Do Patient Preferences Influence Decisions on Treatment for Patients With Steroid- Refractory Ulcerative Colitis?  Kristen O. Arseneau, Shahnaz Sultan, Dawn T. Provenzale, Jane Onken, Stephen J. Bickston, Eugene Foley, Alfred F. Connors, Fabio Cominelli  Clinical Gastroenterology and Hepatology  Volume 4, Issue 9, Pages 1135-1142 (September 2006) DOI: 10.1016/j.cgh.2006.05.003 Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 1 Schematic outline of the Markov model treatment strategies. The 4 treatment strategies for steroid-refractory ulcerative colitis included (1) total colectomy with an ileo pouch–anal anastomosis (TC/IPAA); (2) continuous cyclosporine infusion (8 mg/kg/h), with colectomy for treatment failures or disease relapse (CSA); (3) infliximab infusion (5 mg/kg), with colectomy for treatment failures and reinfusion for disease relapse (INFLX); and (4) infliximab (5 mg/kg), with cyclosporine for treatment failures or disease relapse (INFLX→CSA). Clinical Gastroenterology and Hepatology 2006 4, 1135-1142DOI: (10.1016/j.cgh.2006.05.003) Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 2 Variation in optimal treatment among individual patients. The optimal treatment decision varied substantially among the 48 ulcerative colitis patients interviewed. Between 1/4 and 1/3 of the patients maximized their QALYs by proceeding directly to total colectomy. (A) Optimal treatment based on time trade-off–derived utility weights. (B) Optimal treatment based on visual rating scale–derived utility weights. Clinical Gastroenterology and Hepatology 2006 4, 1135-1142DOI: (10.1016/j.cgh.2006.05.003) Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 3 Frequency of optimal treatment in probabilistic sensitivity analysis. Uncertain parameters were estimated as a distribution in the probabilistic sensitivity analysis. Each distribution was sampled 200 times for each of 200 simulations per patient. The robustness of the optimal treatment decision for each individual patient is represented by the proportion of simulations in which the treatment maximized QALYs. Clinical Gastroenterology and Hepatology 2006 4, 1135-1142DOI: (10.1016/j.cgh.2006.05.003) Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 4 Varying optimal treatment by infliximab response rate. For the average case, optimal treatment was highly dependent on the true infliximab response rate. Sensitivity analysis showed that for the average steroid- refractory ulcerative colitis patient, cyclosporine was superior to infliximab alone for the entire range of reported infliximab response rates, and infliximab with cyclosporine for treatment failures was superior to cyclosporine alone only when the true response rate was >72%. Clinical Gastroenterology and Hepatology 2006 4, 1135-1142DOI: (10.1016/j.cgh.2006.05.003) Copyright © 2006 American Gastroenterological Association Terms and Conditions