title: A discrete-choice experiment of United Kingdom patients' willingness to risk adverse events for improved function and pain control in osteoarthritis.
abstract: OBJECTIVE
  To assess patient preferences for treatment-related benefits and risks associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the management of osteoarthritis (OA).
  
  
  METHODS
  Using a chronic-illness panel in the United Kingdom, patients 45 years or older with a self-reported diagnosis of OA were eligible to participate in the study. Patient preferences were assessed using a discrete-choice experiment that compared hypothetical treatment profiles of benefits and risks consistent with NSAID use. Benefit outcomes (ambulatory pain, resting pain, stiffness, and difficulty doing daily activities) were presented on a 0-to-100 mm scale. Risk outcomes (bleeding ulcer, stroke, and myocardial infarction [MI]) were expressed as probabilities over a fixed time period. Each patient answered 10 choice tasks comparing different treatment profiles. Preference weights were estimated using a random-parameters logit model.
  
  
  RESULTS
  Final sample included 294 patients. Patients ranked reductions in ambulatory pain and difficulty doing daily activities (both: 6.32; 95% confidence interval [CI]: 5.0-7.6) as the most important benefit outcomes, followed by reductions in resting pain (2.80; 95% CI: 1.8-3.8) and stiffness (2.65; 95% CI: 0.9-4.4). Incremental changes (3%) in the risk of MI or stroke were assessed as the most important risk outcomes (10.00; 95% CI: 8.2-11.8; and 8.90; 95% CI: 7.3-10.5, respectively).
  
  
  CONCLUSIONS
  Patients ranked ambulatory pain as a more important benefit than resting pain; likely due to its impact on ability to do daily activities. For a 25-mm reduction, patients were willing to accept four times the risk of MI in ambulatory pain vs resting pain.
authors.affiliation: Health Preference Assessment, RTI Health Solutions, Research Triangle Park, NC 27709-2194, USA. abhauber@rti.org
authors.forename: A B
authors.initials: AB
authors.lastname: Hauber
authors.forename: N K
authors.initials: NK
authors.lastname: Arden
authors.forename: A F
authors.initials: AF
authors.lastname: Mohamed
authors.forename: F R
authors.initials: FR
authors.lastname: Johnson
authors.forename: P M
authors.initials: PM
authors.lastname: Peloso
authors.forename: D J
authors.initials: DJ
authors.lastname: Watson
authors.forename: P
authors.initials: P
authors.lastname: Mavros
authors.forename: A
authors.initials: A
authors.lastname: Gammaitoni
authors.forename: S S
authors.initials: SS
authors.lastname: Sen
authors.forename: S D
authors.initials: SD
authors.lastname: Taylor
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use*; D002755:Choice Behavior; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010003:Osteoarthritis / Q000188:drug therapy* / Q000453:epidemiology*; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology; D010349:Patient Compliance / Q000523:psychology*; D018570:Risk Assessment; D012307:Risk Factors; D013276:Stomach Ulcer / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal