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Variation Among Patients With Crohn's Disease in Benefit vs Risk Preferences and Remission Time Equivalents.

dc.contributor.author Bewtra, Meenakshi
dc.contributor.author Reed, Shelby D
dc.contributor.author Johnson, F Reed
dc.contributor.author Scott, Frank I
dc.contributor.author Gilroy, Erin
dc.contributor.author Sandler, Robert S
dc.contributor.author Chen, Wenli
dc.contributor.author Lewis, James D
dc.date.accessioned 2019-07-29T14:02:52Z
dc.date.available 2019-07-29T14:02:52Z
dc.date.issued 2019-05-14
dc.identifier S1542-3565(19)30520-8
dc.identifier.issn 1542-3565
dc.identifier.issn 1542-7714
dc.identifier.uri https://hdl.handle.net/10161/19117
dc.description.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.
dc.language eng
dc.publisher Elsevier BV
dc.relation.ispartof Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
dc.relation.isversionof 10.1016/j.cgh.2019.05.010
dc.subject Anti-TNF
dc.subject Biologic
dc.subject Corticosteroids
dc.subject Discrete Choice Experiments
dc.title Variation Among Patients With Crohn's Disease in Benefit vs Risk Preferences and Remission Time Equivalents.
dc.type Journal article
duke.contributor.id Reed, Shelby D|0272070
duke.contributor.id Johnson, F Reed|0657133
dc.date.updated 2019-07-29T14:02:52Z
pubs.organisational-group School of Medicine
pubs.organisational-group Duke
pubs.organisational-group Duke Cancer Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Population Health Sciences
pubs.organisational-group Basic Science Departments
pubs.organisational-group Duke Science & Society
pubs.organisational-group Initiatives
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Medicine, General Internal Medicine
pubs.organisational-group Medicine
pubs.organisational-group Clinical Science Departments
pubs.publication-status Published
duke.contributor.orcid Reed, Shelby D|0000-0002-7654-4464


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