Original articleDo Patient Preferences Influence Decisions on Treatment for Patients With Steroid-Refractory Ulcerative Colitis?
Section snippets
Markov Model
A Markov model was created to simulate the decision for patients with steroid-refractory ulcerative colitis to undergo one of the following treatments: (1) total colectomy with an ileo pouch–anal anastomosis (TC/IPAA); (2) continuous cyclosporine infusion (8 mg/kg/hr), with colectomy for treatment failures or disease relapse (CSA); (3) infliximab infusion (5 mg/kg), with colectomy for treatment failures and reinfusion for disease relapse (INFLX); or (4) infliximab (5 mg/kg) with cyclosporine
Individual Cases
Utility weights were obtained from 48 patients with ulcerative colitis treated at the University of Virginia Health System and Duke University Medical Center (Table 1). In this group, the mean Inflammatory Bowel Disease Questionnaire score was 170, and the mean utility score for current health status was .77. When individual utility sets were applied to the model, optimal treatment choices were highly variable (Figure 2). Infliximab with cyclosporine for treatment failures and disease relapse
Discussion
The present study demonstrates that “optimal” treatment choices for steroid-refractory ulcerative colitis (defined as the treatment strategy that maximizes a patient’s quality-adjusted life expectancy) vary among individual patients and are dependent on each patient’s personal preference for the possible treatment outcomes. Within our sample of ulcerative colitis patients, 63% maximized their QALYs through medical treatment with infliximab and/or cyclosporine, whereas 37% benefited most from
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Supported by a Senior Research Award from the Crohn’s and Colitis Foundation of America.