Lee W C, Joshi A V, Woolford S, Sumner M, Brown M, Hadker N, Pashos C L
Abt Associates Inc., Bethesda, MD 20814-5341, USA.
Haemophilia. 2008 May;14(3):454-65. doi: 10.1111/j.1365-2516.2008.01656.x. Epub 2008 Feb 15.
This study sought to identify attributes of treatment important to haematologists in making their decisions regarding optimal care for inhibitor patients in the United States. A conjoint analysis using a discrete choice experiment was conducted to elicit factors that are most important to haematologists. Twelve product attributes were chosen based on published literature and expert opinion: risk of human viral infections, possibility that the titre of the inhibitor may rise, reduction in the likelihood of dose-related thromboembolic events, the number of infusions required to stop haemorrhage, infusion preparation time, infusion time, infusion volume, time required to stop bleeding, time required to alleviate pain, prophylaxis use, ability to undergo major surgery and cost of medications. Thirty haematologists completed the questionnaires via face-to-face interviews at a scientific meeting in April 2006. Data were analysed using a multinomial logit model to obtain the relative importance of each attribute. Responding haematologists had considerable experience in treating haemophilia patients with inhibitors (average : 13 +/- 9 years). 'Time required to stop bleeding' was the most important factor affecting treatment decisions [relative importance (RI) = 16.3%]. Physicians also preferred treatments that resulted in quick pain relief [RI = 12.9%], reduced the possibility that the titre of inhibitor may rise [RI = 12.8%], required fewer number of infusions to stop a haemorrhage [RI = 12.7%] and reduced the risk of human viral infection [RI = 10.8%]. This study revealed that certain clinical outcomes attributes are the most preferred and important. These findings can assist decision makers in their assessments of optimal first-line care.
本研究旨在确定对于美国血液科医生在为有抑制物的患者做出最佳治疗决策时重要的治疗属性。通过离散选择实验进行联合分析，以找出对血液科医生最重要的因素。基于已发表的文献和专家意见选择了12个产品属性：人类病毒感染风险、抑制物滴度可能升高的可能性、剂量相关血栓栓塞事件发生可能性的降低、止血所需的输注次数、输注准备时间、输注时间、输注量、止血所需时间、缓解疼痛所需时间、预防性使用、进行大手术的能力以及药物成本。30名血液科医生于2006年4月在一次科学会议上通过面对面访谈完成了问卷。使用多项logit模型分析数据以获得每个属性的相对重要性。参与调查的血液科医生在治疗有抑制物的血友病患者方面有相当丰富的经验（平均：13±9年）。“止血所需时间”是影响治疗决策的最重要因素[相对重要性（RI）=16.3%]。医生们也更喜欢能快速缓解疼痛的治疗方法[RI=12.9%]、降低抑制物滴度升高的可能性的治疗方法[RI=12.8%]、止血所需输注次数较少的治疗方法[RI=12.7%]以及降低人类病毒感染风险的治疗方法[RI=10.8%]。本研究表明某些临床结果属性是最受青睐且最重要的。这些发现可协助决策者评估最佳一线治疗方案。
