BACKGROUND: Previous studies in multiple sclerosis (MS) showed that therapeutic inertia (TI) affects 60-90% of neurologists and up to 25% of daily treatment decisions. The objective of this study was to determine the most common factors and attribute levels associated with decisions to treatment escalation in an international study in MS care. METHODS: 300 neurologists with MS expertise from 20 countries were invited to participate. Participants were presented with 12 pairs of simulated MS patient profiles described by 13 clinically relevant factors. We used disaggregated discrete choice experiments to estimate the weight of factors and attributes affecting physicians' decisions when considering treatment selection. Participants were asked to select the ideal candidate for treatment escalation from modest to higher-efficacy therapies. RESULTS: Overall, 229 neurologists completed the study (completion rate: 76.3%). The top 3 weighted factors associated with treatment escalation were: previous relapses (20%), baseline expanded disability status scale [EDSS] (18%), and MRI activity (13%). Patient demographics and desire for pregnancy had a modest influence (≤ 3%). We observed differences in the weight of factors associated with treatment escalation between MS specialists and non-MS specialists. CONCLUSIONS: Our results provide critical information on factors influencing neurologists' treatment decisions and should be applied to continuing medical education strategies.

Bootstrap Analytics Calgary Canada

Clinical Outcomes and Decision Neuroscience Unit St Michael's Hospital University of Toronto Toronto Canada

Clinical Outcomes and Decision Neuroscience Unit St Michael's Hospital University of Toronto Toronto Canada; Li Ka Shing Knowledge Institute St Michael's Hospital University of Toronto Canada

Danish Multiple Sclerosis Center University Hospital Rigshospitalet Copenhagen Denmark

Department of Medicine MS Centre Royal Melbourne Hospital Core Unit University of Melbourne Melborne Australia

Department of Neurofarba IRCCS Fondazione Don Carlo Gnocchi University of Florence Florence Italy

Department of Neurology 1st Medical Faculty Center for Clinical Neuroscience Charles University Prague Czech Republic

Department of Neurology Hospital Vall d´Hebron Centre d'Esclerosi Mútiple de Catalunya Universitat Autonoma de Barcelona Spain

Department of Neurology Institute of Translational Neurology University of Münster Germany

Department of Neurology Oslo University Hospital Institute of Clinical Medicine University of Oslo Oslo Norway

Department of Neurology Research Institute and Hospital of National Cancer Center Goyang Republic of Korea

Department of Pharmacology Faculty of Medicine University of Malaga Institute of Biomedical Research of Malaga Regional University Hospital of Malaga Spain

Division of Neurology Department of Medicine St Michael's Hospital University of Toronto 55 Queen St E Toronto Ontario M5C 1R6 Canada; Director and Founder NeuroEconSolutions© Toronto Canada; Clinical Outcomes and Decision Neuroscience Unit St Michael's Hospital University of Toronto Toronto Canada; Li Ka Shing Knowledge Institute St Michael's Hospital University of Toronto Canada

Division of Neurology Department of Medicine St Michael's Hospital University of Toronto 55 Queen St E Toronto Ontario M5C 1R6 Canada; Li Ka Shing Knowledge Institute St Michael's Hospital University of Toronto Canada

Institute of Restorative Neurosciences Buenos Aires Argentina

Li Ka Shing Knowledge Institute St Michael's Hospital University of Toronto Canada

Mellen Center for Multiple Sclerosis Cleveland Clinic Cleveland OH United States

Neurology Department Faculty of Medicine University of Porto Centro Hospitalar Universitário São João Portugal

University MS Centre Noorderhart Hospital Pelt Belgium; Hasselt University Hasselt Belgium

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