Original Contribution

Inflammatory Bowel Disease

Optimizing Selection of Biologics in Inflammatory Bowel Disease: Development of an Online Patient Decision Aid Using Conjoint Analysis

  • The American Journal of Gastroenterology volume 113, pages 5871 (2018)
  • doi:10.1038/ajg.2017.470
  • Download Citation
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Abstract

Objectives:

Recent drug approvals have increased the availability of biologic therapies for inflammatory bowel disease (IBD), making it difficult for patients with ulcerative colitis (UC) and Crohn’s disease (CD) to navigate treatment options. Here we developed a conjoint analysis to examine patient decision-making surrounding biologic medicines for IBD. We used the results to create an online patient decision aid that generates a unique “preferences report” for each patient to assist with shared decision-making with their provider.

Methods:

We administered an adaptive choice-based conjoint survey to IBD patients that quantifies the relative importance of biologic attributes (e.g., efficacy, side effect profile, mode of administration, and mechanism of action) in decision making. The conjoint software determined individual patient preferences by calculating part-worth utilities for each attribute. We conducted regression analyses to determine if demographic and disease characteristics (e.g., type of IBD and severity) predicted how patients made decisions.

Results:

640 patients completed the survey (UC=304; CD=336). In regression analyses, demographics and IBD characteristics did not predict individual patient preferences; the main exception was IBD type. When compared to UC, CD patients were more likely to report side effect profile as most important (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.16–2.30). Conversely, those with UC were more likely to value therapeutic efficacy (OR 1.41, 95% CI 1.01–2.00).

Conclusions:

Biologic decision-making is highly personalized; demographic and disease characteristics poorly predict individual preferences, indicating that IBD patients are unique and difficult to statistically categorize. The online decision tool resulting from this study (www.ibdandme.org) may be used by patients to support shared decision-making and optimize personalized biologic selection with their provider.

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Acknowledgements

We would like to thank and acknowledge Loren C. Karp for her project management and support.

Author information

Affiliations

  1. Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA

    • Christopher V Almario
    • , Michelle S Keller
    • , Michelle Chen
    •  & Brennan M R Spiegel
  2. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA

    • Christopher V Almario
    • , Michelle S Keller
    • , Michelle Chen
    •  & Brennan M R Spiegel
  3. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA

    • Christopher V Almario
    • , Gil Y Melmed
    •  & Brennan M R Spiegel
  4. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California, USA

    • Christopher V Almario
    • , Michelle S Keller
    •  & Brennan M R Spiegel
  5. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA

    • Michelle S Keller
    • , Michelle Chen
    •  & Brennan M R Spiegel
  6. Takeda Pharmaceuticals U.S.A., Inc., Deerfield, Illinois, USA

    • Karen Lasch
    • , Lyann Ursos
    •  & Julia Shklovskaya
  7. F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA

    • Gil Y Melmed

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Competing interests

Guarantor of the article: Brennan M.R. Spiegel, MD, MSHS.

Specific author contributions: Christopher V. Almario: study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; administrative, technical, or material support; study supervision. Michelle S. Keller: study design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; administrative, technical, or material support. Michelle Chen: analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; administrative, technical, or material support. Karen Lasch: study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; obtained funding; administrative, technical, or material support. Lyann Ursos: study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; obtained funding; administrative, technical, or material support. Julia Shklovskaya: study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; obtained funding; administrative, technical, or material support. Gil Y. Melmed: study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content. Brennan M.R. Spiegel: study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; obtained funding; study supervision.

Financial support: This study was funded by Takeda Pharmaceuticals, USA. The Cedars-Sinai Center for Outcomes Research and Education (CS-CORE) is supported by The Marc and Sheri Rapaport Fund for Digital Health Sciences and Precision Health. Dr Almario is supported by a career development award from the American College of Gastroenterology. Access to the MIRIAD research panel email database was provided by the Cedars-Sinai MIRIAD IBD Biobank, which is supported by the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, NIH/NIDDK grants P01DK046763, DK062413, and U54 DK102557, and The Leona M. and Harry B. Helmsley Charitable Trust.

Potential competing interests: Drs Lasch and Ursos and Ms. Shklovskaya are employees of Takeda Pharmaceuticals USA. Dr Melmed has received consulting fees from Abbvie, Celgene, Genentech, Jannsen, Luitpold, Medtronic, Pfizer, Samsung Bioepis, Takeda, and UCB, and research funding from Prometheus Labs and Shire Pharmaceuticals. The remaining authors do not have any relevant disclosures.

Corresponding author

Correspondence to Brennan M R Spiegel.

Supplementary information

SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg