Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Sydney, NSW, 2006, Australia.
CIRUS, Centre for Integrated Research and Understanding of Sleep, The Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
Patient. 2018 Oct;11(5):503-514. doi: 10.1007/s40271-018-0303-y.
Despite the rapid development of effective treatments, both pharmacological and non-pharmacological, insomnia management remains suboptimal at the practice interface. Patient preferences play a critical role in influencing treatment outcomes. However, there is currently a mismatch between patient preferences and clinician recommendations, partly perpetuated by a limited understanding of the patients' decision-making process.
The aim of our study was to empirically quantify patient preferences for treatment attributes common to both pharmacological and non-pharmacological insomnia treatments.
An efficient dual-response discrete choice experiment was conducted to evaluate patient treatment preferences for managing insomnia. The sample included 205 patients with self-reported insomnia and an Insomnia Severity Index ≥ 14. Participants were presented with two unlabelled hypothetical scenarios with an opt-out option across 12 choice sets. Data were analyzed using a mixed multinomial logit model to investigate the influence of five attributes (i.e. time, onset of action, maintainability of improved sleep, length of treatment, and monthly cost) on treatment preferences.
Treatments were preferentially viewed if they conferred long-term sleep benefits (p < 0.05); had an ongoing, as opposed to a predefined, duration of treatment course (p < 0.05); required some, as opposed to no, additional time commitment (p < 0.05); and had lower monthly out-of-pocket treatment costs (p < 0.001). However, treatment onset of action had no influence on preference. Age, help-seeking status, concession card status and fatigue severity significantly influenced treatment preference.
Participants' prioritization of investing time in treatment and valuing the maintainability of therapeutic gains suggests a stronger inclination towards non-pharmacological treatment, defying current assumptions that patients prefer 'quick-fixes' for managing insomnia.
尽管有快速发展的有效治疗方法，包括药理学和非药理学方法，但是在实践中，失眠管理仍然不尽如人意。患者的偏好对治疗结果有重要影响。然而，目前患者的偏好和临床医生的建议之间存在不匹配，部分原因是对患者决策过程的理解有限。
我们的研究旨在实证量化患者对常见于药理学和非药理学失眠治疗的治疗属性的偏好。
采用高效的双反应离散选择实验来评估患者对治疗失眠的治疗偏好。样本包括 205 名自我报告有失眠症且失眠严重程度指数≥14 的患者。参与者在 12 个选择集中呈现两个无标签的假设情景和一个选择退出选项。使用混合多项逻辑回归模型分析数据，以研究五个属性（即时间、起效时间、改善睡眠的维持性、治疗时间长度和每月费用）对治疗偏好的影响。
如果治疗方案能够带来长期的睡眠益处（p<0.05）、具有持续而非预设的治疗疗程（p<0.05）、需要一定的额外时间投入而非无需投入（p<0.05）、以及每月自付治疗费用较低（p<0.001），则治疗方案更受青睐。然而，治疗的起效时间对偏好没有影响。年龄、寻求帮助的状态、优惠卡状态和疲劳严重程度显著影响治疗偏好。
参与者优先考虑在治疗上投入时间并重视治疗效果的维持性，这表明他们更倾向于非药物治疗，这与目前认为患者更愿意选择快速解决失眠问题的假设相矛盾。
