Assessing Patient Decision-Making on Biologic and Small-Molecule Therapies in Inflammatory Bowel Diseases: Insights From a Conjoint Analysis in the United States, Canada and the United Kingdom

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.


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.

© Copyright 2013-2024 GI Health Foundation. All rights reserved.
This site is maintained as an educational resource for US healthcare providers only. Use of this website is governed by the GIHF terms of use and privacy statement.