AlHarbi O, Farsakh NA, Al-Awadhi A, Al-Taweel T, Mikhail I, Batwa F, Bedran K, Balkan D, Cappelleri JC, Boeri M, Habjoka S, Mosli M. Patient preferences for ulcerative colitis treatment in the middle east region: results from a discrete-choice experiment. Poster presented at the 2022 Digestive Disease Week; May 21, 2022. San Diego, CA.


BACKGROUND: Patients with ulcerative colitis (UC) often begin treatment with 5-aminosalicylic acid (5-ASA), a safe and effective therapy for mild-to-moderate UC. When 5-ASA therapy is inadequate, other treatments such as corticosteroids, immunosuppressants, and advanced/biologic therapies are available. These treatments differ in various aspects (safety, efficacy, route of administration), making treatment decisions a preference-sensitive choice. However, little is known about how patients value these differences, and no study to date has explored patient preferences for moderate-to-severe UC treatment in Middle Eastern countries.

METHODS: This study was adapted to replicate in clinical sites in 5 Middle Eastern countries (Saudi Arabia, Kuwait, Jordan, United Arab Emirates, and Lebanon) a discrete-choice experiment (DCE) previously conducted in the United States (US). The DCE aimed to quantify treatment preferences in patients with moderate-to-severe UC. Respondents were asked to choose between experimentally designed profiles for hypothetical UC treatments that varied in efficacy (time until UC symptoms improve and chance that UC symptoms remain controlled after 1 year), side effects (annual risk of serious infection, 5-year risk of malignancy), mode and frequency of administration, and the need for occasional steroid use. A random-parameters logit model was used to estimate preference weights for these attributes. The survey also included the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), to measure respondent health-related quality of life.

RESULTS: A total of 307 adults with moderate-to-severe UC completed the survey. Average patient age was 36 years; 51% were female. Respondents had generally good quality of life, averaging 68% of the maximum SIBDQ score (Table 1). Figure 1 presents preference-weight estimates for each attribute level. The vertical distance between preference weights indicates the change in utility associated with the corresponding attribute levels. Higher weights are preferred, and a larger vertical distance between the least and most preferred attribute level indicates greater overall attribute importance. Better efficacy and lower risk were preferred, as expected. Oral tablets or intravenous infusions were preferred to subcutaneous injections, and respondents preferred avoiding the occasional use of steroids.

CONCLUSION: Patient respondents considered 5-year risk of malignancy and long-term (>1 year) symptom control the most important of the attributes considered. Given possible dosing schedules, patients generally preferred intravenous infusions at a doctor’s office and oral tablets at home to subcutaneous injections at home. Understanding patient preferences for attributes of treatments for moderate-to-severe UC can contribute to patient-physician shared decision making, facilitating the improvement of patient care.

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