Patient and physician preferences for ulcerative colitis treatments in the United States

Abstract

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: discrete-choice experiments; maximum acceptable risk; patient preference; physician preference; ulcerative colitis.

Figure 1

Study design.

Figure 2

Example choice question. Abbreviation: UC, ulcerative colitis.

Figure 3

Preference weights. Notes: This graph presents the preference weights placed on the attribute levels represented on the horizontal axis. Vertical distance between the preferences for various levels of the same attribute represents the weight placed on a specific relative change in that attribute. Calculated mean preference estimates for each value can be compared within each attribute and across different attributes. The vertical bars surrounding each mean preference weight denote the 95% confidence interval about the point estimate (computed by delta method). Abbreviations: IV, intravenous; SC, subcutaneous; UC, ulcerative colitis.

Figure 4

Conditional relative importance for patients and physicians. Notes: This graph plots the conditional relative importance of each attribute, calculated as the difference between the most-preferred and least-preferred level. The importance of each attribute for both patients and physicians is relative to the probability that UC symptoms would be under control after 1 year and is conditional on the levels of the attributes included in the survey. The black vertical bars surrounding each mean preference weight denote the 95% confidence interval about the point estimate. The conditional relative importance for each mode of administration (ie, pill, subcutaneous injection, and intravenous infusion) is reported over the range of frequency levels associated with it. Abbreviations: IV, intravenous; SC, subcutaneous; UC, ulcerative colitis.