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Original research
What benefit–risk trade-offs are acceptable to rheumatoid arthritis patients during treatment selection? Evidence from a multicountry choice experiment
  1. Rieke Alten1,
  2. Juan Carlos Nieto-Gonzalez2,
  3. Peggy Jacques3,
  4. Carlomaurizio Montecucco4,
  5. Robert Moots5,6,
  6. Helga Radner7,
  7. Harald E Vonkeman8,9,
  8. Sebastian Heidenreich10,
  9. Chiara Whichello10,
  10. Nicolas Krucien10 and
  11. Katrien Van Beneden11
  1. 1Schlosspark Klinik, University Medicine Berlin, Berlin, Germany
  2. 2Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  3. 3Department of Rheumatology and VIB Inflammation Research Center, University Hospital Ghent, Ghent, Belgium
  4. 4Division of Rheumatology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  5. 5Department of Rheumatology, Aintree University Hospital, Liverpool, UK
  6. 6Faculty of Health, Care and Medicine, Edge Hill University, Ormskirk, UK
  7. 7Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria
  8. 8Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
  9. 9Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
  10. 10Evidera Inc, London, UK
  11. 11Galapagos NV, Mechelen, Belgium
  1. Correspondence to Dr Rieke Alten; rieke.alten{at}schlosspark-klinik.de

Abstract

Objective Understanding preferences of patients with rheumatoid arthritis (RA) can facilitate tailored patient-centric care. This study elicited trade-offs that patients with RA were willing to make during treatment selection.

Methods Patients with RA completed an online discrete choice experiment, consisting of a series of choices between hypothetical treatments. Treatment attributes were selected based on literature review and qualitative patient interviews. Eligible patients were ≥18 years old, diagnosed with RA, receiving systemic disease-modifying antirheumatic drug therapy, and residents of Europe or USA. Male patients were oversampled for subgroup analyses. Data were analysed using a correlated mixed logit model.

Results Of 2090 participants, 42% were female; mean age was 45.2 years (range 18–83). Estimated effects were significant for all attributes (p<0.001) but varied between patients. Average relative attribute importance scores revealed different priorities (p<0.001) between males and females. While reducing pain and negative effect on semen parameters was most important to males, females were most concerned by risk of blood clots and serious infections. No single attribute explained treatment preferences by more than 30%. Preferences were also affected by patients’ age: patients aged 18–44 years placed less importance on frequency and mode of treatment administration (p<0.05) than older age groups. Patients were willing to accept higher risk of serious infections and blood clots in exchange for improvements in pain, daily activities or administration convenience. However, acceptable trade-offs varied between patients (p<0.05).

Conclusion Treatment preferences of patients with RA were individual-specific, but driven by benefits and risks, with no single attribute dominating the decision-making.

  • arthritis, rheumatoid
  • antirheumatic agents
  • therapeutics

Data availability statement

Data are available on reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Twitter @JCNietoGon

  • Contributors KVB, SH, CW and NK were responsible for the planning and conduct of the work described in this manuscript. SH, CW and NK were responsible for data collection and analysis. All authors contributed to the writing and review of this manuscript. KVB is responsible for the overall content as guarantor.

  • Funding This study was funded by Galapagos NV (Mechelen, Belgium).

  • Competing interests RA, consultancy fees from AbbVie, Amgen, Biogen, Bristol Myers Squibb, Celltrion, Gilead, Janssen, Lilly, Medac, MSD, Mylan, Novartis, Pfizer, Roche, Sandoz, Sanofi-Genzyme, UCB, VIATRIS. JCNG, consultancy fees from Lilly, Janssen, Amgen, GSK, AbbVie, Galápagos, MSD; speakers fees from MSD, Pfizer, BMS, AbbVie, UCB Pharma, Janssen, Lilly, Faes Farma, Roche, Celgene, Sanofi, Nordic Pharma, Gebro, Novartis, Biogen, Amgen, Sandoz. PJ, grants support from Pfizer and Roche; speakers fees from Eli Lilly; support for meeting attendance from Galapagos. CM, consultancy fees from BMS, AbbVie, Gilead; speakers fees from BMS, AbbVie, Eli Lilly, Pfizer, Boehringer, Galapagos, Sanofi, Roche. RM, grant support from Novartis; consultancy fees from Ferring; speakers fees from Amgen and Galapagos. HR, speakers fees from Gilead Science, Merck Sharp; Pfizer Cooperation Austria, Janssen. HEV, grants from Galapagos, Boehringer Ingelheim; speakers fees from Galapagos, AbbVie, Boehringer Ingelheim, Novartis, Pfizer, UCB, Janssen. SH, employee of Evidera Inc, which is part of Thermo Fisher Scientific's Clinical Research Group; Evidera received payment for conducting the work outlined in this manuscript; SH is a minority stockholder of Thermo Fisher Scientific, as part of his employment with Evidera. CW, employee of Evidera Inc, which is part of Thermo Fisher Scientific's Clinical Research Group; Evidera received payment for conducting the work outlined in this manuscript. NK, employee of Evidera Inc, which is part of Thermo Fisher Scientific's Clinical Research Group; Evidera received payment for conducting the work outlined in this manuscript; NK is a minority stockholder of Thermo Fisher Scientific, as part of his employment with Evidera. KVB, employee and shareholder of Galapagos NV.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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