Patient Preferences For Chemotherapy In The Treatment Of Non-Small Cell Lung Cancer: A Multicenter Discrete Choice Experiment (DCE) Study In China
Authors Sun H, Wang H, Xu N, Li J, Shi J, Zhou N, Ni M, Hu X, Chen Y
Received 24 July 2019
Accepted for publication 20 September 2019
Published 8 October 2019 Volume 2019:13 Pages 1701—1709
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Naifeng Liu
Hui Sun,1,2 Huishan Wang,3 Ningze Xu,1 Junling Li,4 Jufang Shi,4 Naitong Zhou,5 Ming Ni,6 Xianzhi Hu,7 Yingyao Chen1
1Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, People’s Republic of China; 2Department of Health Technology Assessment Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China; 3The Second Clinical Medical School of Nanjing Medical University, Nanjing, People’s Republic of China; 4Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 5West China School of Pharmacy, Sichuan University, Chengdu, People’s Republic of China; 6Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; 7Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
Correspondence: Yingyao Chen
School of Public Health, Fudan University, Shanghai 200032, People’s Republic of China
Objective: The study aims to quantify patients’ risk-benefit preferences for chemotherapy in the treatment of non-small cell lung cancer (NSCLC), and to elicit their willingness to pay (WTP) for treatment outcomes.
Methods: A face-to-face discrete choice experiment (DCE) was conducted on NSCLC patients in four tertiary hospitals each from Beijing, Shanghai, Guangzhou and Chengdu in China. Patients were invited to complete choice questions that constructed by seven attributes: progression-free survival (PFS), disease control rate (DCR), rash, nausea and vomiting, tiredness, mode of administration and out-of-pocket costs. A mixed logit model was used to evaluate the choice model. Estimates of relative preferences and marginal willingness to pay for each attribute were then explored.
Results: A total of 361 patients completed the survey. Improvements in PFS (10, 95% CI: 8.4–11.6) were the most important attribute for patients, followed by increase in DCR (4.6, 95% CI: 3.4–5.8). Tiredness (3.9, 95% CI: 2.9–5.1) was judged to be the most important risk. While remaining attributes were ranked in decreasing order of importance: nausea and vomiting (1.9, 95% CI: 0.9–3.0), mode of administration (0.8, 95% CI: 0.2–1.4) and rash (0.5, 95% CI: −0.6–1.5). There was little variation in preferences among patients with different sociodemographic characteristics. Patients were monthly willing to pay $2304 (95% CI, $1916–$2754) that guaranteed 11 months of PFS, followed by $1465 (95% CI, $1163-$1767) per month to improve their disease control rate by 90%.
Conclusion: The results suggested that efficacy was the most important attribute for patients. Side effects, mode of administration and treatment cost significantly influenced patient preferences. Patient engagement in prioritizing their treatment preferences should be emphasized during the clinical decision-making process and regimen implementation.
Keywords: non-small cell lung cancer, chemotherapy, patient preferences, discrete choice experiment
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