title: Are adult patients more tolerant of treatment risks than parents of juvenile patients?
abstract: Understanding patient-specific differences in risk tolerance for new treatments that offer improved efficacy can assist in making difficult regulatory and clinical decisions for new treatments that offer both the potential for greater effectiveness in relieving disease symptoms, but also risks of disabling or fatal side effects. The aim of this study is to elicit benefit-risk trade-off preferences for hypothetical treatments with varying efficacy and risk levels using a stated-choice (SC) survey. We derive estimates of "maximum acceptable risk" (MAR) that can help decisionmakers identify welfare-enhancing alternatives. In the case of children, parent caregivers are responsible for treatment decisions and their risk tolerance may be quite different than adult patients' own tolerance for treatment-related risks. We estimated and compared the willingness of Crohn's disease (CD) patients and parents of juvenile CD patients to accept serious adverse event (SAE) risks in exchange for symptom relief. The analyzed data were from 345 patients over the age of 18 and 150 parents of children under the age of 18. The estimation results provide strong evidence that adult patients and parents of juvenile patients are willing to accept tradeoffs between treatment efficacy and risks of SAEs. Parents of juvenile CD patients are about as risk tolerant for their children as adult CD patients are for themselves for improved treatment efficacy. SC surveys provide a systematic method for eliciting preferences for benefit-risk tradeoffs. Understanding patients' own risk perceptions and their willingness to accept risks in return for treatment benefits can help inform risk management decision making.
authors.affiliation: Research Triangle Institute, Research Triangle Park, NC, USA. frjohnson@rti.org
authors.forename: F Reed
authors.initials: FR
authors.lastname: Johnson
authors.forename: Semra
authors.initials: S
authors.lastname: Ozdemir
authors.forename: Carol
authors.initials: C
authors.lastname: Mansfield
authors.forename: Steven
authors.initials: S
authors.lastname: Hass
authors.forename: Corey A
authors.initials: CA
authors.lastname: Siegel
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Sands
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003424:Crohn Disease / Q000503:physiopathology* / Q000628:therapy*; D003657:Decision Making; D003661:Decision Support Techniques; D006801:Humans; D015233:Models, Statistical; D010342:Patient Acceptance of Health Care; D012306:Risk; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome