Meirelles Isandra, Magliano Carlos
Health Technology Assessment Unit, Instituto Nacional de Cardiologia, Rio de Janeiro, Rio de Janeiro, Brazil.
Patient Prefer Adherence. 2021 Apr 30;15:911-917. doi: 10.2147/PPA.S302394. eCollection 2021.
The different alternatives for non-small-cell lung cancer (NSCLC) treatment can increase survival but cause important adverse events. Therefore, patients' preference can play a critical role in decision-making. Among stated preference methods, discrete choice experiment (DCE) is the most applied in health care to elicit preferences. This research aims to elicit patients' preference evaluating the trade-off between the risks (adverse events) and benefits (survival) of systemic treatments, from the perspective of Brazilian patients with locally advanced, metastatic or recurrent NSCLC.
A DCE was performed following the steps of attributes selection; construction of tasks and respondents' preference elicitation. Patients chose between 2 hypothetical treatments described by the attributes tiredness, hair loss, skin rash, hospitalization, administration mode and survival. A paper-and-pencil survey method was used to elicit the answers from the participants. The statistical data analysis used a mixed logit model to predict the relative importance of the attributes.
Most of the 65 patients interviewed were men (53.8%), mean age of 65 (95% confidence interval [CI]: 63-67) years and lung cancer stage IV (67.7%). Except for hospitalization and administration mode, the attributes coefficients were statistically significant (p < 0.005) for patients' preferences. Patients would require a minimum survival gain of 11.72 (CI: 10.28-4.22) months and 19.72 (CI: 17.31-7.09) months to accept a treatment that causes severe tiredness and severe skin rash, respectively. The market share of the treatments was calculated according to the DCE aggregate-level estimation, considering the impact of each treatment's side effects. Paclitaxel plus carboplatin had an estimated market share of 31%, followed by gefitinib (27%), erlotinib (24%) and docetaxel (18%).
In general, less than a year of survival gain would not suffice for the appearance of severe skin rash or tiredness.
非小细胞肺癌（NSCLC）的不同治疗方案可提高生存率，但会引发重要的不良事件。因此，患者的偏好可能在决策中发挥关键作用。在陈述偏好方法中，离散选择实验（DCE）在医疗保健领域应用最为广泛，用于引出偏好。本研究旨在从巴西局部晚期、转移性或复发性NSCLC患者的角度，引出患者对全身治疗的风险（不良事件）和益处（生存率）之间权衡的偏好。
按照属性选择、任务构建和受访者偏好引出的步骤进行DCE。患者在由疲劳、脱发、皮疹、住院、给药方式和生存率等属性描述的两种假设治疗方案之间进行选择。采用纸笔调查法从参与者那里获取答案。统计数据分析使用混合逻辑模型来预测属性的相对重要性。
接受访谈的65名患者中，大多数为男性（53.8%），平均年龄65岁（95%置信区间[CI]：63 - 67），肺癌分期为IV期（67.7%）。除住院和给药方式外，各属性系数对患者偏好具有统计学意义（p < 0.005）。患者分别需要至少11.72（CI：10.28 - 4.22）个月和19.72（CI：17.31 - 7.09）个月的生存获益，才会接受导致严重疲劳和严重皮疹的治疗。根据DCE总体水平估计，考虑每种治疗副作用的影响，计算了各治疗方案的市场份额。紫杉醇加卡铂的估计市场份额为31%，其次是吉非替尼（27%）、厄洛替尼（24%）和多西他赛（18%）。
一般而言，不到一年的生存获益不足以抵消严重皮疹或疲劳的出现。
