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采用离散选择实验评估哥伦比亚城市人口中 HIV 治疗的患者偏好。

A discrete choice experiment to assess patients' preferences for HIV treatment in the urban population in Colombia.

机构信息

Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.

Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK.

出版信息

J Med Econ. 2020 Aug;23(8):812-818. doi: 10.1080/13696998.2020.1735399. Epub 2020 Apr 6.

Abstract

This study aimed to assess patients' preferences for HIV treatment in an urban Colombian population. A Discrete Choice Experiment (DCE) was conducted. Urban Colombian HIV patients were asked to repetitively choose between two hypothetical treatments that differ in regard to five attributes 'effect on life expectancy', 'effect on physical activity', 'risk of moderate side effects, 'accessibility to clinic' and 'economic cost to access controls'. Twelve choice sets were made using an efficient design. A Mixed Logit Panel Model was used for the analysis and subgroup analyses were performed according to age, gender, education level and sexual preference. A total of 224 HIV patients were included. All attributes were significant, indicating that there were differences between at least two levels of each attribute. Patients preferred to be able to perform all physical activity without difficulty, to have large positive effects on life expectancy, to travel less than 2 h, to have lower risk of side-effects and to have subsidized travel costs. The attributes 'effect on physical activity' and 'effects on life expectancy' were deemed the most important. Sub-analyses showed that higher educated patients placed more importance on the large positive effects of HIV treatment, and a more negative preference for subsidized travel cost (5% level). A potential limitation is selection bias as it is difficult to make a systematic urban/rural division of respondents. Additional, questionnaires were partly administered in the waiting rooms, which potentially led to some noise in the data. Findings suggests that short-term efficacy (i.e. effect on physical activity) and long-term efficacy (i.e. effect on life expectancy) are the most important treatment characteristics for HIV urban patients in Colombia. Preference data could provide relevant information for clinical and policy decision-making to optimize HIV care.

摘要

本研究旨在评估城市哥伦比亚人群中 HIV 治疗的患者偏好。进行了离散选择实验(DCE)。城市哥伦比亚 HIV 患者被要求在两种假设治疗方案之间反复选择,这两种治疗方案在五个属性上有所不同:“对预期寿命的影响”、“对身体活动的影响”、“中度副作用风险”、“就诊可及性”和“获得控制的经济成本”。使用有效设计制作了 12 个选择集。使用混合 Logit 面板模型进行分析,并根据年龄、性别、教育水平和性偏好进行了亚组分析。共纳入 224 名 HIV 患者。所有属性均具有统计学意义,表明至少有两种属性水平之间存在差异。患者更愿意能够毫不费力地进行所有身体活动,对预期寿命有较大的积极影响,旅行时间少于 2 小时,副作用风险较低,旅行费用得到补贴。属性“对身体活动的影响”和“对预期寿命的影响”被认为是最重要的。亚组分析显示,受教育程度较高的患者更重视 HIV 治疗的积极影响,对补贴旅行费用的负面偏好程度更高(5%水平)。一个潜在的限制是选择偏差,因为很难对城市/农村的受访者进行系统划分。此外,部分问卷在候诊室进行,这可能导致数据中存在一些噪音。研究结果表明,短期疗效(即对身体活动的影响)和长期疗效(即对预期寿命的影响)是哥伦比亚城市 HIV 患者最重要的治疗特征。偏好数据可以为临床和政策决策提供相关信息,以优化 HIV 护理。

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