Session Title: Health Services Research
Session Type: Abstract Submissions (ACR)
Background/Purpose: To identify the most and least important characteristics of rheumatoid arthritis (RA) treatment according to patients currently on biologic therapy.
Methods: From the HealthCore Integrated Research Environment, RA patients (ICD-9-CM: 714.0x) ≥18 years old with ≥1 claim for a biologic therapy between 5/1/2012 and 7/31/2013 were identified. All eligible patients were targeted to complete a survey measuring their quality of life, RA treatment history, treatment satisfaction, and treatment preferences, among other measures. The Maximum Difference Scaling Instrument (MaxDiff) was used to determine what characteristics of RA treatments (e.g., efficacy; side effects; costs; how, when, and where the medication is administered) were most and least important to the patients. A MaxDiff score <100 denotes characteristics that are less important to the patient, while a score >100 signifies characteristics of higher importance.
There were 9,802 patients meeting all study criteria, of which 219 completed a patient survey. Survey patients were 56 years old on average, 82% were female, 89% were white, and 51% had at least a 4-year college degree. 29% of patients were currently taking etanercept, while the next most common treatments were adalimumab (22%), infliximab (17%), and abatacept (12%).
The MaxDiff results identified that the 3 most important characteristics of RA treatment were related to the efficacy of the treatment: ‘Keeps my disease from getting worse’ (MaxDiff score = 209), ‘Improves my physical abilities’ (199), and ‘Reduces Pain’ (195). ‘Potential side effects’ (117) and ‘How long treatment effects last’ (102) were neither relatively important or unimportant to the patients surveyed, while ‘How quickly (within a few weeks)’ treatment works (70) and ‘Personal costs’ (67) were seen as less important. The least important characteristics were those that identified the ‘how’, ‘when’, and ‘where’ of treatment administration: ‘How treatment is given (oral, injection, IV, etc.)’ (15), ‘How often treatment must be taken’ (13), and ‘Where treatment is given (home, doctor’s office, hospital, etc.)’ (13). Results were consistent across groups based on their current biologic therapy.
A separate question found that 75% of patients would like to take their medication at home if it were possible; however, the MaxDiff results show that relative to efficacy this is not a priority for patients. Additionally, when asked why patients stopped taking prior biologic therapy the statement ‘I didn’t feel that the drug was working’ was cited as a major reason 66% of the time, more than any other reason. ‘I don’t like needles’ and ‘I don’t like infusions’ were cited as major reasons for stopping therapy just 1% and 3% of the time, respectively; while the cost of treatment and side effects were a major reason 12% and 21% of the time, respectively.
Conclusion: The effectiveness of RA treatment is the most important attribute according to patients currently treated with biologic therapy, while administration characteristics were seen as relatively unimportant. Reducing symptoms, improving physical abilities, and slowing disease progression should be considered as primary outcomes in studies comparing RA treatments.
D. M. Kern,
A. E. Williams,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/preferences-of-biologic-treatment-characteristics-among-rheumatoid-arthritis-patients-who-are-current-biologic-therapy-users/