PMS68 PHYSICIANS' STATED PREFERENCES OVER BENEFITS AND RISKS ASSOCIATED WITH NSAID USE IN PATIENTS WITH OSTEOARTHRITIS IN UNITED KINGDOM

Abstract

PMS68 PHYSICIANS’ STATED PREFERENCES OVER BENEFITS AND RISKS ASSOCIATED WITH NSAID USE IN PATIENTS WITH OSTEOARTHRITIS IN UNITED KINGDOM Bridges JF, Taylor SD, Arden N, Hauber AB, Johnson FR, Watson D, Mavros P, Pellissier JM, Peloso P, Sen S, Mohamed A, Gonzalez JM Johns Hopkins University, Baltimore, MD, USA; Merck & Co., Inc., Whitehouse Station, NJ, USA; University of Southampton, Southampton, UK, UK; RTI Health Solutions, Research Triangle Park, NC, USA; MRL, Whitehouse Station, NJ, USA BACKGROUND: Treatments for symptom control in osteoarthritis (OA) confer varying degrees of benefi ts alongside medication-related risks. Physicians’ preferences over benefi ts and risks of NSAIDS are an important aspect of understanding clinical practice. OBJECTIVES: To estimate physicians’ preferences over benefi ts and risks associated with NSAID use in the management of OA and examine differences in preferences between general practitioners (GPs) and specialists. METHODS: Participating physicians treated at least 10 OA patients per-month. Each physician was randomized to receive one of four blocks of discrete-choice questions; each block consisting of 12 paired choice tasks comparing treatment profi les. Treatment profi les were defi ned by four benefi ts (ambulatory pain, resting pain, stiffness, diffi culty doing daily activities) and four medication-related risks (bleeding ulcer, stroke, heart attack, hypertension), each varying across four clinically meaningful levels. Elicitation of preferences was facilitated using standardized patient profi les systematically varying by age, co-morbid conditions and clinically relevant risks of NSAIDs. Preference weights were estimated using mixed-effects logistic regression and were standardized on a 0–10 (low-high) importance scale. RESULTS: 477 physicians participated (61% GPs, 39% specialists). Reductions in ambulatory pain and diffi culty doing daily activities were the most important effi cacy variables (6.45; 95%CI:4.8–8.2) followed by eliminating resting pain (3.18; 95%CI:1.9–4.5) and stiffness (2.79; 95%CI:1.5–4.1). Ambulatory pain was twice as important as resting pain or stiffness (P < 0.05). Risk of heart attack was the most important medication-related risk outcome (10.00; 95%CI:7.6–12.4) followed by stroke (9.42; 95%CI:7.2–11.6), ulcer risk (4.62; 95%CI:3.5–5.7) and hypertension (3.25; 95%CI:3.2–3.4). There were no statistically signifi cant differences in preferences between GPs and specialists. CONCLUSIONS: Ambulatory pain and the incremental risk of heart attack were the most important NSAID-related attributes that infl uence physicians’ treatment choices. Preferences did not vary between GPs and specialists. The fi ndings confi rm that benefi t-risk tradeoffs are important aspects in treament selection for OA management.