Assessing Drug Treatment Preferences of Patients with Crohn's Disease A Conjoint Analysis

Background: Patient preference has been recognized as being of increasing importance when choosing a drug therapy for chronic conditions for which there are no cures and for which long-term treatment is needed. Objective: To quantify treatment preferences and priorities of patients with Crohn's disease (CD). Methods: This was a prospective Internet-based survey of adult participants with moderate to severe CD who were recruited through two national survey panels in the US. The survey included questions about diagnostic and treatment histories, attitudes and perceptions related to CD, and CD therapy. In a discrete-choice-based conjoint exercise, respondents selected a preferred biologic treatment option from each of 16 pairs of drug profiles that systematically varied efficacy, convenience, and product history attributes. A hierarchical Bayes probit model was utilized to estimate respondent-level 'utility scores' for each of the attribute levels. In a separate exercise, respondents also directly ranked each specific attribute. Two-tailed tests were conducted to determine statistical significance at p < 0.05. Results: A total of 252 participants were surveyed, 202 (80%) of whom were biologic naive. Mean age was 44.1 years and mean disease duration was 11.6 years. The majority (71.8%) were female. In the conjoint exercise, the three attributes of greatest importance in accounting for patients' biologic therapy preference were (greater) proportion of patients achieving lasting remission, (decreased) frequency of medication administration, and (higher) proportion of patients responding in 2 weeks. In the direct ranking exercise, the proportion of CD patients achieving lasting remission was selected as the most important attribute by the most respondents (27%), followed by the proportion of CD patients responding in 2 weeks (23%). Conclusion: Achievement of lasting remission and a rapid clinical response were the biologic treatment characteristics highly valued by respondents in this survey. It is critical that physicians provide patients with balanced information regarding the benefits and risks, convenience, and medication history of each treatment option available to them in order for patients to make informed therapy choices that reflect their personal priorities.