Maculaitis Martine C, Kim Ruth, Hunsche Elke, Beusterien Kathleen M, Cislo Paul, Ansani Nicole T, Hauber Brett
RWE Data & Analytics, Oracle Life Sciences, Austin, TX, USA.
Patient & Health Impact, Pfizer Inc, New York, NY, USA.
Womens Health (Lond). 2025 Jan-Dec;21:17455057251331700. doi: 10.1177/17455057251331700. Epub 2025 Sep 7.
Endometriosis symptoms have multifaceted manifestations, and there are few approved nonsurgical treatment options. Gonadotropin-releasing hormone (GnRH) agonists/antagonists for endometriosis vary on efficacy, safety profile, and out-of-pocket (OOP) cost, among other features.
This study quantified the importance that women with endometriosis in the United States (US) placed on pain and non-pain features that differ among these medications.
English-speaking, 18 to 50 years (premenopausal) US women with healthcare coverage for the past 3 years, who self-reported a laparoscopy-confirmed endometriosis diagnosis, were recruited via healthcare research panels to complete a cross-sectional survey.
A discrete choice experiment (DCE) with a surgery opt-out option assessed preferences for eight GnRH agonist/antagonist attributes (reducing different types of pain, treatment administration, impact on daily activities, etc.). Best-worst scaling (BWS) assessed preferences for 11 non-pain medication attributes (dosage flexibility, short treatment onset, reversible side effects, etc.). Relative importance (RI) was estimated for each attribute.
Overall, 300 women were included (mean age 33.0 years; 76.7% White). Across DCE choice tasks, GnRH agonist/antagonist was chosen over surgery 46.7% of the time. Non-menstrual pelvic pain relief (RI = 23.1%), reducing monthly OOP cost (RI = 22.1%), and relief of dyspareunia (RI = 21.4%) and dysmenorrhea (RI = 12.9%) were most important for GnRH treatment choice. Among non-pain attributes in the BWS, short onset of treatment effect (RI = 13.1%), long-term safety (RI = 12.9%), and reducing fatigue (RI = 11.2%) were most important to women when choosing a pharmacologic endometriosis treatment.
Relieving the three types of endometriosis pain and reducing cost are the most important considerations for women when selecting GnRH agonist/antagonist treatment. Women with endometriosis strongly prefer a medication that can be safely taken for longer periods of time, takes effect within a few menstrual cycles, and can reduce endometriosis-related fatigue. Findings can inform discussions between patients and healthcare providers to better align endometriosis treatment decision-making with patients' individual needs and preferences.
子宫内膜异位症症状具有多方面表现，且获批的非手术治疗方案较少。用于子宫内膜异位症的促性腺激素释放激素（GnRH）激动剂/拮抗剂在疗效、安全性和自付费用等方面存在差异。
本研究量化了美国患有子宫内膜异位症的女性对这些药物之间存在差异的疼痛和非疼痛特征的重视程度。
通过医疗研究小组招募过去3年有医保覆盖、年龄在18至50岁（绝经前）、自我报告经腹腔镜确诊为子宫内膜异位症的美国英语使用者，以完成一项横断面调查。
采用带有手术不选择选项的离散选择实验（DCE）来评估对8种GnRH激动剂/拮抗剂属性（减轻不同类型疼痛、治疗给药方式、对日常活动的影响等）的偏好。采用最佳-最差尺度法（BWS）评估对11种非疼痛药物属性（剂量灵活性、治疗起效快、副作用可逆等）的偏好。估计每种属性的相对重要性（RI）。
共纳入300名女性（平均年龄33.0岁；76.7%为白人）。在DCE选择任务中，46.7%的时间选择了GnRH激动剂/拮抗剂而非手术。缓解非经期盆腔疼痛（RI = 23.1%）、降低每月自付费用（RI = 22.1%）、缓解性交困难（RI = 21.4%）和痛经（RI = 12.9%）对GnRH治疗选择最为重要。在BWS的非疼痛属性中，治疗效果起效快（RI = 13.1%）、长期安全性（RI = 12.9%）和减轻疲劳（RI = 11.2%）在女性选择子宫内膜异位症药物治疗时最为重要。
缓解三种类型的子宫内膜异位症疼痛和降低成本是女性选择GnRH激动剂/拮抗剂治疗时最重要的考虑因素。患有子宫内膜异位症的女性强烈倾向于一种可以安全长期服用、在几个月经周期内起效且能减轻与子宫内膜异位症相关疲劳的药物。研究结果可为患者与医疗服务提供者之间的讨论提供参考，以便更好地使子宫内膜异位症治疗决策与患者的个人需求和偏好相匹配。
