Piedmont Heart Institute, Atlanta, GA (D.E.K.).
SUNY Downstate College of Medicine, Brooklyn, NY (M.A.W.).
Circ Cardiovasc Qual Outcomes. 2023 Jan;16(1):e008997. doi: 10.1161/CIRCOUTCOMES.122.008997. Epub 2022 Dec 9.
Discrete choice experiment is a survey method used to understand how individuals make decisions and to quantify the relative importance of features. Using discrete choice experiment methods, we quantified patient benefit-risk preferences for hypertension treatments, including pharmaceutical and interventional treatments, like renal denervation.
Respondents from the United States with physician-confirmed uncontrolled hypertension selected between treatments involving a procedure or pills, using a structured survey. Treatment features included interventional, noninterventional, or no hypertension treatment; number of daily blood pressure (BP) pills; expected reduction in office systolic BP; duration of effect; and risks of drug side effects, access site pain, or vascular injury. The results of a random-parameters logit model were used to estimate the importance of each treatment attribute.
Among 400 patients completing the survey between 2020 and 2021, demographics included: 52% women, mean age 59.2±13.0 years, systolic BP 155.1±12.3 mm Hg, and 1.8±0.9 prescribed antihypertensive medications. Reduction in office systolic BP was the most important treatment attribute. The remaining attributes, in decreasing order, were duration of effect, whether treatment was interventional, number of daily pills, risk of vascular injury, and risk of drug side effects. Risk of access site pain did not influence choice. In general, respondents preferred noninterventional over interventional treatments, yet only a 2.3 mm Hg reduction in office systolic BP was required to offset this preference. Small reductions in office systolic BP would offset risks of vascular injury or drug side effects. At least a 20% risk of vascular injury or drug side effects would be tolerated in exchange for improved BP.
Reduction in systolic BP was identified as the most important driver of patient treatment preference, while treatment-related risks had less influence. The results indicate that respondents would accept interventional treatments in exchange for modest reductions in systolic BP compared with those observed in renal denervation trials.
离散选择实验是一种用于了解个体如何做出决策并量化特征相对重要性的调查方法。我们使用离散选择实验方法，量化了高血压治疗（包括药物和介入治疗，如肾去神经治疗）的患者获益-风险偏好。
来自美国的、经医生确诊的未控制高血压患者通过结构化调查在涉及手术或药丸的治疗方案之间进行选择。治疗方案的特征包括介入性、非介入性或不进行高血压治疗；每天服用的降压药数量；预期的诊室收缩压降低值；作用持续时间；以及药物副作用、穿刺部位疼痛或血管损伤的风险。使用随机参数对数模型的结果来估计每个治疗属性的重要性。
在 2020 年至 2021 年间完成调查的 400 名患者中，人口统计学特征包括：52%为女性，平均年龄 59.2±13.0 岁，诊室收缩压 155.1±12.3mmHg，以及 1.8±0.9 种处方降压药物。诊室收缩压降低是最重要的治疗属性。其余属性按降序排列依次为作用持续时间、治疗是否介入、每天服用的药丸数量、血管损伤风险和药物副作用风险。穿刺部位疼痛风险不影响选择。总体而言，患者更喜欢非介入性治疗而非介入性治疗，但只需降低 2.3mmHg 的诊室收缩压即可抵消这种偏好。较小的诊室收缩压降低幅度可以抵消血管损伤或药物副作用的风险。血管损伤或药物副作用的风险至少要达到 20%才会被容忍，以换取血压的改善。
诊室收缩压降低被确定为患者治疗偏好的最重要驱动因素，而治疗相关风险的影响较小。结果表明，与肾去神经治疗试验中观察到的相比，患者愿意接受介入治疗以换取诊室收缩压的适度降低。
