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Rheumatology (Oxford). 2016 Nov;55(11):1959-1968. Epub 2016 Jul 31.

Treatment preferences of patients with early rheumatoid arthritis: a discrete-choice experiment.

Author information

1
Department of Medicine, University of Calgary, Calgary, Alberta glenhazlewood@gmail.com.
2
Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.
3
Department of Community Health Sciences, University of Calgary, Calgary, Alberta.
4
Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto.
5
Toronto General Research Institute, University Health Network.
6
Division of Rheumatology, Mount Sinai Hospital, Toronto.
7
Department of Medicine, University Health Network/Mt Sinai Hospital, Toronto.
8
Southlake Regional Health Centre, Newmarket, Ontario, Canada.
9
Hospital for Special Surgery, New York, New York, USA.
10
Schulich School of Medicine and Dentistry, Western University, London, Ontario.
11
Department of Medicine, University of Calgary, Calgary, Alberta.
12
McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.

Abstract

OBJECTIVE:

To quantify the preferences of patients with early RA (ERA) with the benefits and harms of DMARDs.

METHODS:

We assessed patients' preferences using a discrete-choice experiment, an experimentally designed survey to measure trade-offs. Consecutive adult patients with ERA (<2 years since diagnosis) were presented 13 different sets of three treatment options described by eight attributes (clinical outcomes, risks and dosing regimens) and asked to choose one. From patients' responses we estimated the average importance of each attribute and explored preference heterogeneity through latent-class analysis.

RESULTS:

A total of 152 patients completed the survey (86% response rate): mean age 52 years, 63% female, disease duration 7.8 months. Treatment benefits (increasing the chance of a major symptom improvement and reducing the chance of serious joint damage) were most important. Of potential adverse events, a small risk of serious infections/possible increased risk of cancer was most important. Patients were willing to accept this risk for a 15% absolute increase in the chance of a major symptom improvement. Patients had an aversion to i.v. therapy, but were relatively indifferent to other dosing regimens. Through latent-class analysis, we identified two patient groups: 54% who were more risk averse, particularly to a possible risk of cancer/infection, and others who were highly benefit-driven.

CONCLUSION:

On average, patients with ERA were risk tolerant, but important differences in preferences were identified. In particular, a subgroup of patients may prefer to avoid treatments with a possible increased risk of cancer/infection if other effective options are available.

KEYWORDS:

anti-rheumatic agents; patient preference; rheumatoid arthritis

PMID:
27477807
DOI:
10.1093/rheumatology/kew280
[Indexed for MEDLINE]

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