Patients with steroid-refractory ulcerative colitis face a difficult treatment decision between colectomy and therapy with infliximab or cyclosporine.
Dr Dr Fabio Cominelli and colleagues from Virginia determined how individual patient preferences for treatment outcomes influence the optimal treatment decision for a given patient.
The team used a Markov model to simulate treatment with total colectomy with an ileo pouch-anal anastomosis, cyclosporine, infliximab, and infliximab followed by cyclosporine for treatment failures.
Utility weights for treatment outcomes were elicited from 48 patients using both time trade-off and visual rating scale methods.
|A third of patients may benefit most from immediate colectomy|
|Clinical Gastroenterology & Hepatology|
The researchers applied preference sets to the model to identify the therapy that maximized quality-adjusted life years for each patient.
Sensitivity analyses were performed to assess model robustness.
The researchers found that optimal treatment was highly variable among patients.
However, when average preference weights from the team's sample were applied to the model, medical treatments were superior to total colostomy.
Dr Cominelli's team concluded, “Patient preferences have a clear impact on the optimal treatment for steroid-refractory ulcerative colitis.”
“Although averaged preferences support the use of medical interventions, a third of individual patients may benefit most from proceeding directly to colectomy.”
“Failure to fully assess individual preferences may result in suboptimal treatment for these patients.”