January 31, 2014
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UC patients preferred high-risk medical therapy over permanent ostomy

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Surveyed patients with ulcerative colitis preferred to receive medical therapy as a means to sustain clinical remission, and any associated risks for fatal complications, than to undergo permanent ostomy in a recent study.

Using a novel discrete-choice experiment (DCE), 293 patients (mean age, 47 years; 57% women) with ulcerative colitis (UC) who visited participating outpatient gastroenterology clinics completed and returned mail surveys. Patients’ mean UC duration was 13 years, 54% of patients currently or previously used immunosuppressants, and more than half were in remission. The surveys allowed for patients’ preferences of varying strengths and trade-offs in choosing between medical and surgical interventions for UC.

“Discrete choice may be thought of as the state-of-the-art method to illicit patient preferences,” Meenakshi Bewtra, MD, MPH, PhD, assistant professor of medicine and epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, told Healio.com. “Prior work using standard-gamble and time-trade-off methodologies have not shown a willingness to accept surgery among UC patients. Our novel findings therefore illustrate the need for rigorous methodologies to accurately assess patient preferences for therapies.”

Bewtra

Meenakshi Bewtra

Bewtra and colleagues wrote that patients’ preferences to avoid surgery and the type of surgery, either J-pouch or ostomy, were more influential in their choices than disease activity (mild vs. remission) or a range of 10-year mortality risks from infection or lymphoma. Patients were willing to face a 0.5% increase in the risk for dying from medication-related lymphoma during 10 years if they achieved complete remission as opposed to having ostomy. Patients also indicated an equal preference, however, between not fully effective medical therapy that resulted in mild disease activity for 10 years and J-pouch surgery.

“This is the first DCE examining UC patients’ preferences regarding life-threatening adverse events from medical therapy, surgical options and symptom relief in UC,” Bewtra said. “We found that UC patients are willing to accept high levels of risk for serious adverse events from medical therapy to avoid an ostomy. However, if a durable remission cannot be achieved, patients were equally satisfied with J-pouch surgery and mildly active disease.”

Matthew Galella

Disclosure: See the study for a full list of relevant financial disclosures.