title: A discrete choice experiment to explore patients' willingness to risk disease relapse from treatment withdrawal in psoriatic arthritis.
abstract: The objective of this study is to assess patient preferences for treatment-related benefits and risk of disease relapse in the management of low disease states of psoriatic arthritis (PsA). Focus groups with patients and a literature review were undertaken to determine the characteristics of treatment and symptoms of PsA important to patients. Patient preferences were assessed using a discrete choice experiment which compared hypothetical treatment profiles of the risk and benefits of treatment withdrawal. The risk outcome included increased risk of disease relapse, while benefit outcomes included reduced sickness/nausea from medication and changes in health-related quality of life. Each patient completed 12 choice sets comparing treatment profiles. Preference weights were estimated using a logic regression model, and the maximum acceptable risk in disease relapse for a given improvement in benefit outcomes was elicited. Final sample included 136 patients. Respondents attached the greatest importance to eliminating severe side effects of sickness/nausea and the least importance to a change in risk of relapse. Respondents were willing to accept an increase in the risk of relapse of 32.6 % in order to eliminate the side effects of sickness/nausea. For improvements in health status, the maximum acceptable risk in relapse was comparable to a movement from some to no sickness/nausea. The study suggests that patients in low disease states of PsA are willing to accept greater risks of relapse for improvements in side effects of sickness/nausea and overall health status, with the most important benefit attribute being the elimination of severe sickness or nausea.
authors: Centre for Health Economics, University of York, York, YO10 5DD, UK. claire.rothery@york.ac.uk.
authors: Claire
authors: C
authors: Rothery
authors: Centre for Health Economics, University of York, York, YO10 5DD, UK.
authors: Laura
authors: L
authors: Bojke
authors: Centre for Health Economics, University of York, York, YO10 5DD, UK.
authors: Gerry
authors: G
authors: Richardson
authors: Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK.
authors: Chris
authors: C
authors: Bojke
authors: Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, University of Leeds, Leeds, UK.
authors: Anna
authors: A
authors: Moverley
authors: Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, University of Leeds, Leeds, UK.
authors: Laura
authors: L
authors: Coates
authors: Bradford Institute for Health Research, Bradford, UK.
authors: Liz
authors: L
authors: Thorp
authors: Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, University of Leeds, Leeds, UK.
authors: Robin
authors: R
authors: Waxman
authors: Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, University of Leeds, Leeds, UK.
authors: Philip
authors: P
authors: Helliwell
mesh_terms: D000328:Adult; D015535:Arthritis, Psoriatic / Q000523:psychology* / Q000628:therapy*; D002755:Choice Behavior; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011788:Quality of Life; D012008:Recurrence; D012044:Regression Analysis; D012219:Rheumatology / Q000379:methods; D012306:Risk; D016896:Treatment Outcome; D028761:Withholding Treatment
keywords: Discrete choice experiment; Patient preferences; Psoriatic arthritis; Relapse risk