Department of Anesthesiology, School of Medicine, University of Washington, Seattle, WA, USA.
RTI Health Solutions, Belfast, UK.
Osteoarthritis Cartilage. 2020 Sep;28(9):1202-1213. doi: 10.1016/j.joca.2020.06.006. Epub 2020 Jul 8.
To quantify preferences for attributes of potential analgesic treatments for moderate-to-severe pain associated with osteoarthritis (OA) and/or chronic low back pain (CLBP) as relevant to injectable nerve growth factor (NGF)-inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids.
We used a discrete-choice experiment (DCE) to elicit preferences for attributes of OA and CLBP pharmaceutical treatments, and a best-worst scaling (BWS) exercise to further characterize the relative importance of treatment-related side-effect risks. The survey was completed online by 602 US residents with self-reported chronic, moderate-to-severe OA pain and/or CLBP who had tried, had contraindications for, or were unwilling to take currently available pharmaceutical therapies. In the DCE, respondents repeatedly chose between two hypothetical treatments defined by six attributes (symptom control; treatment-related risks of (1) severe joint problems, (2) heart attack, and (3) physical dependence; mode/frequency of administration; and cost). In the BWS exercise, respondents evaluated ten side-effect risks. Random-parameters logit models were estimated; conditional relative attribute importance, maximum acceptable risks, and willingness to pay were calculated.
The most important DCE attributes were improving symptom control (scaled conditional relative importance, 10.00) and reducing risk of physical dependence (6.99). The three most important BWS attributes were, in rank order, risks of stroke, physical dependence, and heart attack. Respondents were willing to accept a > 4% treatment-related risk of severe joint problems for even modest symptom improvement.
A pharmaceutical treatment with a risk of severe joint problems was viewed as an acceptable alternative to other treatments with comparable efficacy but risks associated with NSAIDs or opioids.
量化对潜在镇痛治疗方法的属性的偏好，这些治疗方法与注射用神经生长因子（NGF）抑制剂、非甾体抗炎药（NSAIDs）和阿片类药物相关，适用于治疗中度至重度骨关节炎（OA）和/或慢性下背痛（CLBP）。
我们使用离散选择实验（DCE）来引出对 OA 和 CLBP 药物治疗属性的偏好，并使用最佳最差分级（BWS）进一步描述与治疗相关的副作用风险的相对重要性。该调查通过在线方式完成，共涉及 602 名美国居民，他们报告患有慢性、中度至重度 OA 疼痛和/或 CLBP，曾尝试过、有禁忌或不愿意接受当前可用的药物治疗。在 DCE 中，受访者反复在两种假设治疗方法之间做出选择，这两种方法由六个属性定义（症状控制；与治疗相关的（1）严重关节问题、（2）心脏病发作和（3）身体依赖的风险；管理/频率；和成本）。在 BWS 练习中，受访者评估了十种副作用风险。估计了随机参数对数模型；计算了条件相对属性重要性、最大可接受风险和支付意愿。
DCE 中最重要的属性是改善症状控制（标度条件相对重要性，10.00）和降低身体依赖风险（6.99）。BWS 中最重要的三个属性依次为中风、身体依赖和心脏病发作的风险。受访者愿意接受治疗相关的严重关节问题风险>4%，以换取症状的适度改善。
与具有 NSAIDs 或阿片类药物相关风险的其他治疗方法相比，具有严重关节问题风险的药物治疗被视为可接受的替代方法。
