Appendix A: Questionnaire

Tufts-CEVR Survey - Symptoms of MS - Questionnaire -

Assessment the Value of Addressing Mobility and Other Neurological Symptoms Associated with Multiple Sclerosis

GENERAL PROGRAMMING NOTESOrder of text for Scenarios 1 and 2

o MS patient population: Scenario 1 should always begin with the text section below that runs from: “As you

know, multiple sclerosis (MS) is a chronic…” to “…or only improve somewhat (partly better).”

Scenario 2 should always begin with the text: “Recall that there is no cure for MS, but there are treatments that may help you have fewer relapses each year and that may slow the rate at which symptoms worsen.”

o Physician population: Scenario 1 should always begin with the text: “Imagine you have a patient with

multiple sclerosis (MS).” Scenario 2 should NOT begin with the same line as Scenario 1. In other words,

Scenario 2 will always start with the text “Imagine that your patient has an MS relapse. During the relapse…”

Randomization of treatment descriptions for Scenarios 1 and 2 (all populations) o The two treatment options (1. improves mobility and does NOT improve the other

symptom, 2. improves both mobility and the other symptom) should be randomized to the two scenarios. Approximately half of the respondents for each population and each symptom pair should see the treatment option that improves mobility and does NOT improve the other symptom in Scenario 1, followed by the treatment that improves both mobility and the other symptom in Scenario 2; the other half of respondents should see the treatment options presented in the opposite order. A given respondent should see each of the two treatment descriptions one time.

Prompt for maximum willingness to pay question o MS patient population:

The question “What is the most you would be willing to pay per month for the new treatment?” appears twice for each respondent (once per scenario). The prompt that checks the answer for logic relative to the previous questions should always apply. Currently for some respondents the prompt only works for Scenario 1 but not for Scenario 2.

o Neurologist population: The question “What is the most your patient would be willing to pay per month for

the new treatment? ” appears twice for each respondent (once per scenario). The prompt that checks the answer for logic relative to the previous questions should always apply. Currently for some respondents the prompt only works for Scenario 1 but not for Scenario 2.

[DATA-ONLY VARIABLE: DOV_SYMPTOMPAIR [SP]LOGIC:

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IF DOV_SYMPTOMPAIR =1; MOBILITY IMPAIRMENT/COGNITIVE IMPAIRMENTIF DOV_SYMPTOMPAIR =2; MOBILITY IMPAIRMENT/FATIGUEIF DOV_SYMPTOMPAIR =3; MOBILITY IMPAIRMENT/COMPROMISED EYESIGHTIF DOV_SYMPTOMPAIR =4; MOBILITY IMPAIRMENT/UPPER LIMB DYSFUNCTIONIF DOV_SYMPTOMPAIR=5; MOBILITY/VISION WITH MOBILITY FOCUS][PLEASE RANDOMIZE DOV_SYMPTOMPAIR AND SPLIT EQUALLY. RECORD THE ORDER]

[DATA –ONLY VARIABLE : DOV_PAY [SP]LOGIC:

if Q1=1 and Q2=2

DOV_pay=$300

Orif Q5=1 and Q6=2

orQ15=1 and Q16=2

orQ19=1 and Q20=2

orQ29=1 and Q30=2

orQ33=1 and Q34=2

if Q2=1 or Q6=1 or Q16=1 or Q20=1 or Q30=1 or

Q34=1 DOV_pay=$600Q3=1 or Q7=1 or Q17=1 or Q21=1 or Q31=1 or Q35=1 DOV_pay=$150

SCREENAGE [SP][ASK IF XSAMPLE=2 ]D2a. What is your age?

1. 15-172. 18-243. 25-294. 30-345. 35-396. 40-497. 50-598. 60-699. 70+

[IF D2A=1, TERMINATE][CALCULATE DOV_AGE – SHOW AGE IN YEARS. PUNCH AGE FROM D2A AND PPAGE IN DOV:AGE GROUP. SO BASICALLY WE WANT DOV_AGE GROUP TO CAPTURE DATA OF BOTH ON AND OFF PANEL]

[CREATE A “DOV: AGE” THAT CALCULATES THE RESPONDENTS AGE AND STORES]DOV: Age Group (Note for programmer – this DOV should capture data of both ON and OFF panel)

1. 18-24

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2. 25-293. 30-344. 35-395. 40-496. 50-597. 60-698. 70+

9. [DISPLAY]Thank you for participating in this survey about multiple sclerosis. The survey is part of a research study reviewed by the Tufts University Institutional Review Board. It should take about 10 minutes to complete, and your participation is voluntary. [IF XSAMPLE=2 INSERT “You will be given $2.50 in ERI currency for completing this survey. Other than these points, there are no known risks or benefits from participating in this survey and there is no additional compensation provided” [IF XSAMPLE=3 INSERT “You will be paid $35 for completing this survey. Other than this payment, there are no known risks or benefits from participating in this survey and there is no additional compensation provided.”]. You will not be individually identified, and your responses will be used for research only. Thank you in advance for your help with this survey.

[RANDOMIZE AND RECORD THE RANDOMIZATION ORDER FOR SCENARIO A AND SCENARIO B]

[FOR ALL SYMPTOMS AND FOR ALL SAMPLES PLEASE SHOW THE BELOW DISPLAY BETWEEN SCENARIO A AND SCENARIO B]

[DISPLAY IF (XSAMPLE=2)THANK YOU FOR YOUR ANSWERS SO FAR.

[DISPLAY IF (XSAMPLE=3)THANK YOU FOR YOUR ANSWERS SO FAR. FOR THE NEXT SET OF QUESTIONS, AGAIN, PLEASE IMAGINE THAT YOU HAVE A PATIENT WITH MULTIPLE SCLEROSIS (MS).

[ASK IF (XSAMPLE=2)][DISPLAY]Please answer the following questions so we can see if you are eligible to participate.

[MP]MSSCREENER1.  Have YOU been diagnosed by a doctor or other qualified medical

professional with any of the following medical conditions?

Acid reflux disease............................1Cystic Fibrosis………………………2Diabetes..........................................3Epilepsy……………………………..4

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High blood pressure..........................5High cholesterol................................6Kidney disease.................................7Multiple sclerosis..............................8Rheumatoid arthritis.........................9None of these......................... 10 [SINGLE SELECT]

[TERMINATE IF MSSCREENER1 NE 8 OR MSSCREENER1 =REFUSED]

[IF MSSCREENER1 NE 8 OR MSSCREENER1 =REFUSED][DISPLAY]You are not eligible to participate in this survey. Thank you for your time.

[IF MSSCREENER1 = 8][DISPLAY]You are eligible to participate in this survey. Please continue the survey below.

[ASK IF (XSAMPLE=2) AND DOV_SYMPOTOMPAIR=1]

(XSAMPLE=2) IF Scenario 1 or 2 shown 1st then always show the below message –As you know, multiple sclerosis (MS) is a chronic (long-lasting) disease. In people who have MS, the body’s immune system attacks the nervous system, including the brain and spinal cord. This can cause a range of symptoms, including problems with the use of the arms and hands, walking, tiredness, eyesight, attention, and memory. Many people with MS experience recurring attacks, or “relapses.” During a relapse, a person’s symptoms may get worse and new symptoms may develop. After a relapse, symptoms may return to how they were before the relapse (completely better) or only improve somewhat (partly better).

There is no cure for MS, but there are treatments that may help you have fewer relapses each year, and that may slow the rate at which symptoms worsen.

IF Scenario 1 or 2 shown 2nd then always show the below message –Recall that there is no cure for MS, but there are treatments that may help you have fewer relapses each year and that may slow the rate at which symptoms worsen.

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Scenario 1:

Imagine that you have an MS relapse. During the relapse, you have symptoms that cause problems with walking and concentrating.

When you walk, you sometimes need help or must stop to rest. Your legs may feel heavy, you may have trouble with balance, and sometimes you may have numbness, weakness, or a tingling feeling in your legs.

Because of problems with concentration, you also have problems with planning, making decisions, paying attention – especially to more than one thing at the same time - remembering things, and recalling a word you want to use when you are talking.

After the relapse, your symptoms improve somewhat, but you cannot walk or concentrate as well as you did before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves your walking. The treatment helps you have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

The treatment does NOT improve your ability to concentrate.

[ASK IF (XSAMPLE=2) AND DOV_SYMPOTOMPAIR=2][DISPLAY ON NEXT SCREEN]

Imagine that you have an MS relapse. During the relapse, you have symptoms that cause problems with walking and with your energy level.

When you walk, you sometimes need help or must stop to rest. Your legs may feel heavy, you may have trouble with balance, and sometimes you may have numbness, weakness, or a tingling feeling in your legs.

You are very tired and it affects your body and mind. You have trouble participating in everyday activities and doing your work, and you think about stopping work sooner than you planned.

After the relapse, your symptoms improve somewhat, but you cannot walk as well as you did before the relapse, and your energy level is lower than it used to be.

Imagine that a new treatment is available for people with MS that meaningfully improves your walking. The treatment helps you have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

The treatment does NOT improve your energy level.

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[ASK IF (XSAMPLE=2) AND DOV_SYMPOTOMPAIR=3][DISPLAY ON NEXT SCREEN]

Imagine that you have an MS relapse. During the relapse, you have symptoms that cause problems with walking and with your eyesight.

When you walk, you sometimes need help or must stop to rest. Your legs may feel heavy, you may have trouble with balance, and sometimes you may have numbness, weakness, or a tingling feeling in your legs.

You have problems seeing the edges of stairs, seeing at night when it’s dark, reading, and watching television, and sometimes your vision is blurry.

After the relapse, your symptoms improve somewhat but you cannot walk as well as you used to and your eyesight is worse than it was before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves your walking. The treatment helps you have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

The treatment does NOT improve your eyesight.

[ASK IF (XSAMPLE=2) AND DOV_SYMPOTOMPAIR=4][DISPLAY ON NEXT SCREEN]

Imagine that you have an MS relapse. During the relapse, you have symptoms that cause problems with walking and with arm and hand coordination.

When you walk, you sometimes need help or must stop to rest. Your legs may feel heavy, you may have trouble with balance, and sometimes you may have weakness, numbness, or a tingling feeling in your legs.

Because of problems with coordination, sometimes your hands and arms shake when you try to move them to a particular position, and sometimes when you try to move your arms they move more or less than you wanted them to move. You have trouble with everyday activities such as writing, getting dressed, and drinking from a cup.

After the relapse, your symptoms improve somewhat but you can’t walk as well as you used to and your arm and hand coordination is worse than it was before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves your walking. The treatment helps you have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

The treatment does NOT improve your arm and hand coordination.

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[DISPLAY IF (XSAMPLE=2) AND DOV_SYMPOTOMPAIR=5]

Imagine that you have an MS relapse. During the relapse, you have symptoms that cause problems with walking and with your eyesight.

When you walk, you sometimes need help or must stop to rest sometimes. Your legs may feel heavy, you may have trouble with balance, and sometimes you have numbness, weakness, or a tingling feeling in your legs.

You have problems seeing the edges of stairs, seeing at night when it’s dark, and reading and watching television, and sometimes your vision is blurry.

After the relapse, your symptoms improve somewhat but you cannot walk as well as you did and your eyesight is worse than it was before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves your eyesight. The treatment helps you have fewer problems with seeing the edges of stairs, seeing at night when it’s dark, reading, and watching television, and fewer problems with blurry visions. 

The treatment does NOT improve your walking.

[DISPLAY ON NEXT SCREEN]Imagine that your health insurance does not fully cover the new treatment. You would have to pay part of the cost of the new treatment yourself every month and you would need to continue to take the treatment every month for it to keep working.

[SP]1) Would you take the new treatment if you were responsible for paying $300 per month?

1. Yes (go to 16)2. No (go to 17) [SKIP TO Q17]

[ASK IF Q15=1][SP]2) Would you take the new treatment if you were responsible for paying $600 per month?

1. Yes2. No

[SP][ASK IF Q15=2]3) Would you take the new treatment if you were responsible for paying $150 per month?

1. Yes2. No

PROPMT BELOW IF THE ANSWER IN THE NUMBER BOX DOES NOT MATCH WITH ANSWER GIVEN IN Q15 OR Q16 OR Q17:

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EARLIER, YOU SAID YOU WOULD BE WILLING TO PAY DOV_PAY/WOULD NOT BE WILLING TO PAY DOV_PAY. FOR THIS ANSWER, YOU ARE SAYING THE MOST YOU WOULD PAY IS [INSERT ANSWER FROM Q18]. PLEASE CHANGE YOUR ANSWER IF YOU WOULD LIKE. YOU CAN ALSO CLICK NEXT TO CONTINUE WITHOUT CHANGING YOUR ANSWER.”PROPMT AND SHOW THE BELOW ERROR MESSAGE IF THE ANSWER IN THE NUMBER BOX DOES NOT MATCH WITH THE BELOW CONDITIONS –

IF Q15 = 1 AND Q16=1 THE RANGE SHOULD BE GREATER THAN EQUAL TO $600IF Q15=2 AND Q17=1 THE RANGE SHOULD BE GE $150 AND LESS THAN $300IF Q15=2 AND Q17=2 THE RANGE SHOULD BE LT $150IF Q15=1 AND Q16=2 THE RANGE SHOULD BE GE $300 LT $600

“Earlier, you said you would be willing to pay {Insert the range depending on the above condition} . For this answer, you are saying the most you would pay is $ {Insert from Q18}. Please change your answer if you would like. You can also click next to continue without changing your answer.”

IF REFUSED Q15, Q16, Q17 THE RANGE SHOULD BE 0-999994) What is the most you would be willing to pay per month for the new treatment?

$_____ per month

SCENARIO 2:[ASK IF (XSAMPLE=2) AND DOV_SYMPOTOMPAIR=1][DISPLAY ON NEXT SCREEN]

Imagine that you have an MS relapse. During the relapse, you have symptoms that cause problems with walking and concentrating.

When you walk, you sometimes need help or must stop to rest. Your legs may feel heavy, you may have trouble with balance, and sometimes you may have numbness, weakness, or a tingling feeling in your legs.

Because of problems with concentration, you also have problems with planning, making decisions, paying attention – especially to more than one thing at the same time - remembering things, and recalling a word you want to use when you are talking.

After the relapse, your symptoms improve somewhat, but you cannot walk or concentrate as well as you did before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves both your walking and your ability to concentrate.

The treatment helps you have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

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The treatment also helps you have fewer problems with planning, making decisions, paying attention – especially to more than one thing at the same time - remembering things, and recalling a word you want to use when you are talking.

[ASK IF (XSAMPLE=2) AND DOV_SYMPOTOMPAIR=2][DISPLAY ON NEXT SCREEN]

Imagine that you have an MS relapse. During the relapse, you have symptoms that cause problems with walking and with your energy level.

When you walk, you sometimes need help or must stop to rest. Your legs may feel heavy, you may have trouble with balance, and sometimes you may have numbness, weakness, or a tingling feeling in your legs.

You are very tired and it affects your body and mind. You have trouble participating in everyday activities and doing your work, and you think about stopping work sooner than you planned.

After the relapse, your symptoms improve somewhat, but you cannot walk as well as you did before the relapse, and your energy level is lower than it used to be.

Imagine that a new treatment is available for people with MS that meaningfully improves both your walking and energy level.

The treatment helps you have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

It helps you feel less tired in ways that affect your body and mind, and it lets you participate more in everyday activities and work.

[ASK IF (XSAMPLE=2) AND DOV_SYMPOTOMPAIR=3 OR 5][DISPLAY ON NEXT SCREEN]

Imagine that you have an MS relapse. During the relapse, you have symptoms that cause problems with walking and with your eyesight.

When you walk, you sometimes need help or must stop to rest. Your legs may feel heavy, you may have trouble with balance, and sometimes you may have numbness, weakness, or a tingling feeling in your legs.

You have problems seeing the edges of stairs, seeing at night when it’s dark, reading, and watching television, and sometimes your vision is blurry.

After the relapse, your symptoms improve somewhat, but you cannot walk as well as you used to and your eyesight is worse than it was before the relapse.

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Imagine that a new treatment is available for people with MS that meaningfully improves both your walking and your eyesight.

The treatment helps you have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

It helps you have fewer problems seeing the edges of stairs, seeing at night when it’s dark, reading, and watching television. It improves your blurry vision as well.

[ASK IF (XSAMPLE=2) AND DOV_SYMPOTOMPAIR=4]

Imagine that you have an MS relapse. During the relapse, you have symptoms that cause problems with walking and with arm and hand coordination.

When you walk, you sometimes need help or must stop to rest. Your legs may feel heavy, you may have trouble with balance, and sometimes you may have weakness, numbness, or a tingling feeling in your legs.

Because of problems with coordination, sometimes your hands and arms shake when you try to move them to a particular position, and sometimes when you try to move your arms they move more or less than you wanted them to move. You have trouble with everyday activities such as writing, getting dressed, and drinking from a cup.

After the relapse, your symptoms improve somewhat, but you can’t walk as well as you used to and your arm and hand coordination is worse than it was before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves both your walking and arm and hand coordination.

The treatment helps you have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

It makes your hands and arms shake less, makes it easier to your hands and arms the amount that you want them to move, and lets you participate more in everyday activities such as writing, getting dressed, and drinking from a cup.

[DISPLAY ON NEXT SCREEN]Imagine that your health insurance does not fully cover the new treatment. You would have to pay part of the cost of the new treatment yourself every month and you would need to continue to take the treatment every month for it to keep working.

[SP]5) Would you take the new treatment if you were responsible for paying $300 per month?

1. Yes (go to 6)

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2. No (go to 7) [SKIP TO Q21]

[ASK IF Q19=1][SP]6) Would you take the new treatment if you were responsible for paying $600 per month?

1. Yes2. No

[SP][ASK IF Q19=2]7) Would you take the new treatment if you were responsible for paying $150 per month?

1. Yes2. No

PROPMT BELOW IF THE ANSWER IN THE NUMBER BOX DOES NOT MATCH WITH ANSWER GIVEN IN Q19 OR Q20 OR Q21:

EARLIER, YOU SAID YOU WOULD BE WILLING TO PAY DOV_PAY/WOULD NOT BE WILLING TO PAY DOV_PAY. FOR THIS ANSWER, YOU ARE SAYING THE MOST YOU WOULD PAY IS [INSERT ANSWER FROM Q22]. PLEASE CHANGE YOUR ANSWER IF YOU WOULD LIKE. YOU CAN ALSO CLICK NEXT TO CONTINUE WITHOUT CHANGING YOUR ANSWER.”

PROPMT AND SHOW THE BELOW ERROR MESSAGE IF THE ANSWER IN THE NUMBER BOX DOES NOT MATCH WITH THE BELOW CONDITIONS –

IF Q19 = 1 AND Q20=1 THE RANGE SHOULD BE GREATER THAN EQUAL TO $600 IF Q19=2 AND Q21=1 THE RANGE SHOULD BE GE $150 AND LESS THAN $300IF Q19=2 AND Q21=2 THE RANGE SHOULD BE LT $150IF Q19=1 AND Q20=2 THE RANGE SHOULD BE GE $300 LT $600

“Earlier, you said you would be willing to pay {Insert the range depending on the above condition} . For this answer, you are saying the most you would pay is $ {Insert from Q22}. Please change your answer if you would like. You can also click next to continue without changing your answer.”

IF REFUSED Q19, Q20, Q21 THE RANGE SHOULD BE 0-99999

8) What is the most you would be willing to pay per month for the new treatment?$_____ per month

[DISPLAY]Thank you for your answers so far. Please answer the questions below.

[GRID, SP ACROSS] [DON’T PROMPT THE RESPONDENT IF THERE IS NO TEXT IN “OTHER” TEXTBOX]

9) Please rate the importance of each of the following factors in your decision about whether and how much to pay for the new treatment.

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Not important at all

Somewhat important

Moderately important

Important

Very important

1. How well the treatment works2. Other treatments available3. Possibility of better treatments in the future4. Affordability of treatment5. Other uses for money6. Family commitments7. Other: [TEXTBOX]

[SP]10) Suppose the new treatment causes serious side effects, including a risk of 1 death for

every 2,500 people who are treated. If there were such a risk, would you still be willing to pay the same amount for the drug?

1. Yes2. No

[PLEASE SHOW RANKING FROM 1-7; ONE RANK SHOULD BE GIVEN ONLY ONCE]11) Please rank each of the symptoms below in terms of how important to you it would be to

successfully treat. A rank of “1” means that the symptom is the worst and hence the most important to successfully treat, whereas a rank of “7” would indicate that successful treatment of that symptom is least important.

1. Problems with walking (for example, you have trouble walking and sometimes must get help or stop to rest)

2. Problems with concentrating (for example, you have trouble planning things, paying attention, and remembering things)

3. Problems with your energy level (for example, you are tired and have trouble participating in everyday activities like running errands)

4. Problems with your eyesight (for example, your vision is blurry and you have trouble reading and watching television)

5. Problems with your hands and arms (for example, you have trouble with coordination and activities such as writing and buttoning your shirt)

6. Problems with your bladder and bowels (for example, you have incontinence – the inability to hold in urine, constipation, or diarrhea)

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7. Problems with sexual health (for example, you experience reduced sensation and loss of sexual drive)

12) DELETED

[SP]13) In general, how would you rate your overall health during the last 12 months?

1. Excellent2. Very Good3. Good4. Fair5. Poor

[SP]14) During the last 12 months, how often did you delay seeking or decline to seek medical

care because you were worried about the cost?1. Never2. Sometimes3. Usually4. Always

[ASK IF (XSAMPLE=3)]1.2 Neurologists:[DISPLAY]Please answer the following questions so we can see if you are eligible to participate.

[SP][PROMPT ONCE]S1 . Are you a neurologist experienced in the evaluation of patients with multiple sclerosis?

a. Yesb. No [Reject respondent]

[TERMINATE IF QS1=2 OR QS1=REFUSED]

[IF QS1=2 OR QS1=REFUSED][DISPLAY]You are not eligible to participate in this survey. Thank you for your time.

[IF QS1=1][DISPLAY]You are eligible to participate in this survey. Please continue the survey below. Use your judgment to answer the questions about what a patient of yours would do or think in the scenario.

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XSAMPLE=3) IF Scenario A or B shown 1st then always show the below message –Imagine you have a patient with multiple sclerosis (MS).

Imagine that your patient has an MS relapse.

IF Scenario A or B shown 2nd then always show the below message –Imagine that your patient has an MS relapse.

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[ASK IF (XSAMPLE=3) AND DOV_SYMPOTOMPAIR=1]

Scenario A:[DISPLAY]

During the relapse, your patient has symptoms that affect mobility and cognitive ability . He or she sometimes needs assistance with walking or must stop to rest. Your patient’s legs feel heavy, he or she has trouble with balance, and he or she sometimes experiences weakness, numbness, or a tingling feeling in the legs. Your patient has problems with executive function, memory, concentration, attention, and word finding.

After the relapse, your patient’s symptoms improve somewhat but he or she continues to have more problems with mobility and cognitive function than before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves mobility. The treatment helps patients have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

The treatment does NOT improve cognitive ability.

[ASK IF (XSAMPLE=3) AND DOV_SYMPOTOMPAIR=2] [DISPLAY]

During the relapse, your patient has symptoms that affect mobility and energy level. He or she sometimes needs assistance with walking or must stop to rest. Your patient’s legs feel heavy, he or she has trouble with balance, and he or she sometimes experiences weakness, numbness, or a tingling feeling in the legs. He or she experiences fatigue that involves physical, cognitive, and psychosocial components, has trouble participating in everyday activities and work, and considers stopping work earlier than planned.

After the relapse, your patient’s symptoms improve somewhat but he or she continues to have more problems with mobility and experience more fatigue than before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves mobility. The treatment helps patients have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

The treatment does NOT improve your energy level.

[ASK IF (XSAMPLE=3) AND DOV_SYMPOTOMPAIR=3] [DISPLAY]

During the relapse, your patient has symptoms that affect mobility and eyesight. He or she sometimes needs assistance with walking or must stop to rest. Your patient’s legs feel heavy, he or she has trouble with balance, and he or she sometimes experiences weakness, numbness, or a tingling feeling in the legs. Sometimes your patient has problems in regards to eyesight with

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edge detection (e.g. walking up or down stairs), seeing at night when it’s dark, and reading and watching television. Sometimes he or she experiences scotoma.

After the relapse, your patient’s symptoms improve somewhat but he or she continues to have more problems with mobility and eyesight than before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves mobility. The treatment helps patients have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

The treatment does NOT improve eyesight

[ASK IF (XSAMPLE=3) AND DOV_SYMPOTOMPAIR=4] [DISPLAY] . During the relapse, your patient has symptoms that affect mobility and arm and hand coordination. He or she sometimes needs assistance with walking or must stop to rest. Your patient’s legs feel heavy, he or she has trouble with balance, and he or she sometimes experiences weakness, numbness, or a tingling feeling in the legs. Sometimes your patient experiences intention tremor, decomposition (lack of coordination) of movements, and dysmetria in their arms and hands. The patient has problems with everyday activities such as writing, getting dressed, and drinking from a cup.

After the relapse, your patient’s symptoms improve somewhat but they continue to have more problems with mobility and coordination than before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves mobility. The treatment helps patient have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

The treatment does NOT improve arm and hand coordination.

[ASK IF (XSAMPLE=3) AND DOV_SYMPOTOMPAIR=5] [DISPLAY]

Imagine that your patient has an MS relapse. During the relapse, your patient has symptoms that affect mobility and eyesight. He or she sometimes need assistance or must stop to rest sometimes. Your patient’s legs feel heavy, he or she has trouble with balance, and he or she sometimes experiences weakness, numbness, or a tingling feeling in the legs. Sometimes your patient has problems with edge detection (e.g. walking up or down stairs), seeing at night when it’s dark, and reading and watching television. Sometimes he or she experiences scotoma.

After the relapse, your patient’s symptoms improve somewhat but he or she continues to have more problems with mobility and eyesight than before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves eyesight. The treatment helps patients to have fewer problems with edge detection, seeing at night when it’s dark, reading, and watching television, and scotoma.

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The treatment does NOT improve mobility.

[DISPLAY ON NEXT PAGE]Imagine that your patient’s health insurance does not fully cover the new treatment. Your patient would have to pay part of the cost of the new treatment every month and your patient would need to continue to take the treatment every month for it to keep working.

[DISPLAY ON NEXT PAGE][SP]15) In your judgment, would your patient take the new treatment if he or she were

responsible for paying $300 per month? 1. Yes (go to 2)2. No (go to 3) [SKIP TO 31]

[ASK IF Q29=1][SP]16) Would your patient take the new treatment if he or she were responsible for paying $600

per month?1. Yes2. No

[SP][ASK IF Q29=2]17) Would your patient take the new treatment if he or she were responsible for paying $150

per month? 1. Yes2. No

PROPMT BELOW IF THE ANSWER IN THE NUMBER BOX DOES NOT MATCH WITH ANSWER GIVEN IN Q29 OR Q30 OR Q31:

EARLIER, YOU SAID YOU WOULD BE WILLING TO PAY DOV_PAY/WOULD NOT BE WILLING TO PAY DOV_PAY. FOR THIS ANSWER, YOU ARE SAYING THE MOST YOU WOULD PAY IS [INSERT ANSWER FROM Q32]. PLEASE CHANGE YOUR ANSWER IF YOU WOULD LIKE. YOU CAN ALSO CLICK NEXT TO CONTINUE WITHOUT CHANGING YOUR ANSWER.”

PROPMT AND SHOW THE BELOW ERROR MESSAGE IF THE ANSWER IN THE NUMBER BOX DOES NOT MATCH WITH THE BELOW CONDITIONS –

IF Q29 = 1 AND Q30=1 THE RANGE SHOULD BE GREATER THAN EQUAL TO $600 IF Q29=2 AND Q31=1 THE RANGE SHOULD BE GE $150 AND LESS THAN $300

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IF Q29=2 AND Q31=2 THE RANGE SHOULD BE LT $150IF Q29=1 AND Q30=2 THE RANGE SHOULD BE GE $300 LT $600

“Earlier, you said you would be willing to pay {Insert the range depending on the above condition} . For this answer, you are saying the most you would pay is$ {Insert from Q32}. Please change your answer if you would like. You can also click next to continue without changing your answer.”

IF REFUSED Q29, Q30, Q31 THE RANGE SHOULD BE 0-99999

18) What is the most your patient would be willing to pay per month for the new treatment? $_____ per month

Scenario B:[ASK IF (XSAMPLE=3) AND DOV_SYMPOTOMPAIR=1][DISPLAY] During the relapse, your patient has symptoms that affect mobility and cognitive ability . He or she sometimes needs assistance with walking or must stop to rest. Your patient’s legs feel heavy, he or she has trouble with balance, and he or she sometimes experiences weakness, numbness, or a tingling feeling in the legs. Your patient has problems with executive function, memory, concentration, attention, and word finding.

After the relapse, your patient’s symptoms improve somewhat but he or she continues to have more problems with mobility and cognitive function than before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves both mobility and cognitive ability.

The treatment helps patients have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

The treatment reduces problems with executive function, memory, concentration, attention, and word finding.

[ASK IF (XSAMPLE=3) AND DOV_SYMPOTOMPAIR=2][DISPLAY] During the relapse, your patient has symptoms that affect mobility and energy level. He or she sometimes needs assistance with walking or must stop to rest. Your patient’s legs feel heavy, he or she has trouble with balance, and he or she sometimes experiences weakness, numbness, or a tingling feeling in the legs. He or she experiences fatigue that involves physical, cognitive, and psychosocial components, has trouble participating in everyday activities and work, and considers stopping work earlier than planned.

After the relapse, your patient’s symptoms improve somewhat but he or she continues to have more problems with mobility and experience more fatigue than before the relapse.

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Imagine that a new treatment is available for people with MS that meaningfully improves both mobility and energy level.

The treatment helps patients have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

The treatment improves patients’ fatigue, helps them feel less tired physically and cognitively, and lets them participate more in everyday activities and work.

[ASK IF (XSAMPLE=3) AND DOV_SYMPOTOMPAIR=3 OR 5][DISPLAY] During the relapse, your patient has symptoms that affect mobility and eyesight. He or she sometimes needs assistance with walking or must stop to rest. Your patient’s legs feel heavy, he or she has trouble with balance, and he or she sometimes experiences weakness, numbness, or a tingling feeling in the legs. Sometimes your patient has problems in regards to eyesight with edge detection (e.g. walking up or down stairs), seeing at night when it’s dark, reading, and watching television. Sometimes he or she experiences scotoma.

After the relapse, your patient’s symptoms improve somewhat but he or she continues to have more problems with mobility and eyesight than before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves both mobility and eyesight.

The treatment helps patients have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.The treatment reduces problems with edge detection (e.g. walking up or down stairs), seeing at night when it’s dark, reading, and watching television. It reduces the frequency of scotoma.

[ASK IF (XSAMPLE=3) AND DOV_SYMPOTOMPAIR=4][DISPLAY] During the relapse, your patient has symptoms that affect mobility and arm and hand coordination. He or she sometimes needs assistance with walking or must stop to rest. Your patient’s legs feel heavy, he or she has trouble with balance, and he or she sometimes experiences weakness, numbness, or a tingling feeling in the legs. Sometimes your patient experiences intention tremor, decomposition (lack of coordination) of movements, and dysmetria in their arms and hands. The patient has problems with everyday activities such as writing, getting dressed, and drinking from a cup.

After the relapse, your patient’s symptoms improve somewhat but they continue to have more problems with mobility and coordination than before the relapse.

Imagine that a new treatment is available for people with MS that meaningfully improves both mobility and arm and hand coordination.

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The treatment helps patient to have fewer problems with walking, better balance, and fewer weak, numb, or tingling feelings.

The treatment improves patients’ intentional tremor, decomposition of movement, and dysmetria and lets them participate more in everyday activities such as writing, getting dressed, and drinking from a cup.

[DISPLAY ON NEXT PAGE]Imagine that your patient’s health insurance does not fully cover the new treatment. Your patient would have to pay part of the cost of the new treatment every month and would need to continue to take the treatment every month for it to keep working.

Questions about Scenario 2:[SP]19) In your judgment, would your patient take the new treatment if he or she were

responsible for paying $300 per month? 1. Yes (go to 6)2. No (go to 7) [SKIP TO Q35]

[SP][ASK IF Q33=1]20) Would your patient take the new treatment if he or she were responsible for paying $600

per month? a. Yesb. No

[SP][ASK IF Q33=2]21) Would your patient take the new treatment if he or she were responsible for paying $150

per month? 1. Yes2. No

PROPMT BELOW IF THE ANSWER IN THE NUMBER BOX DOES NOT MATCH WITH ANSWER GIVEN IN Q33 OR Q34 OR Q35:

EARLIER, YOU SAID YOU WOULD BE WILLING TO PAY DOV_PAY/WOULD NOT BE WILLING TO PAY DOV_PAY. FOR THIS ANSWER, YOU ARE SAYING THE MOST YOU WOULD PAY IS [INSERT ANSWER FROM Q36]. PLEASE CHANGE YOUR ANSWER IF YOU WOULD LIKE. YOU CAN ALSO CLICK NEXT TO CONTINUE WITHOUT CHANGING YOUR ANSWER.”

PROPMT AND SHOW THE BELOW ERROR MESSAGE IF THE ANSWER IN THE NUMBER BOX DOES NOT MATCH WITH THE BELOW CONDITIONS –

IF Q33= 1 AND Q34=1 THE RANGE SHOULD BE GREATER THAN EQUAL TO $600 IF Q33=2 AND Q35=1 THE RANGE SHOULD BE GE $150 AND LESS THAN $300IF Q33=2 AND Q35=2 THE RANGE SHOULD BE LT $150

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IF Q33=1 AND Q34=2 THE RANGE SHOULD BE GE $300 LT $600

“Earlier, you said you would be willing to pay {Insert the range depending on the above condition} . For this answer, you are saying the most you would pay is $ {Insert from Q36}. Please change your answer if you would like. You can also click next to continue without changing your answer.”

IF REFUSED Q33, Q34, Q35 THE RANGE SHOULD BE 0-99999

22) What is the most your patient would be willing to pay per month for the new treatment?$_____ per month[DISPLAY]

Thank you for your answers so far. Please answer the questions below.

[GRID, SP ACROSS] DON’T PROMPT THE RESPONDENT IF THERE IS NO TEXT IN “OTHER” TEXTBOX]

23) Based on your judgment, please rate the importance of each of the following factors in your patient’s decision about whether and how much to pay for the new treatment.

Not important at all

Somewhat important

Moderately important

Important

Very important

a. How well the treatment works

b. Other treatments available

c. Possibility of better treatments in the future

d. Affordability of treatment

e. Other uses for your patient’s money

f. Family commitments your patient may have

g. Other: [TEXTBOX]

[SP]24) Suppose the new treatment causes serious side effects, including a risk of 1 death for

every 2,500 people who are treated. If there were such a risk, would your patient still be willing to pay the same amount for the drug?

1. Yes2. No

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[SP] [PLEASE SHOW RANKING FROM 1-7; ONE RANK SHOULD BE GIVEN ONLY ONCE]25) Please rank each of the symptoms below in terms of how important to your patient it

would be to successfully treat. A rank of “1” means that the symptom is the worst and hence the most important to successfully treat, whereas a rank of “7” would indicate that successful treatment of that symptom is least important to your patient.

1. Problems with walking (for example, your patient has trouble walking and sometimes must get help or stop to rest)

2. Problems with concentrating (for example, your patient has trouble planning things, paying attention, and remembering things)

3. Problems with energy level (for example, your patient is tired and has trouble participating in everyday activities like running errands)

4. Problems with eyesight (for example, your patient’s vision is blurry and he or she has trouble reading and watching television)

5. Problems with hands and arms (for example, your patient has trouble with coordination and activities such as writing and buttoning a shirt)

6. Problems with bladder and bowels (for example, your patient has incontinence – the inability to hold in urine, constipation, or diarrhea)

7. Problems with sexual health (for example, your patient experiences reduced sensation and loss of libido)

[DISPLAY ON NEW SCREEN]Please answer the questions below about yourself.

[SP]26) Has a family member or close friend of yours ever been diagnosed with multiple

sclerosis?1. Yes2. No

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