Variation Among Patients With Crohn's Disease in Benefit vs Risk Preferences and Remission Time Equivalents.
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BACKGROUND & AIMS:Patients with Crohn's disease (CD) must make decisions about their treatment. We aimed to quantify patients' preferences for different treatment outcomes and adverse events. We also evaluated the effects of latent class heterogeneity on these preferences. METHODS:An online stated-preference survey was completed by 812 individuals with CD in the Crohn's and Colitis Foundation Partners cohort (IBD Partners). Patients were given information on symptoms and severity of active disease; duration of therapy with corticosteroids; and risks of serious infection, cancer and surgery. Patients were asked to assume that their treatment was not working and to choose an alternative therapy. The primary outcome was remission-time equivalents (RTE) of a given duration of symptom severity or treatment-related risk. Latent class choice models identified groups of patients with dominant treatment-outcome preferences and associated patient characteristics with these groups. RESULTS:Latent class analysis demonstrated 3 distinct groups of survey responders whose choices were strongly influenced by avoidance of active symptoms (61%), avoidance of corticosteroid use (25%), or avoidance of risks of cancer, infection or surgery (14%) when choosing a therapy. Class membership was correlated with age, sex, mean short CD activity index score and corticosteroid avoidance. RTEs in each latent class differed significantly from the mean RTEs for the overall sample, although the symptom-avoidant class most closely approximated the overall sample. CONCLUSIONS:In an online survey of patients with CD, we found substantial heterogeneity in preference for medication efficacy and risk of harm. Physicians and regulators should therefore not assume that all patients have mean-value preferences-this could result in significant differences in health-technology assessment models.
Published Version (Please cite this version)10.1016/j.cgh.2019.05.010
Publication InfoBewtra, Meenakshi; Reed, Shelby D; Johnson, F Reed; Scott, Frank I; Gilroy, Erin; Sandler, Robert S; ... Lewis, James D (2019). Variation Among Patients With Crohn's Disease in Benefit vs Risk Preferences and Remission Time Equivalents. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 10.1016/j.cgh.2019.05.010. Retrieved from https://hdl.handle.net/10161/19117.
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F. Reed Johnson
Professor in Population Health Sciences
F. Reed Johnson, PhD, has more than 40 years of academic and research experience in health and environmental economics. He has served on the faculties of several universities in the United States, Canada, and Sweden, and as Distinguished Fellow at Research Triangle Institute. He currently is Senior Research Scholar in the Duke Clinical Research Institute. As a staff member in the US Environmental Protection Agency’s environmental economics research program during the 1980s, Reed helped
Shelby Derene Reed
Professor in Population Health Sciences
Shelby D. Reed, PhD, is Professor in the Departments of Population Health Sciences and Medicine at Duke University’s School of Medicine. She is the director of the Center for Informing Health Decisions and Therapeutic Area leader for Population Health Sciences at the Duke Clinical Research Institute (DCRI). She also is core faculty at the Duke-Margolis Center for Health Policy. Dr. Reed has over 20 years of experience leading multidisciplinary health outcomes research studie
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