Treatment options in knee osteoarthritis: the patient's perspective.
BACKGROUND
The objectives of this study were to (1) examine patient treatment preferences for knee osteoarthritis, (2) determine the influence of specific medication characteristics on patients' choices, and (3) examine whether patient preferences are consistent with current practice.


METHODS
A total of 100 consecutive patients with symptomatic knee osteoarthritis completed an interactive computer questionnaire administered during a face-to-face interview. We measured the relative impact of specific medication characteristics (including administration, risks, benefits, and cost) on patients' choice, and the percentage of patients preferring nonselective nonsteroidal antiinflammatory drugs (NSAIDs), cyclooxygenase-2 inhibitors, glucosamine and/or chondroitin sulfate, opioid derivatives, and capsaicin across varying risks, benefits, and costs.


RESULTS
Of the characteristics studied, variation in the risk of common adverse effects and gastrointestinal ulcer had the greatest impact on patients' choice. Assuming patients are responsible for the full cost of their medications, over 40% prefer capsaicin. Cyclooxygenase-2 inhibitors become patients' preferred choice only if they are described as being 3 times as effective as capsaicin and are covered by insurance. Nonselective NSAIDs are among the least preferred options across all simulations.


CONCLUSIONS
When evaluating multiple alternatives, many older patients with knee osteoarthritis are willing to forgo treatment effectiveness for a lower risk of adverse effects. The patient treatment preferences derived in this study conflict with the current widespread use of nonselective NSAIDs in older patients with arthritis.
Fraenkel
Liana
L
Veterans Affairs Connecticut Healthcare System, West Haven, USA. liana.fraenkel@yale.edu
Bogardus
Sidney T
ST
Concato
John
J
Wittink
Dick R
DR
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D002211:Capsaicin / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy* / Q000191:economics; D017060:Patient Satisfaction; D010437:Peptic Ulcer / Q000139:chemically induced / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D002211:Capsaicin