Al-Omari Basem, McMeekin Peter
College of Medicine & Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.
School of Health & Life Sciences, University of Northumbria, Newcastle-Upon-Tyne, UK.
Patient Prefer Adherence. 2020 Dec 22;14:2501-2515. doi: 10.2147/PPA.S283922. eCollection 2020.
Osteoarthritis (OA) patients consider ranges of harms and benefits offered by alternative pharmaceutical treatments. Choice-based experiments provide a mechanism to value outcomes, but they can pose a significant burden on respondents. Thus, the number of attributes studied is typically artificially restricted. We used an adaptive choice-based conjoint (ACBC) method that allows the inclusion of more attributes affecting patients' preferences regarding non-invasive pharmaceutical treatment for OA than traditional choice-based technique to better understand the trade-offs that OA patients consider, without increasing respondents' burden.
After consulting with OA patients and public involvement (PPI) group, we constructed an online ACBC survey consisting of 9 attributes and a total of 31 levels (two benefits, four harms and three concerning the availability and modality of treatment). A cohort of patients with a diagnosis of OA and reporting joint pain within the last 12 months were recruited.
Our study (n 43) showed that the most important factor in choosing OA medication was the risk of heart attacks and strokes (19.5%), followed by the risk of addiction (18.4%), risk of kidney and liver side effects (17.5%), risk stomach side effects (14.6%), availability (11.6%), frequency of use (5.3%), pain reduction (5%), way of taking medication (4.6%) and mobility improvement (3.5%).
ACBC provides a mechanism for understanding patient preferences that address the limitations of traditional choice-based experiments. For OA patients, avoidance of the risk of side effects were the most affecting medication choices, and reductions in pain and mobility were the least. Clinicians discussing options for medication with OA patients should discuss the potential trade-offs in terms of risks and benefits.
骨关节炎（OA）患者会考虑替代药物治疗带来的一系列危害和益处。基于选择的实验提供了一种评估结果的机制，但可能给受访者带来巨大负担。因此，所研究属性的数量通常会人为受限。我们采用了一种自适应基于选择的联合分析（ACBC）方法，该方法比传统的基于选择的技术能够纳入更多影响患者对OA非侵入性药物治疗偏好的属性，从而在不增加受访者负担的情况下，更好地理解OA患者所考虑的权衡因素。
在咨询OA患者和公众参与（PPI）小组后，我们构建了一项在线ACBC调查，其中包含9个属性，共31个水平（两个益处、四个危害以及三个与治疗的可及性和方式有关的属性）。招募了一组诊断为OA且在过去12个月内报告有关节疼痛的患者。
我们的研究（n = 43）表明，选择OA药物时最重要的因素是心脏病发作和中风的风险（19.5%），其次是成瘾风险（18.4%）、肾和肝副作用风险（17.5%）、胃副作用风险（14.6%）、可及性（11.6%）、使用频率（5.3%）、疼痛减轻（5%）、用药方式（4.6%）和活动能力改善（3.5%）。
ACBC提供了一种理解患者偏好的机制，解决了传统基于选择的实验的局限性。对于OA患者而言，避免副作用风险对药物选择影响最大，而疼痛减轻和活动能力改善的影响最小。与OA患者讨论用药选择的临床医生应就风险和益处方面讨论潜在的权衡。
