PATIENTS' PREFERENCES FOR TREATMENT OF HEPATITIS C

Background: Because treatment for hepatitis C (HCV) is associated with uncertain benefits and significant risks of toxicity, decisions should incorporate patients’ treatment preferences. The objective of this study was to ascertain patient preferences for treatment of HCV and to determine which treatment characteristics most strongly impact on patients’ choices.

Methods: We recruited consecutive patients eligible for treatment of HCV and used Adaptive Conjoint Analysis (ACA) to elicit preferences for pegylated-interferon and ribavirin. Preferences were measured for two choices: 1. Treatment associated with mild side effects versus no treatment, and 2. Treatment associated with severe side effects versus no treatment.

Results: Subjects’ median strength of preference was 87% for HCV treatment associated with mild side effects and 55% for HCV treatment associated with severe side effects. Preferences for treatment of HCV were stronger among women, and subjects with a higher perceived risk of developing cirrhosis, more severe liver disease, worse HCV-related quality of life, and greater trust in their physician. In contrast, those with greater decisional conflict had weaker preferences for treatment. The proportion of subjects choosing treatment was strongly associated with the degree of underlying liver disease. The absolute decrease in the percent of subjects choosing treatment when side effects were increased from mild to severe was 24% for subjects with mild or no fibrosis, and 16% for those with moderate fibrosis. Increasing severity of side effects had no effect on the proportion of subjects with cirrhosis choosing treatment, with the vast majority (93%) of patients in this category preferring treatment regardless of the risk of toxicity.

Conclusions: Whether or not to choose treatment for HCV is a difficult decision for many patients. Treatment is usually recommended for those with moderate to severe liver disease and our results demonstrate that most patients’ preferences are concordant with this view. How to proceed for patients with mild disease, however is less clear, and depends primarily on patients’ preferences. ACA may represent a useful tool for clinicians to integrate patient preferences into the treatment decision.