Shared decision-making for biologic treatment of autoimmune disease: influence on adherence, persistence, satisfaction, and health care costs

Abstract

Background Shared decision-making (SDM), a process whereby physicians and patients collaborate to select interventions, is not well understood for biologic treatment of autoimmune conditions. Methods This was a cross-sectional survey of adults initiating treatment for Crohn’s disease or ulcerative colitis (inflammatory bowel disease, IBD) or psoriatic arthritis or rheumatoid arthritis (RA/PA). Survey data were linked to administrative claims for 6 months before (baseline) and after (follow-up) therapy initiation. Measures included the Shared Decision Making Questionnaire, Patient Activation Measure (PAM), Morisky Medication Adherence Scale (MMAS), general health, and treatment satisfaction. Claims-based Quan-Charlson comorbidity scores, persistence, medication possession ratio (MPR), and health care costs were examined. Patients were compared by participation (SDM) and nonparticipation (non-SDM) in SDM. Results Among 453 respondents, 357 were eligible, and 306 patients (204 RA/PA and 102 IBD) were included in all analyses. Overall (n=357), SDM participants (n=120) were more often females (75.0% vs 62.5%, P =0.018), had lower health status (48.0 vs 55.4, P =0.005), and higher Quan–Charlson scores (1.0 vs 0.7, P =0.035) than non-SDM (n=237) participants. Lower MMAS scores (SDM 0.17 vs non-SDM 0.41; P <0.05) indicated greater likelihood of adherence; SDM participants also reported higher satisfaction with medication and had greater activation (PAM: SDM vs non-SDM: 66.9 vs 61.6; P <0.001). Mean MPR did not differ, but persistence was longer among SDM participants (111.2 days vs 102.2 days for non-SDM; P =0.029). Costs did not differ by SDM status overall, or among patients with RA/PA. The patients with IBD, however, experienced lower ( P =0.003) total costs ($9,404 for SDM vs $25,071 for non-SDM) during follow-up. Conclusion This study showed greater likelihood of adherence and satisfaction for patients who engaged in SDM and reduced health care costs among patients with IBD who engaged in SDM. This study provides a basis for defining SDM participation and detecting differences by SDM participation for biologic treatment selection for autoimmune conditions.

Real‐world evidence on adherence, persistence, switching and dose escalation with biologics in adult inflammatory bowel disease in the United States: A systematic review

“…The studies varied in terms of methodology, data sources (eg database study vs single‐centre chart review), population (eg CD vs IBD; prior exposure to biologics), follow‐up time (exactly 6 months to a median of 22 months) and the definition of adherence. In six studies, adherence was measured by medication possession ratio (MPR), which is calculated by adding up the total days’ supply of a drug administered during a defined follow‐up period, which can be fixed (eg 365 days) or variable (start to end of therapy), and dividing by the total number of days in that period . Three studies adopted the commonly used adherence threshold MPR of ≥80% to define adherence, one study used a SAS macro programme to determine an optimal MPR threshold of ≥86% and two studies reported average MPR of the entire cohort .…”

“…In the four studies that used an MPR threshold to define adherence, the overall proportion of adherent patients ranged from 38% to 77% (percentage of non‐adherent patients, 23%‐62%) . Among two studies reporting the average MPR of the entire patient cohort, adherence ranged from 89.7% to 97.4% …”

“…The two studies reporting adherence for patients with CD enrolled biologic‐naive patients . Of the six IBD studies, two included biologic‐naive patients, one included biologic‐experienced patients and one included a mixed patient population; prior biologic use was unclear in two studies . In the only study that enrolled a population with mixed percentages of prior biologic use (32% of the patients were biologic‐naive and 68% had a history of prior biologic use), outcomes were not presented by line of biologic therapy.…”

Safety, Effectiveness, and Treatment Persistence of Golimumab in Elderly Patients with Rheumatoid Arthritis in Real-World Clinical Practice in Japan

“…In fact, shared decisionmaking, as part of a successful treat-to-target approach [10,42], has been reported to improve patient satisfaction and adherence to medication in autoimmune diseases, allowing patients to achieve optimal management of their condition [48][49][50]. In addition, effective communication between a treating physician and a patient will enable the physician to promptly identify any potential AEs, ultimately leading to desirable clinical outcomes.…”

Improving Shared Decision Making Between Patients and Clinicians: Design and Development of a Virtual Patient Simulation Tool (Preprint)

“…The case of Montgomery v Lanarkshire Health Board highlighted that patients need to be involved in their own care, in particular that they should have a say in their own treatment [7]; merely doing what professional's think is in the patient's best interest is not sufficient, the process of decision making has to be shared and the patient's own preferences established. SDM with patients who were initiating treatment for inflammatory bowel disease was shown to increase patient satisfaction, the likelihood of adherence to therapy, and a reduction in costs [8]. Reduction in prescribing [9], increased patient satisfaction [10] and greater patient confidence in decisions made [11,12] have all been reported.…”