法国哮喘和慢性阻塞性肺疾病患者对干粉吸入器属性的偏好：一项离散选择实验。
Patient preferences for dry powder inhaler attributes in asthma and chronic obstructive pulmonary disease in France: a discrete choice experiment.
机构信息
Creativ-Ceutical, Westblaak 92, 3012 KM, Rotterdam, The Netherlands.
Teva Pharmaceuticals Europe BV, Amsterdam, The Netherlands.
出版信息
BMC Pulm Med. 2017 Jul 6;17(1):99. doi: 10.1186/s12890-017-0439-x.
BACKGROUND
Dry powder inhalers (DPIs) are often used in asthma and chronic obstructive pulmonary disease (COPD) therapies. Using the discrete choice experiment (DCE) methodology, this study conducted in France was designed to assess patients' preferences for different attributes of DPIs.
METHODS
Attributes of DPIs were defined based on a literature review, patient focus group discussions and interviews with healthcare professionals (qualitative phase of the study). An online survey was then conducted among French patients with asthma or COPD to elicit patient preferences and willingness to pay (WTP) for these attributes using the DCE methodology (quantitative phase). A fractional factorial design including three blocks of 12 choice sets was created. Each choice set comprised three alternatives: two fictitious inhalers and the patient's current inhaler. Marginal utilities were estimated using a ranked ordered logit model. Interactions between attributes and disease (asthma or COPD) were tested.
RESULTS
Six DPI attributes were defined based on the qualitative phase: ease of use/fool-proof priming; accurate and easy-to-read dose counter; dose confirmation; hygiene of the mouthpiece; flexibility of the device handling; ability to use the inhaler with breathing difficulties. Overall, 201 patients with asthma and 93 with COPD were included in the online survey. Patients with asthma placed most value on an inhaler that requires one step for dose preparation (WTP €4.83 [95% CI: €3.77-€5.90], relative to an inhaler requiring four steps) and one that could be used during episodes of breathing difficulties (WTP €4.49 [95% CI: €2.95-€6.02]). Patients with COPD placed most value on an inhaler that could be used during episodes of breathing difficulties (WTP €7.70 [95% CI: €5.65-€9.76]) and on the accuracy of the dose counter (WTP €5.87 [95% CI: €3.98-€ 7.77]).
CONCLUSION
This study suggests that asthma and COPD patients would be willing to change their inhaler if they were offered the option of a new inhaler with improved characteristics and they place a high value on an inhaler with ease of use during breathing difficulty episodes.
背景
干粉吸入器（DPIs）常用于哮喘和慢性阻塞性肺疾病（COPD）的治疗。本研究在法国采用离散选择实验（DCE）方法，旨在评估患者对 DPI 不同属性的偏好。
方法
基于文献回顾、患者焦点小组讨论和与医疗保健专业人员的访谈（研究的定性阶段）定义了 DPI 的属性。然后，在法国进行了一项在线调查，使用 DCE 方法（定量阶段）调查哮喘或 COPD 患者对这些属性的偏好和支付意愿（WTP）。创建了一个包含三个 12 个选择集块的分数阶因子设计。每个选择集由三个选项组成：两种虚构的吸入器和患者当前使用的吸入器。使用有序逻辑回归模型估计边际效用。测试了属性与疾病（哮喘或 COPD）之间的相互作用。
结果
根据定性阶段确定了六个 DPI 属性：易于使用/防错启动；准确且易于阅读的剂量计数器；剂量确认；吸嘴卫生；设备处理的灵活性；能够在呼吸困难时使用吸入器。总体而言，201 名哮喘患者和 93 名 COPD 患者参加了在线调查。哮喘患者最看重需要一步剂量准备的吸入器（相对于需要四步剂量准备的吸入器，WTP 为 4.83 欧元[95%CI：3.77-5.90 欧元]）和在呼吸困难发作时可以使用的吸入器（WTP 为 4.49 欧元[95%CI：2.95-6.02 欧元]）。COPD 患者最看重可以在呼吸困难发作时使用的吸入器（WTP 为 7.70 欧元[95%CI：5.65-9.76 欧元]）和剂量计数器的准确性（WTP 为 5.87 欧元[95%CI：3.98-7.77 欧元]）。
结论
本研究表明，如果患者有机会选择具有改进特性的新型吸入器，他们愿意更换吸入器，并且非常重视在呼吸困难发作时易于使用的吸入器。
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