抑郁症患者药物治疗偏好的系统综述:基于离散选择实验和优劣尺度法

A Systematic Review of Medication Preferences for Patients with Depression Based on Discrete Choice Experiment and Best-worst Scaling

背景药物治疗是治疗抑郁症的主要方式之一,综合考虑患者偏好可以有效提高患者的服药依从性。目前已有一些研究探索抑郁症患者的药物选择偏好,但尚缺少研究对抑郁症患者药物偏好选择进行系统整理和归纳。目的系统回顾离散选择实验(DCE)和优劣尺度法(BWS)应用于抑郁症患者药物治疗偏好选择的相关研究,以期为抑郁症患者临床合理用药及未来开展相关偏好研究提供借鉴和参考。方法2022年1月,以“DCE”“BWS”“depression”“抑郁症”“离散选择实验”“优劣尺度法”等为关键词,在中国知网、万方数据知识服务平台、维普网、PubMed、Web of Science和EmBase数据库系统检索抑郁症患者药物选择偏好的DCE和BWS研究,检索时间限定为建库至2021-12-31。对纳入的文献进行信息提取,并采用PREFS量表对所有研究进行质量评估;将属性按结果、过程和成本3类指标进行汇总,并评估各类属性对患者药物治疗偏好影响的相对重要性。结果共纳入7篇文献,均为DCE研究。7项研究共包含47个属性,41个被归类为结果属性,5个被归类为过程属性,1个被归类为成本属性。7篇文献共获得9个最重要属性结果。其中,结果属性被认为最重要的次数为8,成本属性为1。在结果属性中,不良反应被认为最重要的次数为5,有效性为3。依据PREFS量表,1项研究得4分,6项研究得3分。多数研究在应答者(respondents)和结果解释(findings)方面有待进一步完善。结论结果属性在抑郁症患者服药过程中最为重要,临床医生和决策者应该关注这一点。目前已有的研究在样本差异报告和实验设计等维度仍有改善空间,建议未来研究者开展相关研究时,在应答者、结果解释和实验设计等方面进一步完善研究设计,为抑郁症药物偏好研究提供更多高质量证据。

Background Drug therapy is one of the main treatment approaches for depression,and a consideration of patient preferences can effectively improve patient compliance with medication.Several studies have been conducted to explore the medication choice preferences of patients with depression,but there is a lack of studies to systematically collect and summarize the medication choice preferences of patients with depression.Objective To systematically review the studies related to the application of discrete choice experiment(DCE)and best-worst scaling(BWS)to the medication choice preferences of patients with depression,in order to provide reference for clinical rational drug use of patients with depression and future studies of preferences.Methods CNKI,Wanfang Data Knowledge Service Platform,VIP,PubMed,Web of Science and EmBase were with depression from inception to 2021-12-31,using"DCE""BWS""depression""discrete choice experiment""best-worst scaling"as keywords on January 2022.Data were extracted from the included literature,and the PREFS checklist was used for the quality assessment of all studies.The attributes included in the study were classified into three categories of outcome,process and cost,and their relative importance on the impact of medication preferences of patients was assessed.Results A total of 7 papers were included,all of which were studies related to DCE,involving 47 attributes,among which 41 were classified as outcome attributes,5 were classified as process attributes,and 1 was classified as a cost attribute.A total of 9 most important attribute results were obtained from the 7 studies,the outcome attribute was considered most important 8 times and the cost attribute was considered most important 1 time.Among the outcome attributes,adverse effects were considered most important 5 times and effectiveness was considered most important 3 times.Based on the PREFS checklist,one study received a score of four and six studies received a score of three.Most studies need further improvement in terms of respondents and findings.Conclusion Outcome attributes are most important in the medicine taking process of patients with depression,which needs attention of clinicians and policy makers.There is room for improvement in the dimensions of variance reporting and experimental design,it is recommended for further improvement of research design in terms of respondents interpretation of findings and experimental design in future research,in order to provide more high-quality evidence for research of medication preferences of patients with depression.