Background Evidence suggests that treatment of people at risk of rheumatoid arthritis (RA) with anti-rheumatic drugs could prevent the onset of disease, and there are ongoing randomized controlled trials on the efficacy of preventing RA. However even if these trials are successful, there will be uncertainty around the potential benefits of these programs in practice; namely, the ability to predict those at risk of RA, exact benefits and risks, and inconvenience of treatment.
Objectives To determine the features of a preventative treatment program that are likely to be acceptable to pre-symptomatic people at high risk of RA. Our focus is on preferences for treatment, the values and most important attributes of a preventative treatment program, and the likely uptake of preventative treatment. In this pilot study we sought general population preferences.
Methods A discrete choice experiment was administered to a US general population sample, asking participants to choose between sets of 2 hypothetical preventative RA treatments, then between their preferred treatment and “no treatment for now”. The treatment (risk of developing RA, how treatment is taken, chance of side effects, certainty in estimates, health care provider's opinion) and test attributes (chance test is wrong, who recommends treatment) were identified in focus groups with RA patients, first-degree relatives of RA patients and rheumatologists. An efficient experimental design was developed using SAS and included 2 consistency checks. Responses were analyzed using a conditional logit regression model to estimate the significance and relative importance of attributes in influencing preferences.
Results 201 respondents completed the survey. The majority of the sample was 25–54 years old (modal age category: 30–39 years (38%)) and 50% were female. 23 members (11%) reported having a physician diagnosis of RA, and 91 (45%) had a family member or close friend with RA. All attributes' levels significantly influenced treatment preferences, but risk reduction, how treatment is taken, and health care provider preference were most influential. Respondents were most willing to trade a reduction in risk of RA for a treatment preferred by their health care professional and an oral route of administration. Respondents had a similar strength of preference for reducing uncertainty in evidence and reducing the risk of side effects. The preferred preventative treatment was chosen over no treatment in 67% of choices.
Conclusions Our survey suggests that people value the potential benefits of treatments, but equally values how the treatment is taken and the preference of their health care provider. The degree of confidence in the estimates of a treatment's risks and benefits is as important to people as the risk of side effects. The uptake of a preventative strategy will depend on these key factors. This evidence will help policymakers understand whether different preventative treatment strategies are likely to be acceptable to people they are offered to.
Acknowledgements This work was supported by a grant from the Canadian Rheumatology Association through the Canadian Initiative for Outcomes in Rheumatology Care (CIORA).
Disclosure of Interest None declared