- 學位論文
使用個體選擇試驗法探討乳癌婦女對乳房重建之偏好
Breast Cancer Patients’ Preferences for Breast Reconstruction: a Discrete Choice Experiment
摘要
乳房重建手術的目的在於提昇病患術後的生活品質，在美國乳房重建手術已成為乳癌治療的一部分。個體選擇試驗為一個以屬性為基礎，評估效用的方法。藉由統計的方法，設計出一系列的選擇集合，提供受訪者選擇。每次呈現兩個或兩個以上的方案，所組成的方案，要求受訪者從中，每次都只能選出一個最喜歡的方案。每個方案都由許多不同的屬性，及這些不同屬性的水準所組成。研究者再將受訪者對於不同屬性水準之取捨結果，予以量化，進而推導出受訪者心中的偏好。本研究利用條件邏輯特模型 (conditional logit model, CLM)分析乳癌婦女對乳房重建手術的偏好及願付價格。本研究採面對面訪問的方式，研究對象為年齡為65歲以下已接受乳房重建手術三個月以上乳癌婦女，或即將接受乳房全切除術的乳癌婦女，或已完成乳房切除術半年以上的病患為收案對象。 本研究結果發現，乳癌婦女對很好的外觀與觸感、手術時間愈短與次數愈少、及以自體組織作為重建材料，呈正向偏好。當失敗率愈高、重建費用愈高，婦女的偏好就愈低。本研究亦針對重建方案的屬性水準，推估其願付價格，其中以很好的外觀與觸感此屬性的願付價格為最高；以手術次數2次每次2小時的手術次數與時間此屬性的願付價格為最低。本研究利用條件邏輯特模型估計乳癌婦女心中最偏好的乳房重建手術方案，希望可提供醫師在提升醫療技術時的參考。
並列摘要
Breast reconstruction (BR) is aimed at improving quality of life after mastectomy. In the United States, BR is viewed as part of breast cancer therapy. The discrete choice experiment is an attribute-based survey method for measuring utility. DCEs typically are implemented in surveys comprising several choice sets, each containing hypothetical choices between which respondents choose. Each option is described by a set of attributes, and each attribute takes one of several levels. The underlying statistical design of the DCE allowed us to estimate respondents’ relative preferences for the attribute levels and the relative importance of the attributes in their decisions. The study used face-to-facet interview. Our study sample is the woman who under 65 years old, and who had undergone a mastectomy with BR over three months, or who had undergone a mastectomy without BR over six months, or who will undergo mastectomy. The study finds the results. The excellent aesthetic result, the autologous tissue used for BR, and the lower number and duration of operations, the higher utility that women got from this BR. When the higher failure rate and the higher out-of-pocket, the lower utility that women got from this BR. The BR attributes’ willingness-to-pay are also estimated separately. Among them, the excellent aesthetic result this BR attributes’ willingness-to-pay is the highest, and the number and duration of operations (2 times * 2Hr) this BR attributes’ willingness-to-pay is the lowest.The study utilized conditional logit model to analyze breast cancer women’s BR preference and their willingness-to-pay. Wish the results of this study can be consulted while doctor promoting the BR technology.