Patient preferences for treatment in steroid resistant ulcerative colitis – a discrete-choice experiment

Abstract

Background and aim

Understanding treatment preferences in those patients who are not responding to corticosteroids for ulcerative colitis is important in informing treatment choices. This study aimed to assess the relative importance of treatment characteristics to patients by conducting a discrete-choice experiment.

Methods

Patients completed the questionnaire online. All data were collected between September and December 2020. Participants were shown 13 discrete-choice experiment tasks – a series of side-by-side comparisons of competing, hypothetical treatment characteristics and asked to select a preferred treatment. Survey responses were analysed using descriptive statistics and regression analyses.

Results

115 patients completed the study. Patient preferences were strongest for treatments with a lower chance of side effects, this attribute had the most influence on the choice of treatment patients preferred. The second most important attribute was an improvement in maintaining remission. Conversely, route and frequency of administration were least important on the choice of treatment patients preferred. Respondents were willing to make trade offs and accept treatment benefits to compensate them for receiving a treatment with a less desirable attribute level. Participants were willing to accept a larger benefit of 45% improvement in maintenance of remission to accept a treatment with a higher probability of side effects. The benefit required was smaller with a 10% improvement in remission required to accept a treatment with a lower probability of side effects.

Conclusion

Quantifying preferences helps to identify and prioritise treatment characteristics that are important to patients. The results highlight the importance of careful discussion of side effects, including the magnitude of risk, using visualisation tools during a patient consultation to support decisions.

Keywords:

• Ulcerative colitis
• patient preference
• discrete-choice experiment

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgments

We would like to thank all participants who took part in this research. Many thanks to Professor Arne Risa Hole, Dr. Laura Ternent, Professor Tariq Iqbal, Dr. Gabrielle Thorpe and Mrs. Jayne Kranat for providing guidance during this study.

Ethics statement

The study was reviewed and approved by the NHS Research Ethics Committee – East Midlands Derby (19/EM/0011) and the Health Research Authority approved the research (IRAS ID: 255616).

Disclosure statement

Dr. Lee was a member of the medical research panel for Crohn’s and Colitis UK and reports funding from Crohn’s and Colitis UK. Dr. Probert reports non-financial support from Vifor, and personal fees from Dr. Falk Pharma, Celltrion, Galapagos and Janssen. Dr. Sebastian reports grants from Takeda, Amgen, Pfizer, AbbVie, Tillott Pharma, and personal fees from AbbVie, Celgene, Takeda, Janssen, Tillots Pharma, Falk Pharma, Amgen, and Pharmcocosmos. Dr. Lobo reports personal fees from and Advisory Board membership for Takeda, personal fees from Janssen, Advisory Board membership for Vifor Pharma, Celltrion and Medtronic, and grants from CCUK and grants from Health Foundation. All other authors report no competing interests.

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author

Additional information

Funding

This study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (Grant Reference: HTA 17/72/02). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.