Hardtstock Fraence, Sbarigia Urbano, Kocaata Zeki, Wilke Thomas, Sylvester Shirley V
Ingress-Health HWM GmbH, Wismar 23966, Germany.
Janssen Pharmaceutica, Beerse 2340, Belgium.
Patient Prefer Adherence. 2020 Mar 19;14:613-624. doi: 10.2147/PPA.S238833. eCollection 2020.
Current antiviral therapies for chronic hepatitis B (CHB) rarely achieve functional cure, thus often requiring lifelong therapy. A therapy achieving functional cure in a significant percentage of patients could change the treatment landscape substantially. However, the acceptability of functional cure by patients is unknown, especially if associated with additional treatment burden.
A Discrete Choice Experiment (DCE) including patients with CHB was performed between 2018 and 2019 in Germany. Patient inclusion criteria were confirmed CHB; age of at least 18 years; no history of hepatocellular carcinoma; no HIV or HCV/HDV co-infection. The final DCE included the following attributes: route of administration (oral administration by tablets; subcutaneous injection + tablets; intramuscular electroporation + tablets), side effect frequency (0/1/3 days per month), functional cure (1%/30%/50% of patients), frequency of physician visits (monthly, half-yearly) and travel time to treating physician (15/45 min).
The main analysis sample consisted of 108 patients with CHB (mean age: 49.1 years, female: 37.0%, average time since CHB diagnosis: 14.0 years, 52.8% with Hepatitis B surface antigen (HBsAg) chronic HBV infection). High efficacy was found to be the main driver of decisions for/against the presented treatment options (impacted 57% of patients' decisions), followed by therapy regimen (17%), safety profile (12%) and number of physician visits (11%). Latent class analysis revealed first insights into different decision patterns, with age, gender and previous side-effect experience affecting patients' decisions.
In comparison to all other treatment-related attributes such as therapy regimen or safety profile, patients with CHB showed a strong preference towards a scenario where a substantial number of patients benefit from sustained disease remission, which mimics functional cure.
目前用于慢性乙型肝炎（CHB）的抗病毒疗法很少能实现功能性治愈，因此常常需要终身治疗。一种能使相当比例患者实现功能性治愈的疗法可能会极大地改变治疗格局。然而，患者对功能性治愈的接受程度尚不清楚，尤其是如果这与额外的治疗负担相关。
2018年至2019年在德国对CHB患者进行了一项离散选择实验（DCE）。患者纳入标准为确诊的CHB；年龄至少18岁；无肝细胞癌病史；无HIV或HCV/HDV合并感染。最终的DCE包括以下属性：给药途径（口服片剂；皮下注射+片剂；肌肉电穿孔+片剂）、副作用频率（每月0/1/3天）、功能性治愈（1%/30%/50%的患者）、看医生频率（每月、每半年）以及前往治疗医生处的行程时间（15/45分钟）。
主要分析样本包括108例CHB患者（平均年龄：49.1岁，女性：37.0%，自CHB诊断以来的平均时间：14.0年，52.8%为乙肝表面抗原（HBsAg）慢性HBV感染）。发现高疗效是决定接受/拒绝所提供治疗方案的主要驱动因素（影响57%患者的决策），其次是治疗方案（17%）、安全性（12%）和看医生次数（11%）。潜在类别分析首次揭示了不同的决策模式，年龄、性别和既往副作用经历会影响患者的决策。
与所有其他与治疗相关的属性（如治疗方案或安全性）相比，CHB患者对大量患者受益于持续疾病缓解（类似于功能性治愈）的方案表现出强烈偏好。
