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A Bayesian model that jointly considers comparative effectiveness research and patients' preferences may help inform GRADE recommendations: an application to rheumatoid arthritis treatment recommendations
- Source :
- Journal of clinical epidemiology. 93
- Publication Year :
- 2016
-
Abstract
- Objectives The objective of the study was to estimate the preferred treatment for early rheumatoid arthritis using a novel Bayesian approach that jointly considers patients’ preferences and comparative effectiveness research. Study Design and Setting We estimated the preferred treatment using patients' preferences measured in a discrete-choice experiment to apply weights to benefit and harm outcomes from a network meta-analysis and other considerations (dosing, rare adverse events). Using Bayesian analyses, we considered the variability in patients' preferences and the imprecision in both patients’ preferences and the treatment effects; all key considerations in the Grading of Recommendations Assessment, Development, and Evaluation approach. Results We estimated that most patients in our population would prefer triple therapy as initial treatment (78%) or after an inadequate response to methotrexate (62%). The probability of choosing triple therapy as initial treatment was further from 50% (the point of indifference) for more patients, making our prediction more confident, and suggesting a stronger recommendation could be made. After an inadequate response to methotrexate, the choice was more split, suggesting a decision aid may be helpful. Conclusion Using a novel approach, we estimated that many patients with early rheumatoid arthritis may prefer triple therapy to other treatment options, in contrast to existing guidelines. This offers an approach that may help inform Grading of Recommendations Assessment, Development, and Evaluation treatment recommendations.
- Subjects :
- medicine.medical_specialty
Comparative Effectiveness Research
Epidemiology
Population
Bayesian probability
Comparative effectiveness research
Network Meta-Analysis
Bayesian inference
Arthritis, Rheumatoid
03 medical and health sciences
0302 clinical medicine
Medicine
Humans
030212 general & internal medicine
Dosing
education
Intensive care medicine
Adverse effect
Grading (education)
030203 arthritis & rheumatology
education.field_of_study
business.industry
Bayes Theorem
Patient Preference
medicine.disease
Surgery
Sulfasalazine
Methotrexate
Treatment Outcome
Rheumatoid arthritis
Antirheumatic Agents
Practice Guidelines as Topic
Drug Therapy, Combination
business
Hydroxychloroquine
Subjects
Details
- ISSN :
- 18785921
- Volume :
- 93
- Database :
- OpenAIRE
- Journal :
- Journal of clinical epidemiology
- Accession number :
- edsair.doi.dedup.....f3989c21cd5690dcaac67870d6ceb194