Lin Pei-Jung, Saret Cayla J, Neumann Peter J, Sandberg Eileen A, Cohen Joshua T
Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Box #63, Boston, MA, 02111, USA.
Pharmacoeconomics. 2016 Dec;34(12):1255-1265. doi: 10.1007/s40273-016-0435-7.
Although it is well recognized that people with multiple sclerosis (MS) may experience impairments in addition to limited mobility, there has been little effort to study their relative importance to patients with the condition. The objective of this study was to assess patient preferences for addressing various MS symptoms.
This study was conducted at Tufts Medical Center, Boston, Massachusetts. We developed a national online survey of MS patients and neurologists to estimate the value each group places on treating specific MS symptoms. Each respondent was presented with two randomly selected scenarios with different symptoms and treatments. MS patients were asked about their own preferences, whereas neurologists were asked to consider what a patient of theirs would do or think in each scenario. We used a bidding game approach to elicit respondents' willingness to pay (WTP) for the treatments.
To treat mobility alone, WTP for MS patients averaged US$410-US$520 per month, depending on the scenario. For paired symptoms, MS patients would pay most to treat mobility and upper limb function (US$525/month) or mobility and cognition (US$514/month), somewhat less to treat mobility and eyesight (US$445/month), and least to treat mobility and fatigue (US$371/month). Patient WTP values increased with income and education. Neurologists believed their patients would be willing to pay US$216-US$249 per month to treat mobility alone, depending on the scenario. For paired symptoms, neurologists believed patients would pay most to treat mobility and fatigue (US$263/month) and least to treat mobility and upper limb function (US$177/month).
Our findings suggest MS patients may value one outcome (e.g., improved arm and hand coordination) over another (e.g., less fatigue). Further, MS patients and neurologists may rank the importance of treating various symptoms differently. Given this potential mismatch, it is crucial for MS patients and their clinicians to discuss treatment priorities that take into account patient preferences.
尽管人们普遍认识到多发性硬化症（MS）患者除了行动不便外还可能有其他损伤，但对于这些损伤对该疾病患者的相对重要性，几乎没有进行过研究。本研究的目的是评估患者对解决各种MS症状的偏好。
本研究在马萨诸塞州波士顿的塔夫茨医疗中心进行。我们开展了一项针对MS患者和神经科医生的全国性在线调查，以估计每组对治疗特定MS症状的重视程度。每位受访者会看到两个随机选择的、具有不同症状和治疗方法的情景。向MS患者询问他们自己的偏好，而向神经科医生询问他们认为自己的患者在每种情景下会怎么做或怎么想。我们采用投标博弈法来引出受访者为治疗方法支付的意愿（WTP）。
仅针对行动能力进行治疗时，根据情景不同，MS患者的WTP平均为每月410 - 520美元。对于成对症状，MS患者愿意支付最多的费用来治疗行动能力和上肢功能（每月525美元）或行动能力和认知功能（每月514美元），支付较少的费用来治疗行动能力和视力（每月445美元），支付最少的费用来治疗行动能力和疲劳（每月371美元）。患者的WTP值随收入和教育程度的提高而增加。神经科医生认为他们的患者仅为治疗行动能力每月愿意支付216 - 249美元，具体取决于情景。对于成对症状，神经科医生认为患者愿意支付最多的费用来治疗行动能力和疲劳（每月263美元），支付最少的费用来治疗行动能力和上肢功能（每月177美元）。
我们的研究结果表明，MS患者可能更看重一种结果（例如，改善手臂和手部协调性）而非另一种结果（例如，减轻疲劳）。此外，MS患者和神经科医生对治疗各种症状重要性的排序可能不同。鉴于这种潜在的差异，MS患者及其临床医生讨论考虑患者偏好的治疗优先级至关重要。
