Patient and physician preferences for ulcerative colitis treatments in the United States
Received 27 February 2019
Accepted for publication 14 May 2019
Published 11 June 2019 Volume 2019:12 Pages 263—278
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Ms Justinn Cochran
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Wing-Kin Syn
Marco Boeri,1 Kelley Myers,2 Claire Ervin,2 Amy Marren,3 Marco DiBonaventura,4 Joseph C Cappelleri,5 Brett Hauber,2 David T Rubin6
1RTI Health Solutions, Health Preference Assessment, Belfast, BT2 8LA, UK; 2RTI Health Solutions, Health Preference Assessment, Research Triangle Park, NC, 27709, USA; 3Pfizer, Inflammation and Immunology, Collegeville, PA, 19426, USA; 4Pfizer, Health Economics and Outcomes Research, New York, NY, 10017, USA; 5Pfizer, Global Product Development, Groton, CT, 06340, USA; 6Department of Medicine, Inflammatory Bowel Disease Center, University of Chicago, Chicago, IL 60637, USA
Purpose: This study aimed to elicit patient and physician preferences for ulcerative colitis (UC) treatments in the United States (US).
Patients and methods: The following UC treatment attributes included in the discrete-choice experiment (DCE) were identified during qualitative interviews with both patients and physicians: time to symptom improvement, chance of long-term symptom control, risks of serious infection and malignancy, mode and frequency of administration, and need for steroids. The DCE survey instruments were developed and administered to patients and physicians. A random-parameters logit model was used to estimate preference weights and conditional relative importance for these attributes.
Results: A total of 200 patients with moderate to severe UC (status determined using self-reported medication history) and 200 gastroenterologists completed the survey. Patients’ average age was 42 years; most (59%) were female. Patients considered symptom control 2.5 times as important as time to symptom improvement and 5-year risk of malignancy almost as important as long-term symptom control (relative importance, 0.79 vs 0.96 for long-term symptom control); they preferred oral to subcutaneous or intravenous administration (relative importance, 0.47 vs 0.11 and 0.18, respectively). For physicians, symptom control was the most important attribute and was five times as important as the risk of malignancy.
Conclusion: Both patients and physicians considered long-term symptom control the most important attribute relative to others; however, risk of malignancy was of almost-equal importance to patients but not physicians. Differences between patients’ and physicians’ preferences highlight the need for improved communication about the relevant benefits and risks of different UC treatments to improve therapeutic decision-making.
Keywords: ulcerative colitis, discrete-choice experiments, maximum acceptable risk, patient preference, physician preference
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