Patient Preferences for Treatment Attributes in Inflammatory Bowel Disease: Results From a Large Survey Across Seven European Countries Using a Discrete Choice Experiment

Abstract

Background: Inflammatory bowel disease requires long-term treatment; therefore, understanding patient preferences is important in aiding informed treatment decision making. This study explored patients' preferences for treatment attributes of available inflammatory bowel disease therapies.

Methods: Adult patients from 7 European countries who self-reported previous/current treatment for Crohn's disease (CD) or ulcerative colitis (UC) participated in an online survey via the Carenity platform. In a discrete choice experiment, the relative importance of treatment attributes for CD and UC was estimated using conditional logit models. Latent class analysis was conducted to estimate heterogeneous treatment preferences based on patient profiles. Patients' perspectives and preferences regarding their quality of life were assessed.

Results: Across 686 completed survey responses (CD, n = 360; UC, n = 326), the mean patient age was 48 and 50 years, respectively. Patients with CD ranked route of administration as the most important attribute (attribute importance: 32%), preferring subcutaneous over intravenous treatment (P < .001). Patients with UC ranked route of administration and frequency of serious adverse events as the most important attributes (attribute importance: 31% and 23%, respectively), preferring oral (P < .001) and subcutaneous (P < .001) over intravenous treatment and treatment that minimized the risk of serious adverse events (P < .001) or mild adverse events (P < .01). Latent class analyses confirmed the impact of patients' sociodemographic profile on their preferences. All patients prioritized general well-being, energy level, and daily activities as the most important aspects for improvement through treatment.

Conclusions: Patient preferences for treatment attributes varied among patients with CD or UC, highlighting the importance of personalized care and shared decision making to maximize treatment benefits.

Keywords: discrete choice experiment; inflammatory bowel disease; patient preference.

Graphical Abstract

Figure 1.

Preference for treatment attributes among patients with inflammatory bowel disease. A, Attribute importance for patients with Crohn’s disease (CD) and ulcerative colitis (UC). ^aLong-term remission on maintenance treatment for CD or UC; ^bCorticosteroid-free remission after 1 year for patients with UC. B, Level part-worths for the conditional logit model (CD) showing relative importance of treatment attributes. Percentage weights with coefficient >0 vs percentage weights constrained to be 0 (percentage weights constrained to be 0 are not displayed in the graph). REM indicates remission after 1 year (32% and 51% vs 7% of patients); LTM-REM indicates long-term remission on maintenance treatment (82% and 92% vs 69% of patients); SAE indicates occurrence of serious adverse events (9% vs 25% of patients); AE indicates occurrence of mild adverse events (59% vs 87% of patients); RoA indicates route of administration of the medication (subcutaneously every 1-2 weeks [SC 1/2], subcutaneously every 4-12 weeks [SC 4/12] vs intravenously every 4-8 weeks [IV]). *P < .01, **P < .001. C, Level part-worths for the conditional logit model (UC) showing relative importance of treatment attributes. Percentage weights with coefficient >0 vs percentage weights constrained to be 0 (percentage weights constrained to be 0 are not displayed in the graph). CS-REM indicates corticosteroid-free remission after 1 year (14% and 45% vs 6% of patients); MUC indicates healing of the intestinal mucosa after 1 year (31% and 55% vs 13% of patients); LTM-REM (85% and 95% vs 72% of patients); SAE (5% vs 23% of patients); AE (49% vs 85% of patients); RoA (SC 1/2, SC 4/12, tablets twice daily [Tab] vs intravenously every 4-8 weeks). *P < .01, **P < .001.

Figure 2.

Differences in preferences for Crohn’s disease (CD) and ulcerative colitis (UC) treatment attributes by variables. Treatment attributes stratified by (A) patient profile, (B), country, (C) route of administration (RoA), and (D) care pathway. Numbers in parenthesis refer to the number of patients in each category. For some of the variables, the total percentage value is either 99% or 101% due to rounding of values. *All patients who have received at least once an intravenous (IV) treatment. **All patients who have received at least once a subcutaneous (SC) treatment but have never received an IV treatment. AE, adverse event; SAE, serious adverse event; UK, United Kingdom.

Figure 3.

Latent classes determined by patient preferences in Crohn’s disease (CD). Latent classes were determined based on the latent class multinomial logit model. The graphs indicate the results of regression analysis, and the error bars denote the standard error. *P < .05, **P < .01, ***P < .001. REM indicates remission after 1 year (32% and 51% vs 7% of patients); SAE indicates occurrence of serious adverse events (9% vs 25% of patients); AE indicates occurrence of mild adverse events (59% vs 87% of patients); LTM-REM indicates long-term remission on maintenance treatment (82% and 92% vs 69% of patients); RoA indicates route of administration of the medication (subcutaneously every 1-2 weeks [SC 1/2], subcutaneously every 4-12 weeks [SC 4/12] vs intravenously every 4-8 weeks [IV]). IBD, inflammatory bowel disease.

Figure 4.

Latent classes determined by patient preferences in ulcerative colitis (UC). Latent classes were determined based on the latent class multinomial logit model regression analysis. Results are represented as regression coefficient, and the error bars denote the standard error. *P < .05, **P < .01, ***P < .001. CS-REM indicates corticosteroid-free remission after 1 year (14% and 45% vs 6% of patients); MUC indicates healing of the intestinal mucosa after 1 year (31% and 55% vs 13% of patients); LTM-REM indicates long-term remission on maintenance treatment (85% and 95% vs 72% of patients); SAE indicates occurrence of serious adverse events (5% vs 23% of patients); AE indicates occurrence of mild adverse events (49% vs 85% of patients); RoA indicates route of administration of the medication (subcutaneously every 1-2 weeks [SC 1/2], subcutaneously every 4-12 weeks [SC 4/12], tablets twice daily [TAB] vs intravenously every 4-8 weeks [IV]). IBD, inflammatory bowel disease.