P688 Patient preferences in medication to treat Ulcerative Colitis: a discrete choice experiment
Straatmijer, T.(1)*;van den Akker-van Marle, E.(2);van der Horst, D.(3);Scherpenzeel, M.(3);Duijvestein, M.(4);van der Meulen, A.(5);
(1)Initiative on Crohn and Colitis, Gastroenterology and Hepatology, Amsterdam, The Netherlands;(2)LUMC, Medical decision making, Leiden, The Netherlands;(3)CCNL, Gastroenterology and hepatology, Woerden, The Netherlands;(4)Radboudumc, Gastroenterology and Hepatology, Nijmegen, The Netherlands;(5)LUMC, Gastroenterology and hepatology, Leiden, The Netherlands;
Background
Since the number of treatment options for Ulcerative Colitis (UC) has expanded, patients and physicians face challenges regarding decisions about the medication options. In shared decision making, treating physicians help patients understand the trade-offs and their own preferences. We aimed to identify patients preferences about the relative risks and benefits of UC treatment options in patients with UC in the Netherlands. Furthermore, we assessed after how many failed treatment options, patients are willing to consider surgical treatment.
Methods
We conducted a web-based, discrete choice experiment (DCE) among adult UC patients. Patients were repeatedly asked to choose between two hypothetical treatment options with varying combinations of attribute levels (fig 1). Attributes were based on consecutively a literature search, patient interviews, surveys and a focus group. The six included attributes were: administration route, administration location, chance on symptom reduction (short and long term), chances on infection and on adverse events. A balanced overlap design was used. Patients were recruited via the patient association Crohn & Colitis NL and in two academic hospitals. Data were analyzed by using Hierarchical Bayes estimation.
Results
A total of 172 patients participated in the DCE. Median disease duration was 8 (IQR 3-16) years. Most patients were anti-TNF experienced (52.9%). Symptom reduction after one year (relative importance (RI) 27.7 (95% CI 25.6-29.7)) was the most important when choosing between treatment options (table 1), followed by the chance of infection (22.3 (21.2 - 23.4)) and chance of symptom reduction after eight weeks (RI 19.5 (18.1 - 20.9)). The location of administration of the treatment and the chance of adverse events were the least important (8.7 (7.7 - 9.79) and 8.5 (7.9 - 9.2), respectively). Patients preferred oral administration over subcutaneous injections. Intravenous route of administration was least favorite. The differences in average utilities of patients previous treated with biologic therapy or small molecules or naïve patients are displayed in table 2. 133 patients filled in the trade off questions regarding surgery. Forty-four patients (33.1%) responded with unknown. Nineteen patients (14.3%) would not even consider surgery after failing all treatment options without any new available therapies left. Nine patients would consider surgery before trying any treatment options. Of the remaining patients, nine (6.8%) would consider surgery after failing six treatment options.
Conclusion
We found that symptom reduction after one year was the most important treatment attribute in UC patients. These outcomes can help understand the trade-offs and preferences of UC patients.