Craig Benjamin M, Mitchell Sandra A
Health Outcomes and Behavior, Moffitt Cancer Center and University of South Florida, Tampa, Florida, USA.
Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, Maryland, USA.
Value Health. 2016 Mar-Apr;19(2):158-66. doi: 10.1016/j.jval.2015.11.002. Epub 2015 Dec 4.
Menopausal symptoms can cause significant distress to women, yet little is known about the value women place on these symptoms.
In April 2013, 3397 US women, aged 40 to 69 years, completed an online survey that included 30 paired comparisons. Specifically, respondents were shown two menopausal symptoms described using the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events and asked, "Which do you prefer?" From their choices, we estimated a generalized linear model to assess the values women place on symptom relief in terms of quality-adjusted life-years (QALYs).
Approximately half the respondents (1753 of 3397 [52%]) always preferred a reduced lifespan (up to 90 days) instead of experiencing menopausal symptoms at their worst for 30 days. For most of the symptoms (248 of 263 [94%]), including low-grade events, QALYs were significantly reduced (P < 0.05). The value women placed on relief ranged widely by symptom domain: the relief from depression, problems with memory, headache, pain in abdomen, problems with anger, and vomiting were the most valuable.
Overall, the value women place on menopausal symptom relief is surprisingly high. As the first national study to directly ask women about their preferences and to estimate the value of menopausal symptom relief on a QALY scale, this work provides critical evidence for health outcomes research in midlife women and can be applied in the evaluation of treatments that reduce or eliminate menopausal symptoms. This work also provides proof-of-concept for an approach to value Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events responses on a QALY scale.
更年期症状会给女性带来极大困扰，但对于女性对这些症状的重视程度却知之甚少。
2013年4月，3397名年龄在40至69岁之间的美国女性完成了一项在线调查，其中包括30组配对比较。具体而言，向受访者展示了两个使用不良事件通用术语标准患者报告结局版本描述的更年期症状，并询问：“你更喜欢哪一个？”根据她们的选择，我们估计了一个广义线性模型，以根据质量调整生命年（QALY）评估女性对症状缓解的重视程度。
大约一半的受访者（3397名中的1753名[52%]）总是宁愿缩短寿命（最多90天），也不愿在最严重的状态下经历30天的更年期症状。对于大多数症状（263种中的248种[94%]），包括轻度事件，QALY显著降低（P<0.05）。女性对缓解症状的重视程度因症状领域而异：从抑郁、记忆问题、头痛、腹痛、愤怒问题和呕吐中得到缓解是最有价值的。
总体而言，女性对更年期症状缓解的重视程度高得出奇。作为第一项直接询问女性偏好并在QALY量表上估计更年期症状缓解价值的全国性研究，这项工作为中年女性的健康结局研究提供了关键证据，可应用于评估减轻或消除更年期症状的治疗方法。这项工作还为在QALY量表上评估不良事件通用术语标准患者报告结局版本反应的价值的方法提供了概念验证。
