Preferences for potential benefits and risks for gene therapy in the treatment of sickle cell disease.

Objective is to quantify benefit-risk tradeoffs pertaining to potential gene therapies among adults and parents/caregivers of children with sickle-cell disease (SCD). A discrete-choice experiment (DCE) survey was developed in which respondents selected their preferred treatment alternatives in a series of experimentally-controlled pairs of hypothetical gene therapies and a "no gene therapy" option. Gene therapy alternatives were defined based on the chance of eliminating SCD symptoms, expected increases in life expectancy they could offer, treatment-related risk of death and potential increases in lifetime cancer risk. Respondents made selections based on their current disease severity and in the context of expectations of worsened disease. Three clinical sites and one patient organization recruited 174 adult patients and 109 parents of children with SCD to complete the survey. Adult and parent respondents were generally willing to choose gene therapies, but the adults required higher expected levels of efficacy (i.e., higher chance of eliminating symptoms) than parents to choose gene therapies that conferred mortality risks of 10% or more. When adults and parents of children with less severe symptoms were asked to consider scenarios of higher levels of disease severity, the risk tolerance increased, and the lowest acceptable level of efficacy for gene therapies with mortality risks dropped by more than 50%. Baseline SCD symptoms are a major driver of gene therapy acceptability. Adults and parents of patients with milder symptoms may prefer other treatment options; however, an expectation of symptoms deterioration triggers strong reassessment of the acceptable benefit-risk balance of this novel technology.