Purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) used to manage osteoarthritis (OA) can differ in their benefit and risk profiles. Shared-decision making requires that informed OA patients choose among these options, yet little is known about patient preferences for NSAIDs. We estimated the preferences for NSAIDs among a sample of OA patients from the UK and tested for differences in defined patient subgroups.
Methods: We applied a conjoint analysis across relevant benefits (ambulatory pain, resting pain, stiffness, and difficulty doing daily activities) and risks (bleeding ulcer, stroke, heart attack, and hypertension) of NSAIDS in a sample of OA patients aged >44 y recruited from a chronic disease panel. Respondents randomly received one of four blocks of 10 forced-choice, paired-comparison conjoint choice tasks drawn from an efficiency experimental design. Preferences were estimated via a mixed-effects logit and differences in standardized preference weights - ranging from least preferred (0) to most preferred (10) - were assessed by subgroups defined by age and current medication use.
Results: Of the 294 patients who met eligibiity criteria, 65% were female, 62% married. 56% were diagnosed with OA >4y and had an average age of 59y. 76% were on prescription OA medications, 49% had hypertension and 36% were using PPIs. Patients ranked ambulatory pain (6.32; 95% CI 5.0- 7.6) and difficulty doing daily activities (6.32; 95% CI 5.0- 7.6) as the most important benefit followed by resting pain (2.80, 95% CI 1.8-3.8), and stiffness (2.65; 95% CI .9-4.4). Incremental changes (3%) in the risk of heart attack or stroke were assessed as the most important risk (10.00; 95% CI 8.2-11.8; and 8.90; 95% CI 7.3-10.5, respectively). A 2.5% incremental change in one-year ulcer risk (3.61; 95% CI2.6-4.6) and the risk of hypertension (3.02; 95% CI 2.8-3.2) were valued less. Overall we identified no significant differences in preferences across subgroups, but patients with hypertension weighed CV risks higher and patients on PPIs placed less weight on the risk of ulcer.
Conclusions: Patients do have well defined preferences across NSAID-related benefits and risks. These preferences can be estimated and used to examine acceptable tradeoffs between benefits and risks. The observed differences in defined subgroups serve to validate our results, but need to be more rigorously examined in a larger sample of OA patients.
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