Preferences for COVID-19 Vaccination in People With Chronic Immune-Mediated Inflammatory Diseases

Glen S Hazlewood; Ines Colmegna; Carol Hitchon; Paul R Fortin; Sasha Bernatsky; Ann E Clarke; Dianne Mosher; Todd Wilson; Megan Thomas; Claire E H Barber; Mark Harrison; Nick Bansback; Laurie Proulx; Dawn P Richards; Gilaad G Kaplan

doi:10.3899/jrheum.220697

Preferences for COVID-19 Vaccination in People With Chronic Immune-Mediated Inflammatory Diseases

J Rheumatol. 2023 Jul;50(7):949-957. doi: 10.3899/jrheum.220697. Epub 2023 Jan 15.

Authors

Glen S Hazlewood¹, Ines Colmegna², Carol Hitchon³, Paul R Fortin⁴, Sasha Bernatsky², Ann E Clarke⁵, Dianne Mosher⁵, Todd Wilson⁶, Megan Thomas⁷, Claire E H Barber⁵, Mark Harrison⁸, Nick Bansback⁹, Laurie Proulx¹⁰, Dawn P Richards¹⁰, Gilaad G Kaplan¹¹

Affiliations

¹ G.S. Hazlewood, MD, PhD, A.E. Clarke, MD, D. Mosher, MD, C.E.H. Barber, MD, PhD, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia; gshazlew@ucalgary.ca.
² I. Colmegna, MD, S. Bernatsky, MD, PhD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec.
³ C. Hitchon, MD, MSc, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba.
⁴ P.R. Fortin, MD, Division de Rhumatologie, Departement de Medecine, CHU de Quebec, and Centre de Recherche ARThrite, Universite Laval, Quebec City, Quebec.
⁵ G.S. Hazlewood, MD, PhD, A.E. Clarke, MD, D. Mosher, MD, C.E.H. Barber, MD, PhD, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia.
⁶ T. Wilson, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary.
⁷ M. Thomas, MSc, Arthritis Research Canada, and Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia.
⁸ M. Harrison, PhD, Arthritis Research Canada, and Pharmaceutical Sciences, and School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia.
⁹ N. Bansback, PhD, Arthritis Research Canada, and School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia.
¹⁰ L. Proulx, BCom, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Ontario.
¹¹ G.G. Kaplan, MD, MPH, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

PMID: 36642432
DOI: 10.3899/jrheum.220697

Abstract

Objective: To understand how people with chronic immune-mediated inflammatory diseases (IMIDs) trade off the benefits and risks of coronavirus disease 2019 (COVID-19) vaccine options.

Methods: We conducted an online discrete-choice experiment in people with IMIDs to quantify the relative importance (RI) of attributes relevant to COVID-19 vaccination. Participants were recruited between May and August 2021 through patient groups and clinics in Canada, and completed 10 choices where they selected 1 of 2 hypothetical vaccine options or no vaccine. The RI of each attribute was estimated and heterogeneity was explored through latent class analysis.

Results: The survey was completed by 551 people (89% female, mean age 46 yrs) with a range of IMIDs (inflammatory bowel disease [48%], rheumatoid arthritis [38%], systemic lupus erythematosus [16%]). Most had received 1 (94%) or 2 (64%) COVID-19 vaccinations. Across the ranges of levels considered, vaccine effectiveness was most important (RI = 66%), followed by disease flare (21%), rare but serious risks (9%), and number/timing of injections (4%). Patients would accept a risk of disease flare requiring a treatment change of ≤ 8.8% for a vaccine with a small absolute increase in effectiveness (10%). Of the 3 latent classes, the group with the greatest aversion to disease flare were more likely to be male and have lower incomes, but this group still valued effectiveness higher than other attributes.

Conclusion: Patients perceived the benefits of COVID-19 vaccination to outweigh rare serious risks and disease flare. This supports COVID-19 vaccine strategies that maximize effectiveness, while recognizing the heterogeneity in preferences that exists.

Keywords: COVID-19 vaccines; autoimmune diseases; inflammatory bowel diseases; patient preference; rheumatoid arthritis; systemic lupus erythematosus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 Vaccines* / therapeutic use
COVID-19* / prevention & control
Female
Humans
Immunomodulating Agents
Male
Symptom Flare Up
Vaccination

Substances

COVID-19 Vaccines
Immunomodulating Agents

Grants and funding

VR5-172684/CIHR/Canada