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UBC Theses and Dissertations

Risk-benefit tradeoffs for NSAIDs for the management of rheumatoid arthritis (RA)- a discrete choice experiment (DCE) Chen, Belinda Shin-Chieh


Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs that are used to reduce pain and inflammation in those with rheumatoid arthritis (RA). There are two types of NSAID drugs available for treating those with RA, nonselective NSAIDs and coxibs. Rofecoxib, is a coxib that was taken off the market due to evidence of an increased risk of cardiovascular events from the use of this drug relative to placebo. However, there are those who benefited from this drug and were willing to take the risk. Objective The primary objective of this study is to use a DCE to quantify the risk preferences of those with RA, i.e., how much potential risk they are willing to accept in order to gain a specified potential benefit. It is hypothesized that given greater potential benefit, those with RA will be willing to accept greater risk of AEs, in particular myocardial infarction and stroke, than what they are currently exposed to in their NSAIDs. Methodology The DCE requires the creation of a questionnaire-based survey that was administered online to a sample of RA patients. Discrete choice experimentation allows the elicitation of patients’ preference for different treatment attributes through paired choice scenarios where respondents are required to choose between treatment options based on the risks of adverse events and benefits associated with each treatment. Conclusions For those with RA, the benefits outweigh the risks. In particular, given greater chance of benefit with improvement in pain and function, RA patients are willing to accept a greater risk of ulcers, dyspepsia, myocardial infarction, and stroke than what is present in current and past NSAIDs. Increased knowledge of the risk preferences of those with RA may aid decision-makers in better-informed drug approval and withdrawal decisions, thereby preventing patients from losing access to potentially beneficial drugs.

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