Aristides Mike, Chen Jack, Schulz Mark, Williamson Eve, Clarke Stephen, Grant Kaye
M-TAG Pty Ltd, Sydney, New South Wales, Australia.
Pharmacoeconomics. 2002;20(11):775-84. doi: 10.2165/00019053-200220110-00006.
To estimate the willingness to pay for a new chemotherapy, raltitrexed (Tomudex trade mark ) over conventional therapy with fluorouracil plus leucovorin (FU-LV) from the perspective of patients with advanced colorectal cancer. The study was part of the product's reimbursement application in Australia.
The key differences relevant to patients between the two therapies, frequency of administration and severity of mouth ulceration, were used to develop a self-administered questionnaire. A relatively new technique to healthcare, that of conjoint analysis (CA), was used to estimate willingness to pay and strength of preference. A discrete choice CA was used. Analysis was via a logit model with adjustment for the cluster effect (or intra-patient correlation).
Oncology nurses served as proxies for patients with advanced colorectal cancer.
The participation rate was 87% (62/71) with questionnaires from 56 respondents eligible for analysis. The CA method generated a mean incremental willingness to pay of 745 Australian dollars (dollar A; dollars US 507) per cycle of chemotherapy, comprising dollars A 550 (dollars US 374) and dollars A 195 (dollars US 133) for the toxicity and administration improvements, respectively (1998 values). Both features were related to preference with independent odds of 6.87 and 1.98, respectively, however only the toxicity attribute was a significantly related to preference. Subscription to private health insurance was the only significant demographic predictor identified, however, the homogeneous income structure of the respondents seems likely to have masked any significant income effect.
This study highlights the advantages of using CA in healthcare, where new therapies or treatments are often composed of a number of attributes. The CA allows both strength of preference and willingness to pay for individual treatment attributes to be estimated and can be used to assign statistical significance to these parameters.
从晚期结直肠癌患者的角度评估，相较于传统的氟尿嘧啶加亚叶酸钙（FU-LV）疗法，患者对新型化疗药物雷替曲塞（商品名：拓优得）的支付意愿。该研究是该产品在澳大利亚报销申请的一部分。
使用两种疗法在给药频率和口腔溃疡严重程度方面与患者相关的关键差异，编制一份自填式问卷。采用一种医疗保健领域相对较新的技术——联合分析（CA）来评估支付意愿和偏好强度。使用离散选择CA。通过逻辑模型进行分析，并对聚类效应（或患者内相关性）进行调整。
肿瘤护理人员作为晚期结直肠癌患者的代理人。
参与率为87%（62/71），56份问卷符合分析条件。CA方法得出每个化疗周期的平均增量支付意愿为745澳元（1998年价值，相当于507美元），其中毒性改善方面为550澳元（374美元），给药改善方面为195澳元（133美元）。这两个特征均与偏好相关，独立比值分别为6.87和1.98，但只有毒性属性与偏好显著相关。唯一确定的显著人口统计学预测因素是购买私人医疗保险，然而，受访者收入结构的同质性似乎掩盖了任何显著的收入效应。
本研究突出了在医疗保健领域使用CA的优势，新疗法或治疗通常由多个属性组成。CA可以估计对个体治疗属性的偏好强度和支付意愿，并可用于确定这些参数的统计学显著性。
