Impact of disease severity and gastrointestinal side effects on the health state preferences of patients with osteoarthritis

Abstract Objective To describe the health state preferences of patients with osteoarthritis (OA) according to the level of pain and disability and the extent of gastrointestinal side effects from nonsteroidal antiinflammatory drugs (NSAIDs). Methods Using combinations of 5 OA health states (4 specifying medication use) and 6 gastrointestinal side effect profiles, we developed 25 scenarios. In an Internet survey, adults with OA evaluated 5 randomly chosen health state–side effect scenarios (in addition to scenarios for congestive heart failure and wearing dentures, as benchmarks). They rated the scenarios on a 0–100 scale, in which 100 corresponds to best imaginable health. Unadjusted mean ratings were calculated using a difference‐in‐difference approach. A generalized linear model was used to estimate the effects of disease severity and side effect severity on the ratings, after controlling for patient characteristics. Results A total of 4,386 respondents whose mean age was 55.3 years, of whom 3,107 (70.8%) were women and 4,007 (91.4%) were white, completed the survey. Mean adjusted ratings for health state–side effect scenarios ranged from 94.9 for the mildest scenario to 25.3 for the most severe scenario. Severity of NSAID side effects had a greater negative influence on the ratings in milder OA states than in more severe OA states. Ratings were lower among men ( P < 0.001) and among respondents with OA pain in the previous 24 hours ( P < 0.001). Disease severity had a greater effect on ratings than did side effect severity. Conclusion Patients consider pain and functional limitations associated with OA to be important determinants of well‐being. Future research should attempt to determine whether patients prefer reductions in their OA‐related pain and disability over improvements in treatment side effect profiles.