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Variation Among Patients With Crohn's Disease in Benefit vs Risk Preferences and Remission Time Equivalents.

Publication ,  Journal Article
Bewtra, M; Reed, SD; Johnson, FR; Scott, FI; Gilroy, E; Sandler, RS; Chen, W; Lewis, JD
Published in: Clin Gastroenterol Hepatol
February 2020

BACKGROUND & AIMS: Patients with Crohn's disease (CD) must make decisions about their treatment. We aimed to quantify patients' preferences for different treatment outcomes and adverse events. We also evaluated the effects of latent class heterogeneity on these preferences. METHODS: An online stated-preference survey was completed by 812 individuals with CD in the Crohn's and Colitis Foundation Partners cohort (IBD Partners). Patients were given information on symptoms and severity of active disease; duration of therapy with corticosteroids; and risks of serious infection, cancer and surgery. Patients were asked to assume that their treatment was not working and to choose an alternative therapy. The primary outcome was remission-time equivalents (RTE) of a given duration of symptom severity or treatment-related risk. Latent class choice models identified groups of patients with dominant treatment-outcome preferences and associated patient characteristics with these groups. RESULTS: Latent class analysis demonstrated 3 distinct groups of survey responders whose choices were strongly influenced by avoidance of active symptoms (61%), avoidance of corticosteroid use (25%), or avoidance of risks of cancer, infection or surgery (14%) when choosing a therapy. Class membership was correlated with age, sex, mean short CD activity index score and corticosteroid avoidance. RTEs in each latent class differed significantly from the mean RTEs for the overall sample, although the symptom-avoidant class most closely approximated the overall sample. CONCLUSIONS: In an online survey of patients with CD, we found substantial heterogeneity in preference for medication efficacy and risk of harm. Physicians and regulators should therefore not assume that all patients have mean-value preferences-this could result in significant differences in health-technology assessment models.

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Published In

Clin Gastroenterol Hepatol

DOI

EISSN

1542-7714

Publication Date

February 2020

Volume

18

Issue

2

Start / End Page

406 / 414.e7

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surveys and Questionnaires
  • Physicians
  • Humans
  • Gastroenterology & Hepatology
  • Crohn Disease
  • Adrenal Cortex Hormones
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
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ICMJE
MLA
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Bewtra, M., Reed, S. D., Johnson, F. R., Scott, F. I., Gilroy, E., Sandler, R. S., … Lewis, J. D. (2020). Variation Among Patients With Crohn's Disease in Benefit vs Risk Preferences and Remission Time Equivalents. Clin Gastroenterol Hepatol, 18(2), 406-414.e7. https://doi.org/10.1016/j.cgh.2019.05.010
Bewtra, Meenakshi, Shelby D. Reed, F Reed Johnson, Frank I. Scott, Erin Gilroy, Robert S. Sandler, Wenli Chen, and James D. Lewis. “Variation Among Patients With Crohn's Disease in Benefit vs Risk Preferences and Remission Time Equivalents.Clin Gastroenterol Hepatol 18, no. 2 (February 2020): 406-414.e7. https://doi.org/10.1016/j.cgh.2019.05.010.
Bewtra M, Reed SD, Johnson FR, Scott FI, Gilroy E, Sandler RS, et al. Variation Among Patients With Crohn's Disease in Benefit vs Risk Preferences and Remission Time Equivalents. Clin Gastroenterol Hepatol. 2020 Feb;18(2):406-414.e7.
Bewtra, Meenakshi, et al. “Variation Among Patients With Crohn's Disease in Benefit vs Risk Preferences and Remission Time Equivalents.Clin Gastroenterol Hepatol, vol. 18, no. 2, Feb. 2020, pp. 406-414.e7. Pubmed, doi:10.1016/j.cgh.2019.05.010.
Bewtra M, Reed SD, Johnson FR, Scott FI, Gilroy E, Sandler RS, Chen W, Lewis JD. Variation Among Patients With Crohn's Disease in Benefit vs Risk Preferences and Remission Time Equivalents. Clin Gastroenterol Hepatol. 2020 Feb;18(2):406-414.e7.

Published In

Clin Gastroenterol Hepatol

DOI

EISSN

1542-7714

Publication Date

February 2020

Volume

18

Issue

2

Start / End Page

406 / 414.e7

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surveys and Questionnaires
  • Physicians
  • Humans
  • Gastroenterology & Hepatology
  • Crohn Disease
  • Adrenal Cortex Hormones
  • 3202 Clinical sciences
  • 1103 Clinical Sciences