Background/Purpose: Patients with rheumatoid arthritis (RA) and their physicians face a range of treatment choices.  The treatments that patients receive should be driven partly by their views and preferences regarding different aspects of the treatments.  The present study was designed to elicit the treatment preferences of people with RA.

Methods: A stated preference survey was developed based on published literature, discussion with clinicians (n=4) and qualitative interviews with patients (n=5).  The survey presented hypothetical treatments that varied in terms of six key attributes: Mode of administration & frequency, Time medication stays in the body, Effectiveness in treating pain, Functional ability, Number of RA flares in next 12 months, and Out of pocket cost.  Socio-demographic, and clinical data were also collected.  Participants (US n=150; UK n=150) completed the survey following IRB approval.  Survey data were analysed using the conditional logit model whereby the attributes were the independent variables and patient choice data were the dependent variable. The coefficients obtained from the logit model provided an estimate of the (log) odds ratios (ORs) of preference for treatment attributes.

Results: 287 participants (143 patients in UK and 144 in US) completed all study questionnaires. Participants reported a median current pain VAS of 5.0 (0-10 scale) and poor quality of life (EQ-5D score = 0.41 (US) and 0.45 (UK) on a 0 (dead) to 1.0 (full health) scale.  Over 90% of the sample reported experiencing at least 7 flares in the last 12 months. All attributes were significant predictors of choice where all or some levels were significantly more important than the reference case as shown by the ORs. The three most important drivers of preference were number of symptom flares per year, effectiveness in reducing pain and functional ability (Table 1).  Treatments which reduced the number of symptom flares per year from 5 to 0 were of high importance to participants. Participants preferred treatments that reduced pain (assessed on a visual analogue scale) score by 80%. Avoiding functional difficulties was also very important to participants (Table 1).  Oral (daily or twice-daily) and subcutaneous treatments (weekly or bi-weekly) were preferred to intravenous therapies (every 4 weeks or 8 weeks), but this was less important to participants; and time medication is in body was not important to participants.  Cost was somewhat a significant predictor of choice, whereby participants were willing to pay more for improvements of therapy.

Conclusion:

The results show the relative importance of different features of RA treatments to patients.  Improving pain control, functioning, and avoiding flares were the most important aspects of treatment.  Participants were much less concerned about the mode or frequency of administration.

Table 1: Results of logit model by country

 

Attribute and level		Odds Ratios (Lower – Upper 95% Confidence intervals)
		US	UK
Administration & Frequency – Sub-cutaneous weekly (reference)‡
Oral daily	1.03 (0.78 – 1.36)		1.45 (1.11 – 1.90)
Oral twice daily	0.82 (0.56 – 1.18)		1.40 (0.99 – 2.0)
Intravenous- 8 weeks	0.52 (0.35 – 0.77)		1.06 (0.73 – 1.55)
Intravenous- 4 weeks	0.44 (0.29 – 0.66)		0.85 (0.58 – 1.26)
Sub-cutaneous- biweekly	0.95 (0.71 – 1.27)		0.93 (0.74 – 1.30)
Time in Body – 8 weeks (reference)
1 day	0.77 (0.65 – 0.09)		0.82 (0.70 – 0.96)
4 weeks	1.19 (1.01 – 1.41)		1.12 (0.95 – 1.32)
Level of pain while taking treatment – Current pain level reduced by 20% (reference)
Current pain level reduced by 80%	6.25 (5.12 – 7.63)		4.44 (3.71 – 5.30)
Current pain level reduced by 40%	2.68 (2.24 – 3.20)		2.12 (1.80 – 2.49)
Functional Ability – Some difficulty & moderate discomfort (reference)
No difficulty	2.29 (1.89 – 2.77)		2.20 (1.86 – 2.62)
Some difficulty & mild discomfort	1.73 (1.44 – 2.08)		1.37 (1.16 – 1.62)
Number of Flares – 5 (reference)
0	5.28 (4.32 – 6.46)		3.85 (3.22 – 4.60)
2	3.09 (2.55 – 3.74)		2.60 (2.19 – 3.09)
Cost
Cost ($)	1.0 (1.0- 1.0)			0.99 (0.99 – 0.99)

 

 

 

 

 

 

 

 

 

^{‡ –}  reference case is the base profile in each attribute.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-preferences-for-biologic-treatments-in-rheumatoid-arthritis/