Fraenkel Liana, Wittink Dick R, Concato John, Fried Terri
VA Connecticut Healthcare System, West Haven, Connecticut 06520-8031, USA.
J Rheumatol. 2004 Mar;31(3):591-3.
To test whether the widespread use of cyclooxygenase-2 (COX-2) inhibitors may be mediated in part by the certainty effect, i.e., by a perception that COX-2 inhibitors eliminate the risk of serious gastrointestinal (GI) events in contrast to merely reduce their risk.
Patients' preferences for conventional nonsteroidal antiinflammatory drugs (NSAID) and COX-2 inhibitors for treatment of arthritis were predicted across a range of absolute risks of GI events using an Adaptive Conjoint Analysis survey.
Preferences for COX-2 inhibitors were much stronger when the risk of serious GI events was eliminated in contrast to reduced, even though the absolute risk reduction (ARR) was the same. Few patients (22%) preferred COX-2 inhibitors when the risk associated with NSAID and COX-2 inhibitors was 4% and 2%, respectively (ARR = 2%). In contrast, the majority (90%) preferred COX-2 inhibitors when the risk associated with NSAID and COX-2 inhibitors was 2% and 0%, respectively (ARR = 2%). We obtained similar findings regardless of the ARR.
The willingness shown by older adults to pay for COX-2 inhibitors may reflect a misperception of the risk of toxicity associated with these medications.
检验环氧化酶-2（COX-2）抑制剂的广泛使用是否可能部分由确定性效应介导，即是否认为COX-2抑制剂能消除严重胃肠道（GI）事件的风险，而非仅仅降低其风险。
使用适应性联合分析调查，预测患者在一系列GI事件绝对风险下对传统非甾体抗炎药（NSAID）和COX-2抑制剂治疗关节炎的偏好。
与风险降低相比，当严重GI事件的风险被消除时，对COX-2抑制剂的偏好要强得多，尽管绝对风险降低（ARR）相同。当与NSAID和COX-2抑制剂相关的风险分别为4%和2%（ARR = 2%）时，很少有患者（22%）偏好COX-2抑制剂。相比之下，当与NSAID和COX-2抑制剂相关的风险分别为2%和0%（ARR = 2%）时，大多数患者（90%）偏好COX-2抑制剂。无论ARR如何，我们都得到了类似的结果。
老年人愿意为COX-2抑制剂付费可能反映出对这些药物毒性风险的误解。
