How are patients’ preferences for anti-TNF influenced by quality of life? A discrete choice experiment in Crohn’s disease patients

Abstract

Background and objective

Anti-TNFs have been shown to significantly improve the health-related quality of life (HRQoL) in Crohn’s disease (CD) patients. The purpose of this study was to investigate to what extend the patients’ preferences for these intravenous (IV) and subcutaneous (SC) treatments differ based on respondents’ quality of life. An online discrete choice experiment (DCE) was conducted to understand patient trade-offs in treatment choice.

Methods

Fifty-seven Crohn's disease anti-TNF naïve patients were asked to choose between two different scenarios, considering the following attributes: mode of administration (MODE), total availability for injection (TIME), speed of onset (DELAY), risk of anti-TNF administration despite a contraindication (RISK) and total monthly out-of-pocket expenses (COST). At the same time, patients completed the IBDQ-32 questionnaire. Conditional logit models without and with interaction terms were estimated to evaluate attribute weights.

Results

Patients preferred to self-administer SC anti-TNF rather than have a primary care nurse do it, whereas the preference for IV route was negative. After adding interaction terms however, the IV route became preferred for patients with impaired HRQoL, this preference having decreased as HRQoL increased. Surprisingly, patients with impaired HRQoL were less willing to spend more time on treatment, and this effect diminished as HRQoL (overall and in each dimension) became higher.

Conclusions

HRQoL level changed patients’ preferences for the anti-TNF treatment. The results suggest the need to optimise the management of IV infusions in the hospital and reinforce the importance of patient-reported outcome measures (PROMS) as a common practice to improve shared medical decision making.

Keywords:

• Discrete choice experiment
• anti-TNF alpha
• health-related quality of life
• Crohn

Acknowledgements

The authors thank the François Aupetit Association (AFA), in the person of Anne Buisson, for the web-communication made on the study before the inclusions.

Ethics approval

Permissions for conducting the study were granted by the Institutional Review and Ethics Committees (CCTIRS n°16-243, ERERC n°2016 046) and the French Data Protection Authority (CNIL n°916388).

Consent to participate

A written informed consent was obtained from all patients prior to inclusion in the study.

Author contributions

S.B.H., F.M., V.D.G., E.R. and A.A. designed the COQC-PIT study. S.B.H designed the discrete choice experiment. D.L., L.P., M.G.F., D.G., C.C., A.B., C.T.P., N.D. and A.A. recruited the patients. F.M., S.B.H., G.B. and A.A. performed the data analysis, discussed the results and drafted the manuscript. All the authors provided critical revision on drafts, approved the final version of the manuscript and were accountable for its content.

Disclosure statement

Ginette Fotsing declares consulting fees for Abbvie, Janssen, MSD, Pfizer, Roche, Takeda and Tillots. Caroline Trang-Poisson has served as a speaker, a consultant and an advisory board member for MSD, Abbvie, Takeda, Janssen, Tillots, Maat Pharma, Mylan. The other authors declare that they have no conflict of interest related to this study.

Additional information

Funding

Financial support for this study was provided by the University of Tours [grant number: 4500194967], in the context of the public research programme named ‘Ambition Research and Development 2020’ dedicated to Biologics, financially supported by the Centre-Val de Loire region. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.