/or oral agents.

Purpose: To understand toenail onychomycosis treatment preferences, and to quantify the impact of toenail onychomycosis, with or without diabetes, on patient well-being.

Methods: Adults living in Canada with self-reported, physician-diagnosed, toenail onychomycosis were recruited online. A discrete choice experiment was used to quantify treatment preferences. Scenarios were randomized; data were analyzed using conditional logit regression. Health state utilities were estimated using the Health Utilities Index Mark 3^®. Results were stratified by diabetes status and toenail onychomycosis severity; the Wilcoxon Rank Sum test was used to assess between-group utility differences.

Results: Three-hundred thirteen participants with toenail onychomycosis were included (161 had comorbid diabetes; 61.3%, severe onychomycosis). The mean age was 57.7 years; 55.9% were male. Treatment attributes with statistically significant impacts on patient preferences were efficacy (odds ratio [OR],1.04; 95% confidence interval [CI], 1.02-1.05 per 1% increased treatment success), administration method (one pill versus topical nail lacquer reference, 1.14; 1.04-1.26; topical solution applicator versus reference: 1.15; 1.03-1.29), severe adverse events (0.85; 0.80-0.90 per 1% increased risk), and risk of potential pharmacodynamic (0.80; 0.76-0.85) and alcohol (0.93; 0.88-0.98) interactions; preferences were more pronounced for efficacy and avoiding severe adverse events among toenail onychomycosis patients with comorbid diabetes. The mean (95% CI) utility value was 0.73 (0.70-0.75) overall, and statistically significantly lower (p=0.02) for toenail onychomycosis patients with diabetes (0.70; CI, 0.66-0.73) than those without (0.76; CI, 0.72-0.79).

Conclusion: Among patients with toenail onychomycosis, the presence of diabetes was associated with differing treatment-related preferences. Utility values for patients with toenail onychomycosis represent a significant decline from full health that is exacerbated by comorbid diabetes.

Keywords: discrete choice experiment; fungus; health-related-quality-of-life; utilities.

Grants and funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: ATM, GLO, and EP are employees of Broadstreet HEOR, which received funds from Bausch Health, Canada Inc. for this work. The design of this study was developed in consultation with Dr. Steve Mathieu (Dermatologist), who received an honorarium from Bausch Health, Canada Inc. for his expert input. However, Dr. Steve Mathieu did not receive any compensation for the preparation and review of this manuscript.