Fifer Simon, Kularatne Thames, Tan Marcus, Drummond Fraser, Rule John
Community and Patient Preference Research Pty Ltd, Sydney, NSW, Australia.
Reimbursement & Market Access, GlaxoSmithKline Australia Pty Ltd, Melbourne, VIC, Australia.
Patient Prefer Adherence. 2023 Jul 26;17:1825-1843. doi: 10.2147/PPA.S405288. eCollection 2023.
To better understand what is most important to people living with human immunodeficiency virus (PLWH) when choosing their treatment. We assessed how PLWH trade off the potential risks and benefits of oral and long acting injectable (LAI) treatments.
Firstly, in-depth interviews were conducted with 11 PLWH to develop a holistic understanding of experiences and determine attributes that contribute to treatment decision-making. Secondly, a discrete choice experiment (DCE) was used to understand the treatment preferences for PLWH with n = 99 PLWH aged 18 years or over with a diagnosis of human immunodeficiency virus (HIV) and who were currently using anti-retroviral therapy (ART). Study participants were presented with 12 scenarios and asked to select their preferred treatment among two hypothetical injectable treatment alternatives, "injection 1" and "injection 2" and their current oral ART treatment. The DCE data were modelled using a latent class model (LCM).
The model revealed significant heterogeneity in preferences for treatment attributes among study participants. Two segments/classes of PLWH were identified. The first segment expressed a strong preference for their current oral treatment; the second segment showed strong preference for the injection treatment and for it to be administered in a GP clinic. Overall, out-of-pocket cost was the most important attribute for participants. One-third of PLWH were willing to switch to an LAI.
Not all PLWH valued the same treatment attributes equally. Overall, out-of-pocket costs for treatments were considered by respondents as the most determining factor in making treatment choices. Results have important implications for healthcare policy and will serve to better inform patients and stakeholders involved in the treatment decision-making process about the treatment preferences of PLWH. Clinicians are encouraged to consider shared decision-making to establish the treatment course that best aligns with PLWH's treatment goals.
为了更好地了解人类免疫缺陷病毒感染者（PLWH）在选择治疗方案时认为最重要的因素。我们评估了PLWH如何权衡口服和长效注射（LAI）治疗的潜在风险和益处。
首先，对11名PLWH进行了深入访谈，以全面了解他们的经历，并确定有助于治疗决策的因素。其次，采用离散选择实验（DCE）来了解PLWH的治疗偏好，该实验纳入了99名年龄在18岁及以上、被诊断为人类免疫缺陷病毒（HIV）且目前正在接受抗逆转录病毒治疗（ART）的PLWH。研究参与者面对12种情景，被要求在两种假设的注射治疗方案“注射1”和“注射2”以及他们目前的口服ART治疗方案中选择他们偏好的治疗方案。DCE数据采用潜在类别模型（LCM）进行建模。
该模型显示研究参与者对治疗因素的偏好存在显著异质性。确定了两类PLWH。第一类对他们目前的口服治疗表现出强烈偏好；第二类则对注射治疗以及在全科医生诊所进行注射表现出强烈偏好。总体而言，自付费用是参与者最重要的因素。三分之一的PLWH愿意改用LAI。
并非所有PLWH对相同的治疗因素都同等重视。总体而言，受访者认为治疗的自付费用是做出治疗选择的最决定性因素。研究结果对医疗政策具有重要意义，将有助于更好地让参与治疗决策过程的患者和利益相关者了解PLWH的治疗偏好。鼓励临床医生考虑共同决策，以确定最符合PLWH治疗目标的治疗方案。
