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在精准医学中解决不确定性和避免伤害的提供者偏好:一项离散选择实验。

Provider preferences for resolving uncertainty and avoiding harms in precision medicine: a discrete choice experiment.

机构信息

The Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, WA 98195, USA.

Canadian Centre for Applied Research in Cancer Control (ARCC), Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada.

出版信息

Per Med. 2020 Sep;17(5):389-398. doi: 10.2217/pme-2020-0018. Epub 2020 Aug 17.

Abstract

Substantial uncertainty exists about how providers assess the value of genomic testing. We developed and administered a discrete choice experiment to a national sample of providers. We analyzed responses using an error components mixed logit model. We received responses from 356 providers. The attributes important to providers were patient health and function, life expectancy, cost, expert agreement, and biomarker prevalence. Providers significantly valued reducing uncertainty only when it eliminated the possibility of decreased life expectancy. Providers valued improving certainty about life expectancy gains from 12 ± 18 to 12 ± 6 months at US$400 (US$200-600) versus US$200 (-US$60-500) for 4 ± 4 to 4 ± 2 years. Providers value resolving uncertainty most when it eliminates the possibility of substantial harm.

摘要

关于提供者如何评估基因组检测的价值,存在很大的不确定性。我们针对全国的提供者样本制定并开展了一项离散选择实验。我们使用错误成分混合对数模型对这些反应进行了分析。我们收到了 356 名提供者的回复。对提供者重要的属性是患者的健康和功能、预期寿命、成本、专家意见和生物标志物的流行率。只有在消除预期寿命降低的可能性的情况下,提供者才会显著重视降低不确定性。与 200 美元(-60 至 500 美元)相比,提供者认为将预期寿命的获益从 12 ± 18 个月提高到 12 ± 6 个月(4 ± 4 至 4 ± 2 年)的收益增加 400 美元(200 至 600 美元)是有价值的。当消除了造成重大伤害的可能性时,提供者最重视解决不确定性。

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