Inflammatory Bowel Disease Patients' Willingness to Accept Medication Risk to Avoid Future Disease Relapse.
OBJECTIVE
Biomarkers, endoscopy and imaging tests can identify patients at increased risk for early recurrence of symptomatic inflammatory bowel disease (IBD). However, patients may be unwilling to accept additional medical therapy risks related to therapy escalation to avoid a future disease relapse. We sought to quantify IBD patients' willingness to accept medication risk to avoid future disease relapse.


METHODS
We conducted a discrete-choice experiment among 202 patients with IBD who were offered choices of therapies with varying risks of lymphoma and infection, and varying time to next IBD relapse. Random parameters logit was used to estimate patients' willingness to accept tradeoffs among treatment features in selecting medication therapy to avoid future disease relapse.


RESULTS
To avoid a disease relapse over the next 5 years, IBD patients were willing to accept an average of a 28% chance of a serious infection; and an average of 1.8% chance of developing lymphoma. These results did not significantly change when patients were offered 10 years until their next disease relapse, but were lower (11 and 0.7%, respectively) when offered 1.5 years until the next disease relapse. Patients with active disease symptoms were significantly less willing to accept medication risk for time in remission.


CONCLUSIONS
IBD patients are willing to accept high levels of lymphoma and serious infection risk to maintain disease remission. These preferences are congruent with the treatment paradigms emphasizing mucosal healing and early aggressive therapy and highlight patients' strong preferences for therapies resulting in durable remission of at least 5 years.
Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.|Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Meenakshi
M
Bewtra
RTI-HS, Research Triangle Institute, Research Triangle Park, North Carolina, USA.
Angelyn O
AO
Fairchild
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Erin
E
Gilroy
Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
David A
DA
Leiman
Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Caroline
C
Kerner
Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
F Reed
FR
Johnson
Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.|Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
James D
JD
Lewis
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002755:Choice Behavior; D004359:Drug Therapy, Combination; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007239:Infections / Q000453:epidemiology; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000517:prevention & control*; D008223:Lymphoma / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000706:statistics & numerical data; D012008:Recurrence; D012306:Risk; D013997:Time Factors
D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents