Physician preferences for chemotherapy in the treatment of non-small cell lung cancer in China: evidence from multicentre discrete choice experiments

• Published in: BMJ open 2020-02, Vol.10 (2), p.e032336-e032336
• Main Authors: Sun, Hui, Wang, Huishan, Shi, Lizheng, Wang, Meifeng, Li, Junling, Shi, Jufang, Ni, Ming, Hu, Xianzhi, Chen, Yingyao
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Chemotherapy; China; Clinical decision making; Clinical Decision-Making - methods; Costs; Decision making; Disease control; Experiments; Female; Health Services Research; Humans; Lung cancer; Lung Neoplasms - drug therapy; Male; Middle Aged; Oncology; Patients; Physicians; Physicians - statistics & numerical data; Polls & surveys; Questionnaires; Sociodemographics; Surgery; Surveys and Questionnaires - statistics & numerical data; Thoracic surgery; Young Adult
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-032336

ObjectiveTo evaluate physician risk-benefit preferences and trade-offs when making chemotherapy decisions for patients with non-small cell lung cancer (NSCLC).DesignA discrete choice experiment (DCE).SettingsTertiary hospitals in Beijing, Shanghai, Guangzhou and Chengdu of China.ParticipantsThe participants were 184 physicians (mean age of 37 years) with more than 1 year of NSCLC chemotherapy practice.OutcomesThe DCE survey was constructed by six attributes: progression-free survival (PFS), disease control rate (DCR), risk of moderate side effects, risk of severe side effects, mode of administration and out-of-pocket costs. Physicians’ relative preferences and trade-offs in patient out-of-pocket costs for each attribute level were estimated using a mixed logit model, and interaction terms were added to the model to assess preferences variation among physicians with different sociodemographic factors.ResultsPhysicians had the strongest preferences for improvements in PFS, followed by reducing the risk of severe side effects. The DCR, risk of moderate side effects and mode of administration were ranked in decreasing order of importance. There was little variation in preferences among physicians with different sociodemographic characteristics. Physicians were willing to trade $4814 (95% CI $4149 to $5480) of patient out-of-pocket costs per month for a chemotherapy that guaranteed 11 months of PFS, followed by $1908 (95% CI $1227 to $2539) for reducing the risk of severe side effects to 2%.ConclusionsWith regard to chemotherapy for patients with NSCLC, prolonging PFS, reducing severe and moderate side effects were primary considerations for physicians in China. The mode of administration and treatment costs significantly influenced physicians’ therapeutic decision. The current findings could add some evidence to inform NSCLC chemotherapy implementation and promote shared decision-making.