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Preferences for treatments to prevent rheumatoid arthritis in Canada and the influence of shared decision-making

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Abstract

Objective

To elicit and compare preferences of patients and first-degree relatives and rheumatologists for preventive treatments for rheumatoid arthritis, understand the influence of shared decision-making, and predict the probability of uptake of the preventive treatments currently being studied.

Methods

An online discrete choice experiment was completed by patients and their first-degree relatives and rheumatologists. Results were analysed using mixed logit model to estimate preferences for the key features of treatments. Preferences for features of treatments were used to predict the probability of uptake of seven preventive treatment options.

Results

A total of 108 potential recipients (78 patients and 30 of their first-degree relatives) and 39 rheumatologists completed the survey. Preferences of patients/first-degree relatives and rheumatologists were similar (shared decision-making was most important, followed by the risk of side effects and potential benefit), but subtle differences existed; rheumatologists placed greater importance on certainty in evidence than patients/first-degree relatives, who felt that how a treatment was taken was more important. Predicted uptake suggested that 38% (95% CI 19%, 58%) of patients/first-degree relatives would not take a preventive treatment, compared with 12% (95% CI − 4%, 27%) of rheumatologists. A consistent finding across all groups was a preference for non-biologic disease-modifying anti-rheumatic drugs.

Conclusion

Only relatively safe options for preventive treatment are likely to be acceptable to at-risk populations. This study of preventive treatments highlights that the preferences of physicians and recipients of treatment should take a central role in the design of clinical studies as well as in decisions to initiate treatments.

Key Points

• This paper is the first to compare preferences for preventive treatments between rheumatologists and patients and at-risk individuals.

• The results of this study indicate that patients and at-risk individuals, as well as rheumatologists, are likely to prefer the safest options as preventive treatment, even if the potential benefit of these is lower.

• Although preferences of patients and at-risk individuals are similar to those of rheumatologists, the choice of preventive treatment may differ between groups; this is important as shared decision-making was a critical factor in treatment decision-making.

• Preferences of physicians and recipients of treatment should take a central role in the design of clinical studies as well as in decisions to initiate treatments.

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Funding

This research was funded by a 2015 Canadian Initiative for Outcomes in Rheumatology cAre (CIORA) grant. Mark Harrison is supported by a Young Investigator Salary Award 2016 from The Arthritis Society (YIS-16-104) and a Michael Smith Foundation for Health Research Scholar Award 2017 (#16813). Mark Harrison held the UBC Professorship in Sustainable Health Care, which between 2014 and 2017 was funded by Amgen Canada, AstraZeneca Canada, Eli Lilly Canada, GlaxoSmithKline, Merck Canada, Novartis Pharmaceuticals Canada, Pfizer Canada, Boehringer Ingelheim (Canada), Hoffman-La Roche, LifeScan Canada, and Lundbeck Canada.

Author information

Authors and Affiliations

  1. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada

    Mark Harrison & Magda Aguiar

  2. Centre for Health Evaluation and Outcome Sciences (CHEOS), St. Paul’s Hospital, Vancouver, Canada

    Mark Harrison & Nick Bansback

  3. Arthritis Research Canada, Richmond, Canada

    Mark Harrison, Nick Bansback & Kam Shojania

  4. School of Population and Public Health, University of British Columbia, Vancouver, Canada

    Nick Bansback

  5. Arthritis Consumer Experts/JointHealth, Vancouver, Canada

    Cheryl Koehn

  6. Division of Rheumatology, University of British Columbia, Vancouver, Canada

    Kam Shojania

  7. Division of Rheumatology, University of Geneva, Geneva, Switzerland

    Axel Finckh

  8. Division of Rheumatology, and Department of Medicine, Jewish General Hospital and Lady Davis Institute, McGill University, Montreal, QC, Canada

    Marie Hudson

Authors
  1. Mark Harrison
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  2. Nick Bansback
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  3. Magda Aguiar
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  4. Cheryl Koehn
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  5. Kam Shojania
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  6. Axel Finckh
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  7. Marie Hudson
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Corresponding author

Correspondence to Mark Harrison.

Ethics declarations

The study was approved by the University of British Columbia’s Behavioural Research Ethics Board (H15-01948).

Conflict of interest

MHa and MHu report grants from CIORA during the conduct of the study. All other authors have nothing to disclose. KS reports the local PI of an investigator-initiated study of abatacept for granulomatosis with polyangiitis (ABROGATE).

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Appendix

Appendix

Table 4 Attribute levels selected to represent each preventive treatment option 
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Harrison, M., Bansback, N., Aguiar, M. et al. Preferences for treatments to prevent rheumatoid arthritis in Canada and the influence of shared decision-making. Clin Rheumatol 39, 2931–2941 (2020). https://doi.org/10.1007/s10067-020-05072-w

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  • DOI: https://doi.org/10.1007/s10067-020-05072-w

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