Department of Policy Analysis and Public Management, Università Commerciale Luigi Bocconi, Via Roentgen 1, 20136, Milan, Italy.
Pharmacoeconomics. 2014 Feb;32(2):209-23. doi: 10.1007/s40273-013-0126-6.
To assess patient preferences for psoriasis treatment features and to investigate the heterogeneity of preferences among patients with different socio-demographic and disease-related characteristics.
A discrete choice experiment was conducted on adult patients with moderate to severe plaque-type psoriasis during a routine visit to their physician at 15 centres in Italy. We investigated the preferences of patients with respect to five treatment attributes: (1) mode and frequency of administration; (2) time to improvement; (3) time free of symptoms; (4) unintended life expectancy reduction resulting from treatment; and (5) monthly treatment cost. The heterogeneity of preferences was investigated in a mixed logit model with normally distributed random coefficients.
Overall, patients preferred the subcutaneous or intravenous route of administration (versus oral administration) and treatments that took less time to show improvement, ensured a longer time free of symptoms, involved a lesser reduction in life expectancy and had lower costs. There was significant preference heterogeneity for all attributes. The cost attribute was found to be significantly more important to females and to older patients (above 60 years of age). Older patients placed significantly greater emphasis on reduced life expectancy, whereas the time free of symptoms was significantly less important to them than to patients under 60 years of age. Patients with higher scores on the Dermatology Life Quality Index (DLQI) placed higher value on the time free of symptoms than those with lower DLQI scores. For the overall sample, the marginal willingness to pay (WTP) for a month's reduction in the time to improvement was
Patient-centred policies should consider the heterogeneity of patients' expectations to identify individualized treatments that would aid in optimizing patient satisfaction and wellbeing, as well as overall treatment effectiveness.
评估患者对银屑病治疗特征的偏好，并调查不同社会人口学和疾病相关特征患者的偏好异质性。
在意大利 15 个中心，在成年中重度斑块型银屑病患者常规就诊期间，进行了一项离散选择实验。我们调查了患者对以下五个治疗属性的偏好：（1）给药方式和频率；（2）改善时间；（3）无症状时间；（4）治疗导致的预期寿命意外缩短；（5）每月治疗费用。使用具有正态分布随机系数的混合 logit 模型，对偏好的异质性进行了调查。
总体而言，患者更喜欢皮下或静脉给药途径（而非口服给药），且更喜欢见效时间较短、无症状时间更长、预期寿命缩短幅度较小、治疗费用较低的治疗方案。所有属性都存在显著的偏好异质性。发现成本属性对女性和年龄较大的患者（60 岁以上）更为重要。年龄较大的患者更注重预期寿命的缩短，而无症状时间对他们的重要性明显低于 60 岁以下的患者。在皮肤病生活质量指数（DLQI）评分较高的患者中，无症状时间比 DLQI 评分较低的患者更重要。对于整个样本，一个月改善时间的减少所带来的边际支付意愿（WTP）低于 32.4 欧元，而一个月无症状的额外 WTP 则明显更高（68.2 欧元）。
以患者为中心的政策应考虑患者期望的异质性，以确定个性化的治疗方案，这有助于优化患者满意度和幸福感，以及整体治疗效果。
