Variation Among Patients With Crohn's Disease in Benefit vs Risk Preferences and Remission Time Equivalents.
Abstract
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.
Type
Journal articlePermalink
https://hdl.handle.net/10161/19117Published Version (Please cite this version)
10.1016/j.cgh.2019.05.010Publication Info
Bewtra, 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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
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
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info