Patient Preferences for Treatment of RA

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Ann Rheum Dis. 2004 Mar 5 [Epub ahead of print]

Patient Preferences for Treatment of Rheumatoid Arthritis.

Fraenkel L, Bogardus ST, Concato J, Felson DT, Wittink DR.

Yale University, USA.

OBJECTIVE: To elicit rheumatoid arthritis (RA) patient treatment

preferences for DMARDs with varying risk profiles. METHODS: Using data

from published literature about side effects, effectiveness, and cost,

we ascertained patient values for 16 DMARD characteristics. Patient

preferences were elicited using Adaptive Conjoint Analysis, an

interactive computer program that predicts preferences by asking

patients to make trade- offs between specific treatment characteristics.

We ran simulations to derive preferences for four medications

representing: methotrexate, gold, leflunomide, and etanercept, under

different risk-benefit scenarios. Infliximab was not included because it

is given with methotrexate, and we did not include preferences for

combination therapy. Based on each patient's expressed preferences, and

the characteristics of the treatments available at the time of the

study, we identified the option that best fit each patient's

perspective. RESULTS: We interviewed 120 patients (mean age 70 years).

For the base-case scenario, (which assumed the maximum benefits reported

in the literature, a low probability of adverse effects, and low equal

monthly co- pays) 95% of the respondents preferred etanercept over the

other treatment options. When all four options were described as being

equally effective, 88% continued to prefer etanercept due to its safer

short-term adverse effect profile. Increasing etanercept's co-pay to

$30.00 decreased the percent of patients preferring this option to 80%.

CONCLUSIONS: In this study, we found that older RA patients, when asked

to consider trade-offs between specific risk and benefits, preferred

etanercept over other treatment options. Preference for etanercept is

explained by older patients' risk aversion for drug toxicity.

PMID: 15020312

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