OptumInsight, Eden Prairie, MN, USA.
OptumInsight, Eden Prairie, MN, USA.
Value Health. 2014 Jun;17(4):380-9. doi: 10.1016/j.jval.2014.01.002. Epub 2014 Mar 27.
Rising out-of-pocket costs for cancer patients have increased shared decision making. Clinical guidelines recommend prophylactic granulocyte colony-stimulating factor (G-CSF) for patients receiving chemotherapy with a 20% or greater risk of febrile neutropenia. A discrete choice experiment was conducted to explore breast cancer patients' preferences and willingness to pay (WTP) for prophylactic G-CSF to decrease the risk of chemotherapy-induced febrile neutropenia.
An online discrete choice experiment questionnaire survey of a national US convenience sample of self-reported breast cancer patients with prior chemotherapy treatment was conducted. Sixteen paired G-CSF treatment scenarios, each with four attributes (risk of disruption to chemotherapy schedule due to low white blood cell counts, risk of developing an infection requiring hospitalization, frequency of administration, and total out-of-pocket cost) were presented with a follow-up "no treatment" option. Participant preferences and WTP out of pocket were estimated by logistic regression.
Participants (n = 296) preferred G-CSF regimens with lower out-of-pocket costs, lower risk of chemotherapy disruption, lower risk of infection, and greater convenience (one G-CSF injection per chemotherapy cycle). Participants' WTP was $1076 out of pocket per cycle to reduce the risk (high to low) of disrupting their chemotherapy schedule, $884 per cycle to reduce the risk (24% [high] to 7% [low]) of infection, and $851 per cycle to decrease the number of G-CSF injections (11 to 1) per cycle.
Participants highly valued specific features of prophylactic G-CSF treatment including maintaining their chemotherapy schedule, lowering their risk of infection, and reducing the number of injections. Physicians should consider patient preferences to inform the best treatment choices for individual patients.
癌症患者自付费用的增加增加了共同决策。临床指南建议对接受化疗且发热性中性粒细胞减少症风险为 20%或更高的患者预防性使用粒细胞集落刺激因子（G-CSF）。本研究采用离散选择实验探讨乳腺癌患者对预防性 G-CSF 降低化疗引起的发热性中性粒细胞减少症风险的偏好和支付意愿（WTP）。
对曾接受化疗的美国全国性便利样本的自我报告乳腺癌患者进行在线离散选择实验问卷调查。呈现了 16 对 G-CSF 治疗方案，每个方案均有四个属性（因白细胞计数低而中断化疗计划的风险、发生需要住院治疗的感染的风险、给药频率和总自付费用），并附有“无治疗”选择。采用逻辑回归估计参与者的偏好和 WTP 自付费用。
参与者（n=296）更喜欢自付费用较低、化疗中断风险较低、感染风险较低且更方便（每化疗周期一次 G-CSF 注射）的 G-CSF 方案。参与者每周期为降低中断化疗计划的风险（高到低）而支付的 WTP 为 1076 美元，为降低感染风险（24%[高]至 7%[低]）而支付的 WTP 为 884 美元，为减少每周期 G-CSF 注射次数（11 次至 1 次）而支付的 WTP 为 851 美元。
参与者高度重视预防性 G-CSF 治疗的特定特征，包括维持化疗计划、降低感染风险和减少注射次数。医生应考虑患者的偏好，为每位患者提供最佳的治疗选择。
