Patients’ Preferences for Treatment of Hepatitis C

Abstract

Background. The objective of this study was to ascertain patient preferences for treatment of hepatitis C virus (HCV). Methods. The authors recruited consecutive patients eligible for treatment of HCV and used adaptive conjoint analysis (ACA), a hybrid approach of conjoint analysis that uses both self-explicated ratings and pair-wise comparisons, to elicit preferences for pegylated-interferon and ribavirin. They examined the association between patient characteristics and treatment preferences using the Mann-Whitney U test and χ2 statistic for continuous and categorical variables, respectively, and subsequently calculated adjusted odds ratios and 95% confidence intervals using logistic regression. Results. A total of 140 subjects completed the ACA task. The mean (±SD) age of the sample was 51±8 y; 85% were male, and 59% were white. When described as being associated with mild side effects, 67% (n = 94) of subjects preferred treatment for HCV. The percentage of subjects preferring therapy decreased to 51% (n = 72) when it was described as being associated with severe side effects. Preferences for treatment of HCV were stronger among subjects with a higher perceived risk of developing cirrhosis, more severe underlying liver disease, and worse HCV-related quality of life. Subjects having more severe disease placed greater weight on the importance of expected benefits and less on the risk of toxicity compared with those with mild or no fibrosis. Conclusions. Whether to choose treatment for HCV is a difficult decision for many patients. Treatment is usually recommended for those with moderate to severe liver disease, and these results demonstrate that most patients’ preferences are concordant with this practice. Key words: hepatitis C; decision making; pegylated-interferon; ribavirin. (Med Decis Making 2010;30:45—57)