Arellano Jorge, Hauber A Brett, Mohamed Ateesha F, Gonzalez Juan Marcos, Collins Helen, Hechmati Guy, Gatta Francesca, Qian Yi
Amgen, Inc., Thousand Oaks, CA, USA.
RTI Health Solutions, Research Triangle Park, NC, USA.
Value Health. 2015 Jan;18(1):78-83. doi: 10.1016/j.jval.2014.10.004.
Several characteristics of bone-targeted agents are considered when making treatment decisions. This study evaluated physicians' therapy preferences for preventing skeletal-related events (SREs) in patients with bone metastases secondary to solid tumors.
A Web-enabled, discrete-choice experiment online survey was conducted among physicians who treated patients with bone metastases and solid tumors in the United States. Respondents chose between pairs of hypothetical medications defined by combinations of six attributes at varying levels for two hypothetical patients. Preference weights for attribute levels were estimated using a random-parameters logit model.
In total, 200 physicians completed the survey. Their mean age was 52 years, 57% were in practice for more than 15 years, 37% were oncologists, and 65% treated 10 or fewer patients with bone metastases weekly. Out-of-pocket cost to patients was the most important attribute overall. Among clinical outcomes, time to first SRE and risk of renal impairment were the most important attributes. Statistically significant preferences were observed for all attribute levels for time to first SRE, risk of renal impairment, and mode of administration. Predicted choice probability analysis showed that physicians preferred a hypothetical medication with attributes similar to those of denosumab over one with attributes similar to those of zoledronic acid.
Physicians indicated that clinical attributes are important when considering bone-targeting therapy for bone metastases, but consistent with the current health care landscape, patient out-of-pocket cost was the most important. With health care costs being increasingly shifted to patients, physicians require accurate information about co-pays and assistance programs to avoid patients receiving less costly, yet potentially inferior, treatment.
在制定治疗决策时会考虑骨靶向药物的几个特征。本研究评估了医生对于预防实体瘤继发骨转移患者发生骨相关事件（SREs）的治疗偏好。
对美国治疗骨转移和实体瘤患者的医生开展了一项基于网络的离散选择实验在线调查。受访者要在针对两名假设患者的、由六个属性不同水平组合定义的成对假设药物之间进行选择。使用随机参数logit模型估计属性水平的偏好权重。
共有200名医生完成了调查。他们的平均年龄为52岁，57%的人从业超过15年，37%为肿瘤学家，65%的人每周治疗10名或更少的骨转移患者。患者自付费用总体上是最重要的属性。在临床结果方面，首次发生SRE的时间和肾功能损害风险是最重要的属性。对于首次发生SRE的时间、肾功能损害风险和给药方式的所有属性水平，均观察到具有统计学意义的偏好。预测选择概率分析表明，医生更喜欢一种属性与地诺单抗相似的假设药物，而非属性与唑来膦酸相似的药物。
医生指出，在考虑针对骨转移的骨靶向治疗时临床属性很重要，但与当前的医疗保健情况一致，患者自付费用是最重要的。随着医疗保健成本越来越多地转嫁给患者，医生需要有关共付费用和援助计划的准确信息，以避免患者接受成本较低但可能较差的治疗。
