Skip Navigation LinksHome > January 2014 - Volume 20 - Issue 1 > Patient Preferences for Surgical Versus Medical Therapy for...
Inflammatory Bowel Diseases:
doi: 10.1097/01.MIB.0000437498.14804.50
Original Clinical Articles

Patient Preferences for Surgical Versus Medical Therapy for Ulcerative Colitis

Bewtra, Meenakshi MD, MPH*,†; Kilambi, Vikram BS; Fairchild, Angelyn O. BA; Siegel, Corey A. MD, MS§; Lewis, James D. MD, MSCE*,†; Johnson, F. Reed PhD

Collapse Box

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.

Copyright © 2013 Crohn's & Colitis Foundation of America, Inc.

You currently do not have access to this article.

You may need to:

Note: If your society membership provides for full-access to this article, you may need to login on your society’s web site first.

Login

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.