Hirano Takao, Tanabe Koji, Murata Toshinori
Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
Novartis Pharma K.K, 1-23-1 Toranomon, Minato-Ku, Tokyo, 105-6333, Japan.
Ophthalmol Ther. 2024 Nov;13(11):2887-2901. doi: 10.1007/s40123-024-01026-6. Epub 2024 Sep 17.
Despite the wide range of treatment options available for diabetic macular edema (DME), adherence to treatment remains a barrier. Therefore, this study used conjoint analysis to examine the factors that patients with DME prioritize when choosing a course of treatment and investigated differences in quality of life and levels of disease self-management in patients with or without experience of anti-vascular endothelial growth factor (VEGF) treatment.
A cross-sectional study was conducted through an online survey in Japan between May 31, 2022, and June 30, 2022. Questionnaires were sent to 27,236 individuals registered in the diabetes panels, with experience of treatment for DME within the last 10 years. Conjoint analysis was employed to calculate the relative importance, i.e., degree of influence on patients' treatment choices, considering the trade-offs among five factors: cost per treatment, frequency of visits, anticipated post-treatment visual acuity, physician's explanation about disease and treatment, and frequency of treatment-related side effects.
A total of 237 responses were used to assess the relative importance of cost per treatment, frequency of visits, anticipated post-treatment visual acuity, physician's explanation about the disease, treatment, and frequency of treatment-related side effects using conjoint analysis. The importance of each factor was anticipated post-treatment visual acuity at 30.0, frequency of treatment-related side effects at 25.5, treatment frequency at 17.7, cost per treatment at 16.5, and physician explanation about the disease and treatment at 10.4. The average EuroQoL 5 dimension 5 level index value in patients with and without anti-VEGF treatment experience was 0.785 and 0.825, respectively, with no major difference.
Anticipated post-treatment visual acuity was identified as the most important factor in selecting a treatment regardless of the anti-vascular endothelial growth factor treatment experience demonstrating when patients with DME make treatment choices, anticipated post-treatment visual acuity is prioritized over treatment frequency and cost.
尽管糖尿病性黄斑水肿（DME）有多种治疗选择，但坚持治疗仍是一个障碍。因此，本研究采用联合分析来考察DME患者在选择治疗方案时优先考虑的因素，并调查有或没有抗血管内皮生长因子（VEGF）治疗经验的患者在生活质量和疾病自我管理水平上的差异。
于2022年5月31日至2022年6月30日在日本通过在线调查进行了一项横断面研究。向在糖尿病专家组登记的27236名个体发送了问卷，这些个体在过去10年内有DME治疗经验。采用联合分析来计算相对重要性，即考虑到每次治疗成本、就诊频率、预期治疗后视力、医生对疾病和治疗的解释以及治疗相关副作用的频率这五个因素之间的权衡，对患者治疗选择的影响程度。
共237份回复用于通过联合分析评估每次治疗成本、就诊频率、预期治疗后视力、医生对疾病和治疗的解释以及治疗相关副作用的频率的相对重要性。各因素的重要性依次为：预期治疗后视力30.0、治疗相关副作用频率25.5、治疗频率17.7、每次治疗成本16.5、医生对疾病和治疗的解释10.4。有和没有抗VEGF治疗经验的患者的欧洲五维健康量表5级指数平均得分分别为0.785和0.825，无显著差异。
无论抗血管内皮生长因子治疗经验如何，预期治疗后视力被确定为选择治疗方案时最重要的因素，这表明DME患者在做出治疗选择时，优先考虑预期治疗后视力而非治疗频率和成本。
