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Do patient preferences influence decisions on treatment for patients with steroid-refractory ulcerative colitis?

Publication ,  Journal Article
Arseneau, KO; Sultan, S; Provenzale, DT; Onken, J; Bickston, SJ; Foley, E; Connors, AF; Cominelli, F
Published in: Clin Gastroenterol Hepatol
September 2006

BACKGROUND & AIMS: Patients with steroid-refractory ulcerative colitis face a difficult treatment decision between colectomy and therapy with infliximab or cyclosporine. The aim of this study was to understand how individual patient preferences for the various treatment outcomes influence the optimal treatment decision for a given patient. METHODS: A Markov model was used to simulate treatment with total colectomy with an ileo pouch-anal anastomosis (TC/IPAA), cyclosporine (CSA), infliximab (INFLX), and infliximab followed by cyclosporine for treatment failures (INFLX-->CSA). Utility weights for treatment outcomes were elicited from 48 patients using both time trade-off and visual rating scale methods. Preference sets were applied to the model to identify the therapy that maximized quality-adjusted life years (QALYs) for each patient. Sensitivity analyses were performed to assess model robustness. RESULTS: Optimal treatment was highly variable among patients (INFLX-->CSA = 42%, 20/48; TC/IPAA = 37%, 18/48; CSA = 21%, 10/48; INFLX = 0%, 0/48). However, when average preference weights from our sample were applied to the model, medical treatments were superior to TC (CSA = .26 QALYs gained vs TC/IPAA; INFLX-->CSA = .25 QALYs gained vs TC/IPAA). CONCLUSIONS: Patient preferences have a clear impact on the optimal treatment for steroid-refractory ulcerative colitis. Although averaged preferences support the use of medical interventions, a third of individual patients may benefit most from proceeding directly to colectomy. Failure to fully assess individual preferences may result in suboptimal treatment for these patients.

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Published In

Clin Gastroenterol Hepatol

DOI

ISSN

1542-3565

Publication Date

September 2006

Volume

4

Issue

9

Start / End Page

1135 / 1142

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Proctocolectomy, Restorative
  • Patient Satisfaction
  • Middle Aged
  • Markov Chains
  • Male
  • Infliximab
  • Immunosuppressive Agents
  • Humans
  • Gastroenterology & Hepatology
 

Citation

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Arseneau, K. O., Sultan, S., Provenzale, D. T., Onken, J., Bickston, S. J., Foley, E., … Cominelli, F. (2006). Do patient preferences influence decisions on treatment for patients with steroid-refractory ulcerative colitis? Clin Gastroenterol Hepatol, 4(9), 1135–1142. https://doi.org/10.1016/j.cgh.2006.05.003
Arseneau, Kristen O., Shahnaz Sultan, Dawn T. Provenzale, Jane Onken, Stephen J. Bickston, Eugene Foley, Alfred F. Connors, and Fabio Cominelli. “Do patient preferences influence decisions on treatment for patients with steroid-refractory ulcerative colitis?Clin Gastroenterol Hepatol 4, no. 9 (September 2006): 1135–42. https://doi.org/10.1016/j.cgh.2006.05.003.
Arseneau KO, Sultan S, Provenzale DT, Onken J, Bickston SJ, Foley E, et al. Do patient preferences influence decisions on treatment for patients with steroid-refractory ulcerative colitis? Clin Gastroenterol Hepatol. 2006 Sep;4(9):1135–42.
Arseneau, Kristen O., et al. “Do patient preferences influence decisions on treatment for patients with steroid-refractory ulcerative colitis?Clin Gastroenterol Hepatol, vol. 4, no. 9, Sept. 2006, pp. 1135–42. Pubmed, doi:10.1016/j.cgh.2006.05.003.
Arseneau KO, Sultan S, Provenzale DT, Onken J, Bickston SJ, Foley E, Connors AF, Cominelli F. Do patient preferences influence decisions on treatment for patients with steroid-refractory ulcerative colitis? Clin Gastroenterol Hepatol. 2006 Sep;4(9):1135–1142.
Journal cover image

Published In

Clin Gastroenterol Hepatol

DOI

ISSN

1542-3565

Publication Date

September 2006

Volume

4

Issue

9

Start / End Page

1135 / 1142

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Proctocolectomy, Restorative
  • Patient Satisfaction
  • Middle Aged
  • Markov Chains
  • Male
  • Infliximab
  • Immunosuppressive Agents
  • Humans
  • Gastroenterology & Hepatology