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Preferences for Fractures and Other Glucocorticoid-Associated Adverse Effects among Rheumatoid Arthritis PatientsDepartment of Internal Medicine, University of Iowa, Iowa City
Smith Kline Beecham & Co., Collegeville, Pennsylvania
Parke-Davis & Co., Ann Arbor, Michigan
Department of Internal Medicine, University of Iowa, Iowa City
Department of Epidemiology, University of Iowa, Iowa City
Division of General Medical Sciences, Washington University, St. Louis, Missouri
Department of Medicine and Center for Education and Research on Therapeutics (CERTs) of Musculoskeletal Disorders, University of Alabama at Birmingham
Department of Medicine and Center for Education and Research on Therapeutics (CERTs) of Musculoskeletal Disorders, University of Alabama at Birmingham Objective. The objective of this study was to determine rheumatoid arthritis (RA) patients’ preferences for validated health state scenarios depicting glucocorticoid adverse events, predictors of these preferences, and psychometric properties of different preference techniques in this population. Methods. Preferences were elicited by rating scale and time trade-off methods. Time trade-offs included trading current health for either time spent alive in an adverse health state for chronic conditions (time trade-off) or time spent in a sleeplike state for acute conditions (sleep trade-off). Results. A total of 107 subjects with long-standing RA participated in the preference interviews. Mean preference values (rating scale/trade-off) were lowest for serious fracture adverse events, including hip fracture requiring a nursing home stay (0.55 ± 0.22/0.76 ± 0.36) and vertebral fracture with chronic pain (0.59 ± 0.23/0.67 ± 0.35), and highest for cataracts (0.84 ± 0.17/0.96 ± 0.09) and wrist fracture (0.82 ± 0.18/0.81 ± 0.29). Rating scales had a stronger correlation (r= 0.88) with physician ranking of scenarios than trade-off methods (r = 0.31). All methods were feasible and demonstrated good reliability, while rating scale method showed better construct validity than trade-off techniques. Conclusion. Relative to their current health, RA patients assigned low preference values to many glucocorticoid adverse events, particularly those associated with chronic fracture outcomes. Results varied with the preference measure used, indicating that methodological attributes of preference determinations must be considered in clinical decision making.
Key Words: preference measurement • time trade-off • rheumatoid arthritis • glucocorticoids • osteoporosis • health-related quality of life
Medical Decision Making, Vol. 21, No. 2,
122-132 (2001) This article has been cited by other articles:
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