CORTICOSTEROIDS IN PATIENTS WITH RHEUMATO ID-ARTHRITIS - UTILITY MEASUREMENTS FOR EVALUATING RISKS AND BENEFITS

The purpose of this study was to use the utility approach to evaluate the risks and benefits of corticosteroid therapy in rheumatoid arthrit is patients. The utility approach provides us with a quantitative meas ure of the value or preference a patient attaches to his overall healt h status defined on a scale from perfect health (1) to death (0). Bene fits and toxicity are combined into a number reflecting the patients c ombined assessment of the benefits of treatment and the side-effects a ssociated with it. Utility of 3 scenarios (rheumatoid arthritis patien ts treated respectively with no, 5 mg/day and 15 mg/day of prednisone) were determined through the time trade-off (TTO) and thermometer scal e (TS) techniques. Twenty-five rheumatoid arthritis patients selected at random among subjects attending an outpatient clinic and 25 rheumat ologists were interviewed using visual aids. Treatment with 15 mg/d pr ednisone was assigned the highest utilities by both patients and physi cians. Coefficients of correlation between thermometer scale and time trade-off utilities were 0.675 (p<0.01) for physician-assigned utiliti es and 0.518 (p<0.05) for patient-assigned utilities. Medical decision s concerning rheumatoid arthritis patients should take into account th e preferences of patients and physicians.