Understanding why rheumatoid arthritis patient treatment preferences differ by race

Abstract

Background Rheumatoid arthritis (RA) patient preferences may account for some of the variability in treatment amongst different racial groups. How and why treatment preferences differ by race is not well understood. We sought to determine whether Black and White RA patients differ in how they evaluate the specific risks and benefits related to medications. Methods 136 RA patients completed a conjoint analysis interactive computer survey to determine how they valued the specific risks and benefits related to treatment characteristics. We calculated the importance that respondents assigned to each characteristic and the ratio of the importance that patients attached to overall benefit versus overall risk. Subjects having a risk ratio of less than one were classified as being risk averse. Results The mean age of the study sample was 55 years (range 22–84), 49% were Black and 51% were White. Black subjects assigned the greatest importance to the risk of cancer, whereas White subjects were most concerned with the likelihood of remission and halting radiographic progression. Fifty-two percent of Black subjects were found to be risk averse compared to 12% of the White subjects (p<0.0001). Race remained strongly associated with risk aversion [adjusted odds ratio (95% CI) = 8.4 (3.1 – 23.1)] after adjusting for relevant covariates. Conclusions Black patients attach greater importance to the risks of toxicity and less importance to the likelihood of benefit than their White counterparts. Effective risk communication and improved understanding of expected benefits may help decrease unwanted variability in healthcare.

Patients' Willingness to Trade Off Between the Duration and Frequency of Rheumatoid Arthritis Treatments

“…These results are consistent with RA patients being concerned with the total amount of time spent receiving treatment. These results are also consistent with previous studies' findings that treatment frequency and mode of administration may be at least as important as treatment response rate and the risk of treatment-related side effects (7)(8)(9). However, by varying frequency and duration independently in the experimental design, our study was the first that allowed the estimation of preferences for both of these treatment attributes.…”

“…Three previous conjoint analyses of patient preferences for RA treatments found that the mode and frequency of administration matter to RA patients and may be at least as important as treatment response rate and the risk of treatment side effects (7)(8)(9). All 3 of these studies measured preferences for combinations of mode of administration and treatment frequency, but none of the studies evaluated patients' preferences for treatment duration or their willingness to trade off between treatment duration and frequency.…”

Parents' preferences for drug treatments in juvenile idiopathic arthritis: A discrete choice experiment

“…This finding is also consistent with preferencebased studies in RA that observed the primacy of treatment effectiveness over other outcomes such as safety, convenience, and cost (23,24). Novel findings from this study show that greater disease durations and experiences with various drug treatments are associated with stronger preferences for improved participation and older child age is associated with a stronger preference for reduced pain.…”

“…Despite a number of published studies examining patients' preferences for drug treatments in rheumatoid arthritis (RA) (21)(22)(23)(24)(25)(26)(27)(28)(29), few have looked at parents' preferences for drug treatments in JIA. Barron et al (30) focused on parents' preferences for nonsteroidal antiinflammatory drug (NSAID) treatments in JIA, using contingent valuation to examine parents' willingness to pay for a drug that leads to remission over one that eliminates gastrointestinalrelated side effects.…”

Health care transition counseling for youth with arthritis: Comment on the article by Scal et al

“…There is an urgent need to develop the evidence base to support developments in transitional care (1). We therefore welcome the article by Scal et al on transition counseling recently published in Arthritis Care & Research (2).…”