Are Care Givers More Risk Averse Than Patients? Acceptable Tradeoffs between Efficacy and Adverse-Event Risks
- Presenter:
Chair: James Burgess; Discussant: TBA Tue June 6, 2006 10:45-12:15 Room 213
Understanding patients’ own risk perceptions and their willingness to accept risks in return for treatment benefits can help inform risk-management decision making. In the case of children, parent caregivers are responsible for treatment decisions and their risk tolerance may be quite different than adult patients’ risk tolerance.
This study compares utility-theoretic estimates of adult patients’ and parents’ willingness to accept adverse event risks in return for increased treatment efficacy for the treatment of an inflammatory bowel disease (IBD). There are a number of medications used to treat symptoms of IBD. However, treatments vary in efficacy and may be associated with risks of serious adverse events including death from tuberculosis, polyomavirus infection, and lymphoma. Treatment decisions thus often require weighing treatment efficacy against adverse-event risks.
Stated-choice (SC) or choice-format conjoint analysis is increasingly being used by health economists to quantify the relative importance of treatment processes and outcomes. SC methods postulate that the utility a person derives from a product or service can be expressed as a function of the positive and negative features of the product or service. The pattern of observed choices among a series of hypothetical treatment and outcome comparisons reveals the implicit relative importance of each attribute and marginal rates of substitution among attributes. The estimated marginal rates of substitution between efficacy and adverse-event risks facilitate calculating maximum acceptable risk (MAR) for various changes in health states.
This study used a pretested SC instrument to elicit patients’ and parents’ preferences for a range of treatment attributes, including various levels of both the benefits and risks of the treatments. The analyzed data were from 345 patients over the age of 18 and 150 parents of a child under the age of 18. Survey subjects were randomly sampled from a large internet panel.
We found that both patients and parents are willing to accept adverse-event risks in return for treatment efficacy. Risk tolerance increases with larger improvements in treatment efficacy and varies by the type of adverse-event risk. We find significant differences between MARs of patients and parents. Parents are more risk averse and have MARs about half as large as patients. Patients with more severe symptoms have higher MARs, but this is not the case for parents whose child has more severe symptoms.
These results confirm that caregivers and patients have different risk perceptions. Parents are more cautious about exposing their child to health risks, which is consistent with previous studies. Nevertheless, both parents and patients are willing to accept some risk in return for increased efficacy. These results may help inform clinical and regulatory decision making, as well as help identify more effective risk-management strategies.
