VA Connecticut Healthcare System and Yale University School of Medicine, New Haven, Connecticut, USA.
Med Decis Making. 2010 Jan-Feb;30(1):45-57. doi: 10.1177/0272989X09341588. Epub 2009 Jul 27.
The objective of this study was to ascertain patient preferences for treatment of hepatitis C virus (HCV).
The authors recruited consecutive patients eligible for treatment of HCV and used adaptive conjoint analysis (ACA), a hybrid approach of conjoint analysis that uses both self-explicated ratings and pair-wise comparisons, to elicit preferences for pegylated-interferon and ribavirin. They examined the association between patient characteristics and treatment preferences using the Mann-Whitney U test and chi(2) statistic for continuous and categorical variables, respectively, and subsequently calculated adjusted odds ratios and 95% confidence intervals using logistic regression.
A total of 140 subjects completed the ACA task. The mean (+/-SD) age of the sample was 51+/-8 y; 85% were male, and 59% were white. When described as being associated with mild side effects, 67% (n = 94) of subjects preferred treatment for HCV. The percentage of subjects preferring therapy decreased to 51% (n = 72) when it was described as being associated with severe side effects. Preferences for treatment of HCV were stronger among subjects with a higher perceived risk of developing cirrhosis, more severe underlying liver disease, and worse HCV-related quality of life. Subjects having more severe disease placed greater weight on the importance of expected benefits and less on the risk of toxicity compared with those with mild or no fibrosis.
Whether to choose treatment for HCV is a difficult decision for many patients. Treatment is usually recommended for those with moderate to severe liver disease, and these results demonstrate that most patients' preferences are concordant with this practice.
本研究旨在确定患者对丙型肝炎病毒（HCV）治疗的偏好。
作者招募了符合 HCV 治疗条件的连续患者，并使用适应性联合分析（ACA），这是一种联合分析的混合方法，同时使用自我解释评分和成对比较，来引出对聚乙二醇干扰素和利巴韦林的偏好。他们使用 Mann-Whitney U 检验和卡方检验分别比较连续和分类变量，来检验患者特征与治疗偏好之间的关联，随后使用逻辑回归计算调整后的优势比和 95%置信区间。
共有 140 名患者完成了 ACA 任务。样本的平均（+/-SD）年龄为 51+/-8 岁；85%为男性，59%为白人。当描述为与轻微副作用相关时，67%（n=94）的患者更喜欢 HCV 的治疗。当描述为与严重副作用相关时，选择治疗 HCV 的患者比例降至 51%（n=72）。对发展为肝硬化、更严重的基础肝病和更差的 HCV 相关生活质量的风险感知较高的患者更倾向于治疗 HCV。与轻度或无纤维化的患者相比，病情更严重的患者更看重预期获益的重要性，而对毒性的风险则不那么看重。
对许多患者来说，是否选择治疗 HCV 是一个艰难的决定。对于中重度肝病患者，通常会建议进行治疗，这些结果表明，大多数患者的偏好与这种做法是一致的。
