Preferences for fractures and other glucocorticoid-associated adverse effects among rheumatoid arthritis patients

Objective. The objective of this study was to determine rheumatoid arthriti s (RA) patients' preferences for validated health state scenarios depicting glucocorticoid adverse events, predictors of these preferences, and psycho metric properties of different preference techniques in this population. Me thods. Preferences were elicited by rating scale and time trade-off methods . Time trade-offs included trading current health for either time spent ali ve in an adverse health state for chronic conditions (time trade-off) or ti me spent in a sleeplike state for acute conditions (sleep trade-off). Resul ts. A total of 107 subjects with long-standing RA participated in the prefe rence interviews. Mean preference values (rating scale-trade-off) were lowe st for serious fracture adverse events, including hip fracture requiring a nursing home stay (0.55 +/- 0.22/0.76 +/- 0.36) and vertebral fracture with chronic pain (0.59 +/- 0.23/0.67 +/- 0.35), and highest for cataracts (0.8 4 +/- 0.17/0.96 +/- 0.09) and wrist fracture (0.82 +/- 0.18/0.81 +/- 0.29). Rating scales had a stronger correlation (r=0.88) with physician ranking o f scenarios than trade-off methods (r=0.31). All methods were feasible and demonstrated good reliability, while rating scale method showed better cons truct validity than trade-off techniques. Conclusion. Relative to their cur rent health, RA patents assigned low preference values to many glucocortico id adverse events, particularly those associated with chronic fracture outc omes. Results varied with the preference measure used, indicating that meth odological attributes of preference determinations must be considered in cl inical decision making.