Qian Yi, Arellano Jorge, Gatta Francesca, Hechmati Guy, Hauber A Brett, Mohamed Ateesha F, Bahl Amit, von Moos Roger, Body Jean-Jacques
Health Economics, Amgen Inc, Thousand Oaks, CA, 91320, USA.
Health Economics, Amgen (Europe) GmbH, Zug, Switzerland.
BMC Health Serv Res. 2018 Jul 3;18(1):518. doi: 10.1186/s12913-018-3272-x.
Several bone-targeted agents (BTAs) are available for preventing skeletal-related events (SREs), but they vary in terms of efficacy, safety and mode of administration. This study assessed data on European physicians' treatment preferences for preventing SREs in patients with bone metastases from solid tumours.
Physicians completed a web-based discrete-choice experiment survey of 10 choices between pairs of profiles of hypothetical BTAs for a putative patient. Each profile included five attributes within a pre-defined range (primarily based on existing BTAs' prescribing information): time (months) until the first SRE; time (months) until worsening of pain; annual risk of osteonecrosis of the jaw (ONJ); annual risk of renal impairment; and mode of administration. Choice questions were developed using an experimental design with known statistical properties. A separate main-effects random parameters logit model was estimated for each country and provided the relative preference for the treatment attributes in the study.
A total of 191 physicians in France, 192 physicians in Germany, and 197 physicians in the United Kingdom completed the survey. In France and the United Kingdom, time until the first SRE and risk of renal impairment were the most important attributes; in Germany, time until the first SRE and delay in worsening of pain were the most important. In all countries, a 120-min infusion every 4 weeks was the least preferred mode of administration (p < 0.05) and the annual risk of ONJ was judged to be the least important attribute.
When making treatment decisions regarding the choice of BTA, delaying the onset of SREs/worsening of pain and reducing the risk of renal impairment are the primary objectives for physicians.
有几种骨靶向药物（BTAs）可用于预防骨相关事件（SREs），但它们在疗效、安全性和给药方式方面存在差异。本研究评估了欧洲医生对预防实体瘤骨转移患者发生SREs的治疗偏好数据。
医生完成了一项基于网络的离散选择实验调查，针对一名假定患者在成对的假设BTA概况中进行10次选择。每个概况包括在预定义范围内的五个属性（主要基于现有BTA的处方信息）：直至首次发生SRE的时间（月）；直至疼痛加重的时间（月）；颌骨坏死（ONJ）的年度风险；肾功能损害的年度风险；以及给药方式。使用具有已知统计特性的实验设计来制定选择问题。为每个国家估计了一个单独的主效应随机参数logit模型，并提供了研究中治疗属性的相对偏好。
法国共有191名医生、德国有192名医生、英国有197名医生完成了调查。在法国和英国，直至首次发生SRE的时间和肾功能损害风险是最重要的属性；在德国，直至首次发生SRE的时间和疼痛加重延迟是最重要的。在所有国家，每4周一次120分钟的输注是最不喜欢的给药方式（p < 0.05），并且ONJ的年度风险被认为是最不重要的属性。
在就BTA的选择做出治疗决策时，延迟SREs的发生/疼痛加重以及降低肾功能损害风险是医生的主要目标。
