David E Kandzari, Michael A Weber, Christine Poulos, Joshua Coulter, Sidney A Cohen, Vanessa DeBruin, Denise Jones, Atul Pathak
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引用次数: 4
Abstract
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
背景:离散选择实验是一种调查方法,用于了解个人如何做出决定和量化特征的相对重要性。采用离散选择实验方法,我们量化了患者对高血压治疗的获益-风险偏好,包括药物和介入治疗,如肾去神经。方法:来自美国的被调查者,医生证实高血压未得到控制,在包括手术或药物治疗之间选择,采用结构化调查。治疗特点包括介入性、非介入性或无高血压治疗;每日服用降压药(BP)的数量;预期办公室收缩压降低;有效时间;以及药物副作用、通路疼痛或血管损伤的风险。随机参数logit模型的结果用于估计每个处理属性的重要性。结果:在2020年至2021年期间完成调查的400例患者中,人口统计学包括:52%的女性,平均年龄59.2±13.0岁,收缩压155.1±12.3 mm Hg, 1.8±0.9处方降压药。降低办公室收缩压是最重要的治疗属性。其余的属性,按降序排列为:疗效持续时间、治疗是否介入性、每日服药次数、血管损伤风险和药物副作用风险。接触部位疼痛的风险不影响选择。一般来说,受访者更喜欢非介入治疗而不是介入治疗,但只需降低办公室收缩压2.3毫米汞柱就可以抵消这种偏好。办公室收缩压的小幅降低可以抵消血管损伤或药物副作用的风险。至少有20%的血管损伤或药物副作用的风险将被容忍,以换取血压的改善。结论:收缩压降低被认为是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,与在肾去神经试验中观察到的结果相比,应答者将接受介入治疗以换取适度的收缩压降低。
期刊介绍:
Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.