應用離散選擇試驗法探討乳癌婦女對荷爾蒙療法選擇之偏好

本研究之主要目的在於瞭解早期乳癌婦女對於荷爾蒙藥物治療特性之偏好態度，並探討影響偏好之因素及各治療特性間的取捨關係。研究發現期望能對醫生未來的治療方向有所助益，及讓藥廠開發新治療產品能更符合目標族群偏好。本研究採面對面問卷調查方式，立意取樣台北地區某醫學中心的乳癌早期、年齡五十歲以下之婦女。研究目的為利用離散選擇試驗法探討乳癌婦女對乳癌荷爾蒙藥物五個治療特性的重視程度與偏好結構。五個治療方案特性則包含給藥途徑與頻率、停經症狀的產生、卵巢功能的影響、復發率及自費金額。統計分析使用條件邏吉斯模型。本研究結果發現，乳癌婦女對注射每三個月一次、輕微的停經症狀及卵巢功能影響，呈正向偏好。當復發率愈高、自費金額愈高，婦女的偏好就愈低。綜合上述結果，受訪者喜歡每三個月一次、輕微的停經症狀及卵巢功能影響、復發率及自費金額越低越好之治療方案；而在加入個人特質控制比較後，研究發現各組偏好情形與全部樣本雷同。根據研究結果，本研究提出下述建議：一、建議後續研究者在決定屬性水準時需謹慎思考、多參酌專家意見，並同時建立許多問題加以衡量受訪者的行為及心理層面，以利將受訪者分類進行群集分析，方能更確立每個治療或篩檢服務的目標族群及可以推行的策略與方案。二、建議藥廠在研發新藥可多參考婦女心中最偏好的乳癌荷爾蒙治療方案。三、醫療政策制訂及醫療產品或治療方案研發者將離散選擇試驗法用於醫療市場中新產品、新藥物與新治療方式的市場調查以尋求更符合目標族群偏好的方式及產品。

關鍵字

乳癌；荷爾蒙治療；離散選擇試驗法；偏好

並列摘要

Patients’ preferences are important determinants in the decision for the health policy and therapy. Understanding the attribute which they consider in the decision for the therapies of breast cancer can contribute to further improvement in doctors’ decision and development of new treatment. We explored patients’ preferences for three breast cancer hormone therapies in a discrete choice experiment (DCE). A discrete choice experiment questionnaire with 13 choice tasks was filled out by 110 women who aged below 50, the breast cancer stage were primary stage and with estrogen receptor (ER) positive gene in a medical center in Taiwan. These women were asked to choose among three hormone therapies that were characterized by five treatment attributes: (1) frequency and administration, (2) menopause symptoms, (3) the function of ovarian, (4) relapse rate, (5) out of the pocket money. The statistical analysis used conditional logit model (CLM). The overall response rate was 95%. Respondents generally expressed a preference for relapse rate and out of the pocket money which had negative effect on preferences. As a whole, breast cancer patients like a therapy which has injected once per three months, slight side effects (menopause symptoms and the function of ovarian), lower relapse rate and lower out of the pocket money. By understand patients’ considerations, doctors and new drug makers will decide which therapy is best suited for an individual patient. Therefore, patients can have better quality of life.