Tinelli Michela, Ozolins Mara, Bath-Hextall Fiona, Williams Hywel C
Centre of Evidence Based Dermatology, University of Nottingham, A103, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, UK.
BMC Dermatol. 2012 Oct 4;12:19. doi: 10.1186/1471-5945-12-19.
The SINS trial (Controlled Clinical Trials ISRCTN48755084; Eudract No. 2004-004506-24) is a randomised controlled trial evaluating long term success of excisional surgery vs. imiquimod 5% cream for low risk nodular and superficial basal cell carcinoma (BCC). The trial included a discrete choice experiment questionnaire to explore patient preferences of a cream versus surgery for the treatment of their skin cancer.
The self-completed questionnaire was administered at baseline to 183 participants, measuring patients' strength of preferences when choosing either alternative 'surgery' or 'imiquimod cream' instead of a fixed 'current situation' option (of surgical excision as standard practice in UK). The treatments were described according to: cost, chance of complete clearance, side effects and appearance. Participants had to choose between various scenarios. Analysis was performed using a mixed logit model, which took into account the impact of previous BCC treatment and sample preference variability.
The analysis showed that respondents preferred 'imiquimod cream' to their 'current situation' or 'surgery', regardless of previous experience of BCC symptoms and treatment. Respondents were more likely to be worried about their cosmetic outcomes and side effects they might experience over and above their chance of clearance and cost. Those with no experience of surgery (compared with experience) valued more the choice of 'imiquimod cream' (£1013 vs £781). All treatment characteristics were significant determinants of treatment choice, and there was significant variability in the population preferences for all of them.
Patients with BCC valued more 'imiquimod cream' than alternative 'surgery' options, and all treatment characteristics were important for their choice of care. Understanding how people with a BCC value alternative interventions may better inform the development of health care interventions.
SINS试验（对照临床试验ISRCTN48755084；欧洲临床试验注册号2004 - 004506 - 24）是一项随机对照试验，旨在评估切除手术与5%咪喹莫特乳膏治疗低风险结节性和浅表性基底细胞癌（BCC）的长期疗效。该试验包含一份离散选择实验问卷，以探究患者对于乳膏与手术治疗皮肤癌的偏好。
在基线时，向183名参与者发放自填式问卷，测量患者在选择“手术”或“咪喹莫特乳膏”替代固定的“现状”选项（英国标准做法为手术切除）时的偏好强度。根据成本、完全清除的几率、副作用和外观对治疗方法进行描述。参与者必须在各种情景中做出选择。使用混合逻辑模型进行分析，该模型考虑了既往BCC治疗的影响和样本偏好的变异性。
分析表明，无论既往有无BCC症状和治疗经历，受访者均更倾向于选择“咪喹莫特乳膏”而非“现状”或“手术”。受访者更担心美容效果以及可能出现的副作用，而非清除几率和成本。无手术经历者（与有手术经历者相比）更看重“咪喹莫特乳膏”这一选择（1013英镑对781英镑）。所有治疗特征都是治疗选择的重要决定因素，并且人群对所有这些特征的偏好存在显著差异。
BCC患者更看重“咪喹莫特乳膏”而非其他“手术”选项，所有治疗特征对他们的治疗选择都很重要。了解BCC患者如何评估不同干预措施，可能有助于更好地为医疗保健干预措施的制定提供信息。
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