Inflamm Bowel Dis. 2021 Oct 18;27(10):1593-1601. doi: 10.1093/ibd/izaa311.

Devin B Patel ¹, Welmoed K van Deen ^1 2, Christopher V Almario ^1 2 3 4, Carine Khalil ^2 5, Esther Warui ², Nirupama Bonthala ^1 3 6, Gil Y Melmed ^1 3 6 7, Brennan M R Spiegel ^{1 2 3 4 8}

Author information

• ¹Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
• ²Cedars-Sinai Center for Outcomes Research and Education, Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA.
• ³Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA.
• ⁴Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
• ⁵Paris Descartes University, LIRAES, Paris, France.
• ⁶Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.
• ⁷F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
• ⁸Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.

Abstract

Background: Recent drug approvals have increased the number of therapies available for inflammatory bowel disease (IBD), making it difficult for patients to navigate available treatment options. We examined patient decision-making surrounding biologic and small-molecule therapies in an international cohort of patients from the United States, Canada, and the United Kingdom using conjoint analysis (CA), a form of tradeoff analysis examining how respondents make complex decisions.

Methods: We performed a CA survey that quantified the relative importance of therapy attributes (eg, efficacy, adverse effects) in decision-making. Patients with IBD were recruited from the general population and through specialty IBD clinics. We used a hierarchical Bayes analysis to model individual patients' preferences and compared the relative importance of medication attributes between countries and practice settings. Using a series of multivariable linear regression models, we assessed whether demographic and clinical characteristics (eg, IBD subtype, severity) predicted how patients made decisions.

Results: Overall, 1077 patients in 3 countries completed the survey. No differences in the relative importance of medication attributes were observed between the 3 countries' general IBD populations. However, efficacy was more important for patients in the US-based IBD specialty care cohort than for the general IBD population (29% and 23% importance, respectively; P < 0.0001). A few demographic and clinical characteristics were associated with small changes in individual preferences.

Conclusions: In this large international CA study, patients prioritized efficacy as the most important therapeutic attribute. Decision-making seemed to be highly personalized in that therapeutic preferences were hard to predict based on patient characteristics.