Mansfield Carol, Sutphin Jessie, Shriner Kelly, Criner Gerard J, Celli Bartolome R
RTI Health Solutions, Research Triangle Park, North Carolina.
Pulmonx Corporation, Redwood City, California.
Chronic Obstr Pulm Dis. 2018 Dec 11;6(1):51-63. doi: 10.15326/jcopdf.6.1.2018.0147.
Patients with severe emphysema have limited treatment options. Little is known about patients' willingness to accept risks for new treatments that offer meaningful benefits. We determined treatment preferences of patients with severe emphysema using a web-based discrete-choice experiment survey. Respondents answered 9 questions that offered choices between 2 hypothetical interventional treatments or continuing current medical management. Variations in 5 attributes defined the 2 interventional treatments: improvement in ability to breathe and carry out day-to-day activities, frequency of hospitalized exacerbations, treatment type, risk of pneumothorax within 30 days of procedure, and risk of death within 3 months. Respondents were recruited through the COPD Foundation's COPD Patient-Powered Research Network and had a self-reported emphysema diagnosis and 2+ score on the modified Medical Research Council Dyspnea Scale. The relative importance of the attributes and the percentage of respondents who would select different treatment options was modeled using random-parameters logit. Among 294 respondents, 51% always chose an interventional treatment option, while 19% always selected continued medical management. The most important change on average was moving from continued medical management (with no improvement in breathlessness) to an interventional treatment with improvement in breathlessness. The model predicted 71% of respondents would select a treatment option similar to removable endobronchial valve implants, 6% would select lung volume reduction surgery (LVRS), and 23% continued medical management. Patients with severe emphysema perceive that a procedure with risks and benefits similar to the Zephyr endobronchial valve implants is desirable over continued medical management or LVRS.
重度肺气肿患者的治疗选择有限。对于那些能带来显著益处的新治疗方法，患者愿意承担何种风险，目前知之甚少。我们通过一项基于网络的离散选择实验调查，确定了重度肺气肿患者的治疗偏好。受访者回答了9个问题，这些问题提供了两种假设的介入治疗方案或继续当前医疗管理之间的选择。5个属性的变化定义了这两种介入治疗方案：呼吸和进行日常活动能力的改善、住院病情加重的频率、治疗类型、术后30天内气胸的风险以及3个月内死亡的风险。受访者通过慢性阻塞性肺疾病（COPD）基金会的COPD患者驱动研究网络招募，自我报告有肺气肿诊断，且在改良的医学研究理事会呼吸困难量表上得分在2分及以上。使用随机参数logit模型对这些属性的相对重要性以及选择不同治疗方案的受访者百分比进行了建模。在294名受访者中，51%总是选择介入治疗方案，而19%总是选择继续医疗管理。平均而言，最重要的变化是从继续医疗管理（呼吸困难无改善）转变为呼吸困难有改善的介入治疗。该模型预测，71%的受访者会选择类似于可移除支气管内瓣膜植入的治疗方案，6%会选择肺减容手术（LVRS），23%会选择继续医疗管理。与继续医疗管理或LVRS相比，重度肺气肿患者认为一种风险和益处与Zephyr支气管内瓣膜植入相似的治疗方法是可取的。
