German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Arch Dermatol Res. 2018 Sep;310(7):567-577. doi: 10.1007/s00403-018-1846-4. Epub 2018 Jun 23.
In psoriasis, several patient-relevant treatment goals must be met to be able to consider a treatment beneficial. To assess treatment benefit, the validated questionnaire Patient Benefit Index (PBI) can be used. Its global score summarizes the degree of patient-relevant treatment goals achieved after treatment, weighted by their individual importance on rating scales. These treatment goals have empirically been assigned to five dimensions. While the weighting procedure of the PBI provides information about the importance patients attach to treatment goals on a rating scale from 0 to 4, methods of preference elicitation provide information on how patients would trade off certain treatment goals against each other. However, since the treatment goals defined in the PBI often overlap conceptually, the dimensions of the PBI might be more suitable for exploration in preference elicitation methods. We used an analytic hierarchy process (AHP) and a discrete choice experiment (DCE) to generate preference-based importance weights for the PBI dimensions, and compared these weights to those derived from the rating scales. We were further interested in the effect of importance weights on the calculation of the PBI score. A total of 120 patients with psoriasis completed a questionnaire at baseline, including AHP, DCE and the rating scales, and at follow-up, regarding the attainment of treatment goals, to calculate the PBI score. In contrast to the results derived from the average rating scores, use of AHP and DCE resulted in both similar importance weights and rankings of dimensions. Presumably, patients rated treatment goals differently than the respective dimension they belong to. However, the differently calculated importance weights led to similar values of the PBI score. Our findings nevertheless provide clear evidence that, regardless of the method used, the importance of treatment goals differs between psoriasis patients, and this should be reflected in treatment decisions.
在银屑病中，必须满足几个与患者相关的治疗目标，才能认为治疗有益。为了评估治疗效果，可以使用经过验证的患者获益指数（PBI）问卷。它的总体评分总结了治疗后患者实现与治疗相关的目标的程度，权重为他们在评分量表上的个体重要性。这些治疗目标已经通过实证分配到五个维度。虽然 PBI 的加权过程提供了有关患者在 0 到 4 的评分量表上对治疗目标重视程度的信息，但偏好 elicitation 方法提供了有关患者如何相互权衡某些治疗目标的信息。然而，由于 PBI 中定义的治疗目标在概念上经常重叠，因此 PBI 的维度可能更适合在偏好 elicitation 方法中进行探索。我们使用层次分析法（AHP）和离散选择实验（DCE）为 PBI 维度生成基于偏好的重要性权重，并将这些权重与评分量表得出的权重进行比较。我们还对重要性权重对 PBI 评分计算的影响感兴趣。共有 120 名银屑病患者在基线时完成了问卷，包括 AHP、DCE 和评分量表，以及在随访时，关于治疗目标的实现，以计算 PBI 评分。与从平均评分得出的结果相反，使用 AHP 和 DCE 得出了相似的重要性权重和维度排名。大概，患者对治疗目标的评价与他们所属的各自维度不同。然而，不同计算的重要性权重导致 PBI 评分的相似值。然而，我们的研究结果清楚地表明，无论使用哪种方法，银屑病患者之间的治疗目标的重要性都不同，这应该反映在治疗决策中。
