DESCRIPTION (provided by applicant): Maureen Dubreuil, MD is a rheumatologist and Instructor of Medicine at Boston University School of Medicine (BUSM) whose research is focused on spondyloarthritis (SpA), an inflammatory arthritis that can cause fusion of the spine, leading to limitation in spinal mobility with resultant substantial disability. Her long-term goal s to identify management strategies that maximize SpA patients' satisfaction, function and quality of life, while minimizing adverse outcomes and costs. Dr. Dubreuil's proposed research will assess SpA treatment from the perspectives of patient preference and cost-effectiveness on a societal level. This work will i) improve treatment decision-making in SpA through greater understanding of the value that SpA patients place on symptom control and medication side effects, and ii) establish the cost-effectiveness of available SpA treatments in the US. The work will include SpA patient focus groups to determine factors that impact medication choice, and discrete choice experiments to quantify and prioritize treatment attributes of greatest importance to SpA patients. A cost-effectiveness analysis will compare treatment strategies, incorporating American SpA patient-derived values. The proposed research will advance the understanding of SpA treatment costs and benefits from both the American patient and societal perspectives, and will impact both shared decision-making and treatment policy. The research and training plan will take place primarily in the Clinical Epidemiology Unit at BUSM, a highly productive NIH-funded section that has trained many successful patient-oriented researchers. Co-primary mentors, Tuhina Neogi, MD, PhD, and Elena Losina, PhD, MSc, will guide Dr. Dubreuil's work based on their experience in conjoint analysis and epidemiology, and in cost-effectiveness, respectively. The training plan includes specific coursework and workshops in patient-reported outcomes and advanced cost effectiveness modeling, and participation in regular study calls with a group engaged in cost-effectiveness research. Dr. Dubreuil's professional development will be enhanced through regular Faculty Development and Clinical Research seminars, as well as consistent meetings with the co-primary mentors and advisors. The proposed research and career development plan will provide Dr. Dubreuil with the experience and skills necessary to become a successful independent clinical researcher in rheumatology with a focus in SpA.

PUBLIC HEALTH RELEVANCE: Spondyloarthritis is a form of arthritis that often affects the spine, causing inflammation and bone fusion, with substantial disability. This project will examine what factors are most important to American patients in choosing to start or continue different types of medication and how the different treatment options improve patients' quality of life compared to the costs to society. Furthermore, these studies will allow the applicant to obtain the training necessary to become an independent clinical investigator in patent-oriented research focused on improving the lives of millions of Americans suffering from spondyloarthritis.