Comparison of benefit-risk preferences of patients and physicians regarding cyclooxygenase-2 inhibitors using discrete choice experiments

Abstract

Purpose: To elucidate and compare benefit-risk preferences among Korean patients and physicians concerning cyclooxygenase-2 (Cox-2) inhibitor treatments for arthritis.

Materials and methods: Subjects included 100 patients with arthritis and 60 board-certified orthopedic surgeon physicians in South Korea. Through a systematic review of the literature, beneficial attributes of using Cox-2 inhibitors were defined as a decrease in the Western Ontario and McMaster Universities Arthritis Index for pain score and improvement in physical function. Likewise, risk attributes included upper gastrointestinal (GI) complications and cardiovascular (CV) adverse events. Discrete choice experiments were used to determine preferences for these four attributes among Korean patients and physicians. Relative importance and maximum acceptable risk for improving beneficial attributes were assessed by analyzing the results of the discrete choice experiment by using a conditional logit model.

Results: Patients ranked the relative importance of benefit-risk attributes as follows: pain reduction (35.2%); physical function improvement (30.0%); fewer CV adverse events (21.5%); fewer GI complications (13.4%). The physicians' ranking for the same attributes was as follows: fewer CV (33.5%); pain reduction (32.4%); fewer GI complications (18.1%); physical function improvement (16.0%). Patients were more willing than physicians to accept risks when pain improved from 20% or 45% to 55% and physical function improved from 15% or 35% to 45%.

Conclusion: We confirmed that patients and physicians had different benefit-risk preferences regarding Cox-2 inhibitors. Patients with arthritis prioritized the benefits of Cox-2 inhibitors over the risks; moreover, in comparison with the physicians, arthritis patients were more willing to accept the trade-off between benefits and risks to achieve the best treatment level. To reduce the preference gap and achieve treatment goals, physicians must better understand their patients' preferences.

Keywords: Cox-2 inhibitors; arthritis; discrete choice experiment; patient and physicians preference; willingness to accept.

Figure 1

Example of a choice set.

Figure 2

Flowchart for subject selection process. Abbreviation: DCE, discrete choice experiment.

Figure 3

Preference weights for benefit–risk attributes for patient and physician groups. Notes: The differences between adjacent weights indicate the relative importance of moving from one level of an attribute to an adjacent level of that attributes. Abbreviations: CV, cardiovascular; FUN, reduction rate in WOMAC physical function scale from baseline; GI, gastrointestinal; PAI, reduction rate in the WOMAC pain scale from baseline; WOMAC, Western Ontario and McMaster Universities Arthritis Index.

Figure 4

Relative importance of benefit–risk attributes for patient and physician groups. Abbreviations: CV, cardiovascular; FUN, reduction rate in WOMAC physical function scale from baseline; GI, gastrointestinal; PAI, reduction rate in the WOMAC pain scale from baseline; WOMAC, Western Ontario and McMaster Universities Arthritis Index.