Preferências declaradas no câncer de pulmão não pequenas células: experimentos de escolhas discretas. Rio de Janeiro
Preferências declaradas no câncer de pulmão não pequenas células: experimentos de escolhas discretas. Rio de Janeiro
Data
2020
Autores
Meirelles, Isandra de Oliveira
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
O câncer de pulmão é a principal causa de morte por câncer no mundo, com baixas taxas de sobrevida global em 5 anos. O diagnóstico do câncer de pulmão de não pequenas células (CPNPC), subtipo mais comum, 85% dos casos, geralmente é realizado em fases tardias da doença. Atualmente, estão disponíveis como opções para tratamento, a quimioterapia a base de platina, terapias alvo direcionadas e imunoterapia. Os ganhos em sobrevida gerados por tais tratamentos e os eventos adversos a eles associados variam em magnitude e qualidade e por isso, incluir a opinião do paciente pode ser fundamental na tomada de decisão. Os métodos de preferências declaradas é o que melhor se adequa à extração de preferências na assistência à saúde. Entre eles, o experimento de escolhas discretas (DCE) é o mais usado. Por isso, o objetivo desse trabalho foi avaliar o trade-off entre os riscos (eventos adversos) e benefícios (ganho em sobrevida) do tratamento sistêmico, na perspectiva dos pacientes com CPNPC em tratamento oncológico no INCA. Foi realizado um DCE dividido entre as etapas de revisão da literatura e grupos de discussão com pacientes e médicos para seleção dos atributos; construção dos cenários; estudo piloto e entrevistas do projeto principal. Os cenários hipotéticos foram impressos e apresentados a 65 pacientes com CPNPC localmente avançado, metastático ou recorrente. As escolhas dos pacientes e os dados clínico-demográficos foram registrados em formulário. Os atributos selecionados foram: rash cutâneo, fadiga, queda de cabelo, chance de hospitalização, modo de administração e tempo de sobrevida. Rash cutâneo, fadiga e sobrevida tiveram maior importância para as escolhas dos pacientes. Enquanto modo de administração e hospitalização não foram estatisticamente significativos para a escolha. Com base nos pesos atribuídos a estes atributos pelos pacientes entrevistados, estimamos que os pacientes exigiriam um ganho mínimo em sobrevida de 11,72 meses e 19,72 meses, para preferir um medicamento que causasse rash grave ou fadiga grave, respectivamente. A partir do cálculo de utilidade dos tratamentos, estimamos o percentual de mercado para cada opção terapêutica. A opção com maior utilidade, e portanto, com maior probabilidade de obter a preferência dos pacientes foi carboplatina mais paclitaxel, com um market share estimado em 31%, seguido de gefitinibe (27%), erlotinibe (24%) e finalmente, docetaxel (18%). Com esse trabalho, foi possível estimar o impacto dos eventos adversos aplicados nos cenários, na perspectiva do paciente. Medicamentos, com melhor perfil de segurança, têm alto potencial de alcançar a preferência dos pacientes caso evitem eventos como rash, queda de cabelo e fadiga, independentemente do modo de administração. Em geral, ganhos em sobrevida inferiores a um ano não compensariam as formas graves de rash cutâneo ou fadiga.
The lung cancer is the major cause of death related to cancer worldwide, with low global survival rates in 5 years. Small-cell lung cancer (NSCLC) is the most common subtype, comprising 85% of cases. Diagnosis is usually performed in late stages of the disease. Available treatment options are platinum-based chemotherapy, targeted therapies, and immunotherapy. Treatments are associated with survival benefits and adverse events, differing in magnitude and quality. Therefore patient’s opinion can play a critical role in decision making. The stated preference methods are the best approach to elicit preferences in health care. Among them, discrete choice experiment (DCE) is the most widely used. The objective of this study was to evaluate the trade-off between the risks (adverse events) and benefits (survival) of systemic treatments, from the perspective of patients with NSCLC undergoing oncologic treatment at National Cancer Institute. A DCE was performed divided in the steps of literature review and focal groups with patients and physicians to select the attributes; construction of scenarios; pilot study and interviews of the main project. Hypothetical scenarios were printed and presented to 65 patients with locally advanced, metastatic or recurrent NSCLC. Patient choices and clinicaldemographic data were recorded on a form. The selected attributes were skin rash, fatigue, hair loss, chance of hospitalization, mode of administration and survival time. Skin rash, fatigue, and survival were the most important for the patients' choices. Mode of administration and hospitalization were not statistically significant for the choice. Based on weights given to these attributes by the patients interviewed, we estimated that the patients would require a minimum survival gain of 11.72 months and 19.72 months, in order to prefer a medication that caused severe rash or severe fatigue, respectively. From the calculation of treatment utility, we estimated the market share for each therapeutic option. The option with higher utility, so more likely to obtain patient preference, was carboplatin plus paclitaxel, with an estimated market share of 31%, followed by gefitinib (27%), erlotinib (24%) and finally, docetaxel (18%). This study showed it was possible to estimate the impact of adverse events applied in the scenarios from the patient's perspective. Medications with a better safety profile have a higher potential to achieve patient preference if they avoid events such as skin rash, hair loss and fatigue, regardless of the mode of administration. In general, less than one year of survival would not compensate for severe forms of skin rash or fatigue.
The lung cancer is the major cause of death related to cancer worldwide, with low global survival rates in 5 years. Small-cell lung cancer (NSCLC) is the most common subtype, comprising 85% of cases. Diagnosis is usually performed in late stages of the disease. Available treatment options are platinum-based chemotherapy, targeted therapies, and immunotherapy. Treatments are associated with survival benefits and adverse events, differing in magnitude and quality. Therefore patient’s opinion can play a critical role in decision making. The stated preference methods are the best approach to elicit preferences in health care. Among them, discrete choice experiment (DCE) is the most widely used. The objective of this study was to evaluate the trade-off between the risks (adverse events) and benefits (survival) of systemic treatments, from the perspective of patients with NSCLC undergoing oncologic treatment at National Cancer Institute. A DCE was performed divided in the steps of literature review and focal groups with patients and physicians to select the attributes; construction of scenarios; pilot study and interviews of the main project. Hypothetical scenarios were printed and presented to 65 patients with locally advanced, metastatic or recurrent NSCLC. Patient choices and clinicaldemographic data were recorded on a form. The selected attributes were skin rash, fatigue, hair loss, chance of hospitalization, mode of administration and survival time. Skin rash, fatigue, and survival were the most important for the patients' choices. Mode of administration and hospitalization were not statistically significant for the choice. Based on weights given to these attributes by the patients interviewed, we estimated that the patients would require a minimum survival gain of 11.72 months and 19.72 months, in order to prefer a medication that caused severe rash or severe fatigue, respectively. From the calculation of treatment utility, we estimated the market share for each therapeutic option. The option with higher utility, so more likely to obtain patient preference, was carboplatin plus paclitaxel, with an estimated market share of 31%, followed by gefitinib (27%), erlotinib (24%) and finally, docetaxel (18%). This study showed it was possible to estimate the impact of adverse events applied in the scenarios from the patient's perspective. Medications with a better safety profile have a higher potential to achieve patient preference if they avoid events such as skin rash, hair loss and fatigue, regardless of the mode of administration. In general, less than one year of survival would not compensate for severe forms of skin rash or fatigue.
Description
Palavras-chave
Patient preferences, Non small cell lung cancer, Discrete choice experiment, Neoplasias Pulmonares, Participação do Paciente, Preferência do Paciente
Citação
Meirelles IO. Preferências declaradas no câncer de pulmão não pequenas células: experimentos de escolhas discretas. Rio de Janeiro. Dissertação [Mestrado Profissional em Avaliação de Tecnologias em Saúde] - Instituto Nacional de Cardiologia; 2020