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Patient and oncologist preferences for attributes of treatments in advanced melanoma: a discrete choice experiment

机译：患者和肿瘤科医生对晚期黑色素瘤治疗属性的偏好：一项离散选择实验

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Purpose: To examine and compare patient and oncologist preferences for advanced melanoma treatment attributes and to document their trade-offs for benefits with risks. Materials and methods: A discrete choice experiment (DCE) was conducted among advanced melanoma patients and oncologists. Qualitative pilot testing was used to inform the DCE design. A series of scenarios asked stakeholders to choose between two hypothetical medications, each with seven attributes: mode of administration (MoA), dosing schedule (DS), median duration of therapy (MDT), objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and grade 3–4 adverse events (AEs). Hierarchical Bayesian logistic regression models were used to determine patients’ and oncologists’ choice-based preferences, analysis of variance models were used to estimate the relative importance of attributes, and independent t -tests were used to compare relative importance estimates between stakeholders. Results: In total, 200 patients and 226 oncologists completed the study. OS was most important to patients (33%), followed by AEs (29%) and ORR (25%). For oncologists, AEs were most important (49%), followed by OS (34%) and ORR (12%). An improvement from 55% to 75% in 1-year OS was valued similar in magnitude to a 23% decrease (from 55% to 32%) in likelihood of AEs for oncologists. Conclusion: Patients valued OS, AEs, and ORR sequentially as the most important attributes in making a treatment decision, whereas oncologists valued AEs most, followed by OS and ORR. In comparison, patients differed significantly from oncologists on the importance of ORR, AEs, and PFS, but were consistent in OS and the rest of attributes.
机译：目的：检查和比较患者和肿瘤科医生对黑色素瘤晚期治疗属性的偏好，并记录他们在权衡利弊方面的取舍。材料和方法：在晚期黑素瘤患者和肿瘤科医生中进行了离散选择实验（DCE）。定性的先导测试用于指导DCE设计。一系列方案要求利益相关者在两种假设的药物之间进行选择，每种药物均具有以下七个属性：给药方式（MoA），给药方案（DS），中位治疗时间（MDT），客观缓解率（ORR），无进展生存期（PFS），总生存期（OS）和3-4级不良事件（AEs）。贝叶斯分层Logistic回归模型用于确定患者和肿瘤科医生基于选择的偏好，方差分析用于估计属性的相对重要性，独立t检验用于比较利益相关者之间的相对重要性估计。结果：总共有200名患者和226名肿瘤学家完成了这项研究。 OS对患者最重要（33％），其次是AEs（29％）和ORR（25％）。对于肿瘤科医生来说，不良事件最为重要（49％），其次是OS（34％）和ORR（12％）。一年内OS从55％改善到75％的价值与肿瘤科医生发生AE的可能性减少23％（从55％减少到32％）相似。结论：在制定治疗方案时，患者依序将OS，AEs和ORR视为最重要的属性，而肿瘤科医生则对AEs的评价最高，其次是OS和ORR。相比之下，患者在ORR，AE和PFS的重要性方面与肿瘤科医生存在显着差异，但在OS和其他属性方面保持一致。

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