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

Figures & data

Figure 1 Study design.

Table 1 Attributes and levels for the treatment profiles

Attribute	Label used in the patient survey	Label used in the physician survey	Levels used in the DCE questions
Time until symptoms begin to improve	How long it takes until you see some improvement in your UC symptoms	Time until the patient’s symptoms begin to improve	3 days 2 weeks 6 weeks
Probability UC symptoms are under control after 1 year	Chance that your UC symptoms will continue to be under control after 1 year	Probability that UC symptoms are under control after 1 year	9 out of 100 people (9%) 25 out of 100 people (25%) 50 out of 100 people (50%)
Annual risk of serious infection	Risk of having a serious infection each year while you are taking the medicine	Annual risk of a serious infection	1 out of 100 people (1%) 3 out of 100 people (3%) 5 out of 100 people (5%)
5-year risk of malignancy	Risk of developing cancer in the next 5 years because you used the medicine	5-year risk of malignancy	1 out of 1,000 people (0.1%) 4 out of 1,000 people (0.4%) 9 out of 1,000 people (0.9%)
Mode of administration	How you take the medicine	Mode of administration	Oral pill or tablet at home Self-injection at home IV infusion at a doctor’s office, hospital or clinic
Dosing schedule	How often you take the medicine	Dosing schedule	Twice a day Once a day Every 2 weeks Every 8 weeks
Need for occasional use of steroids	You will need occasional use of steroids to keep your UC symptoms under control	Need for occasional use of steroids	Yes No

Abbreviations: DCE, discrete-choice experiment; UC, ulcerative colitis; IV, intravenous.

Figure 2 Example choice question.

Abbreviation: UC, ulcerative colitis.

Table 2 Respondent characteristics

Survey question	Responses, n (%)
Patients (N=200)
Mean (SD) age, years	42.1 (14.68)
Gender
Female	118 (59.0)
Male	82 (41.0)
Marital status
Single/never married	68 (34.0)
Married/living as married/civil partnership	113 (56.5)
Other	19 (9.5)
Highest level of education
Some high school	2 (1.0)
High school or equivalent (eg, GED)	21 (10.5)
Some college but no degree	32 (16.0)
Technical school	9 (4.5)
Associate’s degree (2-year college degree)	25 (12.5)
4-year college degree (eg, BA, BS)	71 (35.5)
Some graduate school but no degree	3 (1.5)
Graduate or professional degree	37 (18.5)
Employment status
Employed full time	122 (61.0)
Employed part time	22 (11.0)
Self-employed	10 (5.0)
Retired	16 (8.0)
Other	30 (15.0)
Type of health insurance^a
I do not have health insurance	2 (1.0)
Private insurance that I pay for myself	45 (22.5)
Private insurance that my employer or my spouse’s employer pays all or part of	98 (49.0)
Medicaid	22 (11.0)
Medicare	40 (20.0)
Veteran Health Insurance	3 (1.5)
Other	5 (2.5)
Mean (SD) age at UC diagnosis, years	33.0 (14.45)
Prescription medications ever taken for UC^a
Immunosuppressants	106 (53.0)
Biologics	98 (49.0)
5-aminosalicylates (5-ASAs)	81 (40.5)
Corticosteroid	103 (51.5)
Another prescription medication for UC	28 (14.0)
Experience with modes of administration for UC medication^a
By mouth (oral pills or tablets)	178 (89.0)
By injection (either at home or in your doctor’s office)	81 (40.5)
By intravenous (IV) infusion	52 (26.0)
Suppository (capsule inserted in your rectum)	43 (21.5)
Others	4 (2.0)
Don’t know or not sure	1 (0.5)
Physicians (N=200)
Mean (SD) age, years^b	48.7 (10.39)
Gender
Female	48 (24.0)
Male	146 (73.0)
Prefer not to say	6 (3.0)
Years in practice
6 years or less	42 (21.0)
7–15 years	67 (33.5)
More than 15 years	91 (45.5)
Practice type^a
Office-based private practice	120 (60.0)
Hospital-based private practice	41 (20.5)
Academic-based practice	46 (23.0)
Has infusion chair or suite in practice	161 (80.5)
Number of patients with UC seen each month
10–15 patients	60 (30.0)
16–25 patients	61 (30.5)
More than 25 patients	79 (39.5)
Years of experience treating patients with moderate to severe UC
1–5 years	15 (7.5)
6–10 years	48 (24.0)
11–15 years	42 (21.0)
More than 15 years	95 (47.5)
Percentage of patients with moderate to severe UC currently using biologics
0–20%	20 (10.0)
21–45%	51 (25.5)
46–75%	71 (35.5)
More than 75%	58 (29.0)

Notes: ^aRespondents had the option to select more than one response category. For this reason, the percentages may sum to more than 100%. ^bOne respondent did not provide an answer to this question.

Abbreviations: GED, General Education Development; SD, standard deviation; UC, ulcerative colitis.

Table 3 Maximum acceptable percentage-point increase in annual risk of serious infection

Benefit	From	To	Patients (N=200) Maximum acceptable increase in annual risk of serious infection (95% CI) (percentage points)	Physicians (N=200) Maximum acceptable increase in annual risk of serious infection (95% CI) (percentage points)
Time until symptoms begin to improve	6 weeks	2 weeks	2.33 (–5.07 to 9.72)	6.01^a (3.04–8.98)
	2 weeks	3 days	–0.35 (–1.65 to 0.95)	3.31 (1.29–5.32)
	6 weeks	3 days	1.73 (–0.08 to 3.54)	7.76^a (4.07–11.44)
Probability that UC symptoms are under control after 1 year	9%	25%	3.74 (–3.30 to 10.77)	15.62^a (6.39–24.84)
	25%	50%	5.34^a (–3.77 to 14.44)	15.76^a (6.21–25.32)
	9%	50%	15.31^a (–16.43 to 47.06)	29.81^a (10.21–49.41)
Change in mode and dosing schedule	IV infusion every 2 weeks	SC injection once a day	0.86 (–0.89 to 2.61)	5.89^a (2.87–8.91)
	SC injection once a day	Pill twice a day	17.84^a (–17.02 to 52.70)	12.10^a (5.78–18.42)
	SC injection every 2 weeks	IV infusion every 8 weeks	0.39 (–2.13 to 2.90)	−4.45^a (−10.69 to 1.79)
	IV infusion every 2 weeks	SC injection every 2 weeks	0.58 (–2.20 to 3.37)	10.52^a (4.49–16.56)
Need for occasional use of steroids	Yes	No	0.08 (–1.19 to 1.34)	4.17^a (2.01–6.34)

Notes: ^aThis maximum acceptable percentage-point increase in annual risk of serious infection lies outside of the risk range used in the discrete-choice experiment design (ie, it is greater than a 4% [=5–1%] annual risk of serious infection). The slope computed for the two highest risk levels was used in a linear extrapolation to calculate this maximum acceptable increase in risk.

Abbreviations: CI, confidence interval; IV, intravenous; SC, subcutaneous; 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.

Table 4 Maximum acceptable 1/10 of percentage-point increase in 5-year risk of malignancy

Benefit	From	To	Patients (N=200) Maximum acceptable increase in 5-year risk of malignancy^a (95% CI) (1/10 of percentage points)	Physicians (N=200) Maximum acceptable increase in 5-year risk of malignancy^a (95% CI) (1/10 percentage points)
Time until symptoms begin to improve	6 weeks	2 weeks	2.43 (0.30–4.56)	6.88 (4.59–9.16)
	2 weeks	3 days	–0.41 (–2.01 to 1.19)	4.26 (2.48–6.04)
	6 weeks	3 days	2.02 (0.29–3.75)	8.56^b (6.29–10.84)
Probability that UC symptoms are under control after 1 year	9%	25%	2.83 (0.77–4.89)	16.17^b (11.96–20.38)
	25%	50%	3.70 (–1.44 to 8.83)	16.31^b (12.17–20.46)
	9%	50%	10.70^b (3.23–18.17)	29.91^b (21.54–38.28)
Change in mode and dosing schedule	IV infusion every 2 weeks	SC injection once a day	1.01 (−0.87 to 2.89)	6.76 (4.39–9.12)
	SC injection once a day	Pill twice a day	12.47^b (3.34–21.66)	12.77^b (9.04–16.50)
	SC injection every 2 weeks	IV infusion every 8 weeks	0.45 (−2.55 to 3.45)	−3.25 (−7.25 to 0.75)
	IV infusion every 2 weeks	SC injection every 2 weeks	0.68 (–2.34 to 3.69)	11.24^b (7.76–14.73)
Need for occasional use of steroids	Yes	No	0.09 (–1.39 to 1.57)	5.10 (3.12–7.08)

Notes: ^aThe maximum acceptable percentage-point increase in 5-year risk of malignancy is presented in risk per 1,000 people (1/10 percentage points). The level included in the survey ranged from 1 to 9 in 1,000 people. ^bThis maximum acceptable tenth of a percentage-point increase in a 5-year risk of malignancy lies outside of the risk range used in the discrete-choice experiment design (ie, it is greater than 0.8%, that is, 0.9% minus 0.1%). The slope computed for the 2 highest risk levels was used in a linear extrapolation to calculate this maximum acceptable increase in risk.

Abbreviations: CI, confidence interval; IV, intravenous; SC, subcutaneous.

Data availability

The data used in the analyses are available from the corresponding author on reasonable request.