Do patients and physicians have similar preferences for chronic hepatitis B treatment outcomes in Turkey?

Giriş: Bu çalışmanın amacı kronik hepatit B (KHB) tedavisinde etkinlik, yan etki ve kanıt düzeyindeki belirsizlikler açısından hastaların ve doktorların sonlanım tercihlerini ölçmektir. Materyal ve Metod: Türkiye'de KHB tedavisi yapan doktorlara ve en az bir doktor tarafından KHB tanısı konulduğunu bildiren hastalara, web tabanlı bir ayrık seçim deneysel anketi uygulandı. Hastalar ve doktorlar antiviral tedaviler hakkında, çoktan seçmeli 12 soruyu yanıtladı. İlacın ne kadar süredir araştırıldığı (kanıtın miktarı), beş yıl boyunca hastanın viral yükün belirlenemez olma ve ilerlemiş hastalığın geri dönme olasılığı (etkinlik), beş yıllık tedavide kırık ve böbrek yetersizliği riski ve aylık ilaç maliyetiyle tanımlanmış hipotetik KHB ilaçları hakkında soru çiftleri kullanılarak değerlendirme yapıldı. Mevcut üç KHB tedavisi için oluşturulan profillere yönelik tercih puanlarını ve tüm özellik düzeylerindeki tercih ağırlığını hesaplamak için logit modeller kullanıldı. Tercih yapısında konjoint analizi kullanıldı. Bulgular: Anketi 159 doktor ve 117 hasta tamamladı. Hasta ve doktorların KHB tedavilerinin özelliklerinin görece önemleri değerlendirmesinde çelişkili görüşleri vardı. Hastalar kanıt düzeyini ve etkinliği en önemli özellik olarak sıralarken, doktorlar etkinlik ve böbrek yetmezliği riskini en önemli özellik olarak derecelendirdi. Her iki grup da, potent etkinlik ve düşük yan etki riskine sahip KHB ilacını, potent etkinlik ve orta yan etki risk profiline sahip ilaca göre tercih etti (p> 0.05). Her iki ilaç profili zayıf etkili ve düşük yan etkili risk profiline sahip KHB ilacına göre tercih edildi (hastalar için p> 0.05, doktorlar için p< 0.005). Sonuç: Türkiye'de KHB tedavileri için hasta ve doktor seçimlerini ölçen ilk çalışmadır. Doktor ve hasta tercihleri arasındaki uyumsuzluk, kanıtın ağırlığının önemi ve yan etki riskine karşın etkinlik hakkında taraflar arasındaki eşit olmayan bilgi düzeyi ile açıklanabilir. Bu bulgular, ruhsat ve geri ödeme kararlarına doktor ve hasta bakış açılarının da yansıtılması ihtiyacını göstermektedir.

Türkiye'de hastaların ve doktorların kronik hepatit tedavi sonlanımları için tercihleri benzer midir?

Introduction: We aimed to quantify patients' and physicians' preferences for therapeutic trade-offs involving the efficacy, side-effect risks, and evidence uncertainty in chronic hepatitis B (CHB) treatments. Materials and Methods: Physicians who treat CHB patients and adult patients with a self-reported physician diagnosis of CHB completed a web-enabled, discrete-choice experiment survey in Turkey. Both patients and physicians answered 12 treatment-choice questions. Each question required evaluating a pair of hypothetical CHB medication profiles defined by the years the medicine has been studied (weight of evidence), probability that the patient's viral load remains undetectable for five years with possible reversal of disease progression (efficacy), five-year treatment-related risks of a fracture and renal insufficiency, and monthly medication cost. Logit models were used to estimate preference weights for all attribute levels and the profile preference scores for three current CHB treatments. A choice format conjoint analysis was used. Results: 159 physicians and 117 patients completed the survey. Patients and physicians had discordant views on the relative importance of CHB treatment attributes. Patients ranked weight of evidence and efficacy as the most important attributes, while physicians ranked efficacy and risk of renal insufficiency as the most important attributes. Both groups preferred a CHB medication profile characterized by potent efficacy and low side-effect risk versus a medication profile characterized by a potent efficacy and moderate side-effect risk profile (p> 0.05). Both medication profiles were preferred over a CHB medication with poor efficacy and low side-effect risk profile (p> 0.05 for patients and p< 0.05 for physicians). Conclusion: This is the first study to quantify patients' and physicians' preferences for CHB treatments in Turkey. Discordance between physicians' and patients' preferences can be explained by asymmetric knowledge and information regarding the importance of weight of evidence and efficacy versus side-effect risks. This fact highlights the need for reflection of physician and patient perspectives on regulatory and reimbursement decisions.

Kaynakça

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