疾病标志物和风险评分的利益相关者知情的阳性值:一种方法框架和在阻塞性肺病中的应用
Mohsen Sadatsafavi1, Amir Khakban2, Tima Mohammadi3
1Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada.
Journal of clinical epidemiology
|September 1, 2024
概括
开发基于证据的阳性值需要纳入患者和公众的偏好. 应用到COPD阿兹罗米辛治疗的新框架确定了12%恶化风险的最佳治疗门.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 决策分析 决策分析
- 药物经济学 药物经济学
背景情况:
- 疾病管理中的积极性值通常由临床专家设定,可能会忽视患者和公众的偏好.
- 利益相关者的偏好显著影响治疗的感知净益.
研究的目的:
- 开发一个分析框架来量化基于证据的阳性值的净收益 (NB).
- 将偏好敏感和偏好不可知参数纳入值确定中.
- 将这一框架应用于慢性阻塞性肺病 (COPD) 的阿齐思罗米治疗.
主要方法:
- 提出了一个分析框架,结合了偏好敏感和偏好不可知参数.
- 利用节的选择实验来引起利益相关者的偏好.
- 进行了有针对性的证据综合,以量化偏好不可知参数.
- 应用一个离散选择实验来估计COPD恶化风险和治疗危害的偏好权重.
主要成果:
- 预防中度/严重恶化和听力损失/胃肠道症状的风险是关键属性.
- 偏好权重表明听力损失和胃肠道症状是显著的危害.
- 对于阿兹罗密辛治疗,最大化NB的最佳值是12个月中度或重度恶化风险≥12%.
结论:
- 拟议的方法提供了一个强大的方法来设计积极性值,将利益相关者的偏好纳入其中.
- 对COPD药物治疗的应用产生了利益相关者知情的门,低于当前指南.
- 这一框架加强了临床实践中的共享决策.
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