Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Patient. 2022 Nov;15(6):679-690. doi: 10.1007/s40271-022-00586-8. Epub 2022 Jun 14.
The side effects of dry eye medications can lead to medication non-adherence and, eventually, to poor outcomes. This study aimed to quantify to what extent the side effects of dry eye disease (DED) medications (burning/stinging sensation and blurring) are important to patients compared to medication benefits or costs.
Patients diagnosed with DED were recruited at a referral eye center in Singapore (n = 139). This study utilized a Discrete Choice Experiment where patients were presented with 10 choice tasks where they were asked to choose between their current medication (or no medication), and two hypothetical medications that varied based on five attributes: duration of burning/stinging, duration of blurring, time to medication effectiveness, medication frequency, and out-of-pocket cost. The main outcomes were relative attribute importance and predicted uptake.
Latent class logistic regressions found two groups with distinct preferences. For both classes, duration of burning/stinging (Class 1 = 23%, Class 2 = 29%) and cost (Class 1 = 24%, Class 2 = 27%) were the most important attributes while duration of blurring (Class 1 = 15%, Class 2 = 9%) was the least important. The predicted uptake of a medication increased 18 percentage-points when burning/stinging duration decreased from 2 h to a few minutes. The predicted uptake for new medications was lowest for those on medication with well-controlled symptoms and highest for those who were not on medication and could not control their symptoms effectively.
This study showed that duration of burning/stinging was an important factor when choosing medications. Incorporating patient preferences in medication decisions can potentially improve patient acceptance of a treatment regimen.
干眼症药物的副作用可能导致患者不遵医嘱，最终导致治疗效果不佳。本研究旨在定量评估干眼症（DED）药物（烧灼感/刺痛感和模糊感）的副作用相对于药物益处或成本对患者的重要程度。
在新加坡的一家眼科转诊中心招募了被诊断为 DED 的患者（n=139）。本研究采用离散选择实验，患者需在 10 项选择任务中进行选择，其中包括他们目前的药物（或无药物）和两种基于五个属性的假设药物：烧灼感/刺痛感持续时间、模糊感持续时间、药物起效时间、用药频率和自付费用。主要结局为相对属性重要性和预测采用率。
潜在类别逻辑回归发现两组患者的偏好存在明显差异。对于两组患者，烧灼感/刺痛感持续时间（第 1 类=23%，第 2 类=29%）和成本（第 1 类=24%，第 2 类=27%）是最重要的属性，而模糊感持续时间（第 1 类=15%，第 2 类=9%）是最不重要的属性。当烧灼感/刺痛感持续时间从 2 小时减少到几分钟时，预测采用率增加了 18 个百分点。对于症状得到良好控制的用药患者，新药物的预测采用率最低；对于那些正在用药但无法有效控制症状的患者，预测采用率最高。
本研究表明，烧灼感/刺痛感持续时间是选择药物时的一个重要因素。在药物决策中纳入患者的偏好，可能会提高患者对治疗方案的接受程度。
