This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (21)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Osteoarthritis  • Alert me on articles by topic  Social Bookmarking   What's this?

The Patient's Perspective

Liana Fraenkel, MD, MPH; Sidney T. Bogardus, Jr, MD; John Concato, MD, MS, MPH; Dick R. Wittink, PhD

Arch Intern Med. 2004;164:1299-1304.

Background  The objectives of this study were to (1) examine patient treatment preferences for knee osteoarthritis, (2) determine the influence of specific medication characteristics on patients' choices, and (3) examine whether patient preferences are consistent with current practice.

Methods  A total of 100 consecutive patients with symptomatic knee osteoarthritis completed an interactive computer questionnaire administered during a face-to-face interview. We measured the relative impact of specific medication characteristics (including administration, risks, benefits, and cost) on patients' choice, and the percentage of patients preferring nonselective nonsteroidal antiinflammatory drugs (NSAIDs), cyclooxygenase-2 inhibitors, glucosamine and/or chondroitin sulfate, opioid derivatives, and capsaicin across varying risks, benefits, and costs.

Results  Of the characteristics studied, variation in the risk of common adverse effects and gastrointestinal ulcer had the greatest impact on patients' choice. Assuming patients are responsible for the full cost of their medications, over 40% prefer capsaicin. Cyclooxygenase-2 inhibitors become patients' preferred choice only if they are described as being 3 times as effective as capsaicin and are covered by insurance. Nonselective NSAIDs are among the least preferred options across all simulations.

Conclusions  When evaluating multiple alternatives, many older patients with knee osteoarthritis are willing to forgo treatment effectiveness for a lower risk of adverse effects. The patient treatment preferences derived in this study conflict with the current widespread use of nonselective NSAIDs in older patients with arthritis.

From the Veterans Affairs Connecticut Healthcare System, West Haven (Drs Fraenkel and Concato); Department of Medicine, Yale University, New Haven, Conn (Drs Fraenkel, Bogardus, and Concato); and School of Management, Yale University (Dr Wittink). The authors have no relevant financial interest in this article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTER

Capsaicin Cream Unpopular With Patients
Daniel Reinharth
Arch Intern Med. 2005;165(6):702.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

How redesigning AD clinical trials might increase study partners' willingness to participate
Karlawish et al.
Neurology 2008;71:1883-1888.
ABSTRACT | FULL TEXT  

Acupuncture for osteoarthritis of the knee
DTB 2007;45:76-79.
ABSTRACT | FULL TEXT  

Capsaicin Cream Unpopular With Patients
Reinharth
Arch Intern Med 2005;165:702-702.
FULL TEXT