Patient preferences for surgical versus medical therapy for ulcerative colitis.

Abstract

BACKGROUND:

Therapy options for mesalamine-refractory ulcerative colitis (UC) include immunosuppressive medications or surgery. Chronic immunosuppressive therapy increases risks of infection and cancer, whereas surgery produces a permanent change in bowel function. We sought to quantify the willingness of patients with UC to accept the risks of chronic immunosuppression to avoid colectomy.

METHODS:

We conducted a state-of-the-art discrete-choice experiment among 293 patients with UC who were offered a choice of medication or surgical treatments with different features. Random parameters logit was used to estimate patients' willingness to accept trade-offs among treatment features in selecting surgery versus medical treatment.

RESULTS:

A desire to avoid surgery and the surgery type (ostomy versus J-pouch) influenced patients' choices more than a specified range of 10-year mortality risks from lymphoma or infection, or disease activity (mild versus remission). To avoid an ostomy, patients were willing to accept a >5% 10-year risk of dying from lymphoma or infection from medical therapy, regardless of medication efficacy. However, data on patients' stated choice indicated perceived equivalence between J-pouch surgery and incompletely effective medical therapy. Patient characteristics and disease history influenced patients' preferences regarding surgery versus medical therapy.

CONCLUSIONS:

Patients with UC are willing to accept relatively high risks of fatal complications from medical therapy to avoid a permanent ostomy and to achieve durable clinical remission. However, patients view J-pouch surgery, but not permanent ileostomy, as an acceptable therapy for refractory UC in which medical therapy is unable to induce a durable remission.

• Authors: Meenakshi Bewtra, Vikram Kilambi, Angelyn O Fairchild, Corey A Siegel, James D Lewis, F Reed Johnson
• Journal: Inflammatory bowel diseases (Inflamm Bowel Dis) Vol. 20 Issue 1 Pg. 103-14 (Jan 2014) ISSN: 1536-4844 [Electronic] England
• PMID: 24280881 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Immunosuppressive Agents

Topics

• Colectomy
• Colitis, Ulcerative (drug therapy, psychology, surgery)
• Colonic Pouches
• Female
• Follow-Up Studies
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Ostomy
• Patient Preference
• Prognosis
• Risk Factors