Dong Di, Ozdemir Semra, Mong Bee Yong, Toh Sue-Anne, Bilger Marcel, Finkelstein Eric
Health Services and Systems Research Program, Duke-NUS Graduate Medical School, Singapore, Singapore; Global Health Research Center, Duke Kunshan University, Kunshan, China.
Health Services and Systems Research Program, Duke-NUS Graduate Medical School, Singapore, Singapore.
Value Health. 2016 Sep-Oct;19(6):767-775. doi: 10.1016/j.jval.2016.03.1837. Epub 2016 May 6.
To investigate patient preferences and willingness to pay (WTP) for a genetic test that can reduce the risk of life-threatening adverse drug reactions (ADRs). We hypothesize that test features (risk of developing the adverse reaction with and without testing, test cost, and treatment cost) and the choice context (physician recommendation and the most common choice made by peer patients) will influence choices.
A discrete choice experiment was conducted in which 189 patients at high risk for gout were asked to choose between treatment options that varied along key attributes. A latent class logit model was used to analyze the choice data and test the hypotheses.
We identified two classes of patients: the risk-averse class and the cost-conscious class. The WTP to reduce the risk of life-threatening ADRs from 1 out of 600 to 1 out of 1 million was SGD1215 in the risk-averse class. In contrast, in the cost-conscious class, the WTP was insensitive to the extent of risk reduction. Overall, the predicted take-up rate for the test is 65% at a price of SGD400. If the test was recommended by a physician or was chosen by most of the patients, the take-up rate for the test would increase by 8.5 and 1.5 percentage points, respectively.
There is a potentially large demand for genetic tests that could reduce the risk of life-threatening ADRs. Physician recommendations and providing information on the choices of others are powerful influences on demand, even more so than moderate price reductions.
调查患者对于一种能够降低危及生命的药物不良反应（ADR）风险的基因检测的偏好和支付意愿（WTP）。我们假设检测特征（检测与不检测时发生不良反应的风险、检测成本和治疗成本）以及选择背景（医生建议和同龄患者的最常见选择）会影响选择。
进行了一项离散选择实验，其中189名痛风高危患者被要求在沿关键属性变化的治疗方案之间进行选择。使用潜在类别逻辑模型分析选择数据并检验假设。
我们识别出两类患者：风险厌恶型和成本意识型。在风险厌恶型患者中，将危及生命的ADR风险从600分之一降低到百万分之一的支付意愿为1215新元。相比之下，在成本意识型患者中，支付意愿对风险降低程度不敏感。总体而言，在价格为400新元时，该检测的预测接受率为65%。如果该检测由医生推荐或大多数患者选择，检测的接受率将分别提高8.5和1.5个百分点。
对于能够降低危及生命的ADR风险的基因检测存在潜在的巨大需求。医生建议和提供他人选择的信息对需求有强大影响，甚至比适度降价的影响更大。
