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

Bewtra, Meenakshi

Reed, Shelby D

Johnson, F Reed

Scott, Frank I

Gilroy, Erin

Sandler, Robert S

Chen, Wenli

Lewis, James D

2019-07-29T14:02:52Z

2019-07-29T14:02:52Z

2019-05-14

2019-07-29T14:02:52Z

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.

S1542-3565(19)30520-8

1542-3565

1542-7714

https://hdl.handle.net/10161/19117

eng

Elsevier BV

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

10.1016/j.cgh.2019.05.010

Anti-TNF

Biologic

Corticosteroids

Discrete Choice Experiments

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

Journal article

Reed, Shelby D|0000-0002-7654-4464

Johnson, F Reed|0000-0002-7572-2150

School of Medicine

Duke

Duke Cancer Institute

Institutes and Centers

Duke Clinical Research Institute

Population Health Sciences

Basic Science Departments

Duke Science & Society

Initiatives

Institutes and Provost's Academic Units

Medicine, General Internal Medicine

Medicine

Clinical Science Departments

Published