Neurologists’ preferences for device-aided therapy for advanced Parkinson’s disease in Japan

This study measures the relative preference for attributes of device-aided therapies (DATs) for advanced Parkinson’s Disease (PD) from the perspective of Japanese neurologists. Attributes and levels were elicited based on literature and interviews with certified neurologists experienced with DATs. An online survey including a discrete choice experiment (DCE) was developed, pilot tested, and distributed through an online panel to neurologists treating advanced PD patients. Participants were asked to choose treatments among several choice sets of two hypothetical DATs described only by the attributes, or no DAT (continuing oral treatment). A conditional logit model using the Bayesian framework was developed to estimate the marginal utilities of attributes’ levels, and the relative utility of treatments available to Japanese advanced PD patients or being developed in Japan was assessed. The DCE survey completed by 308 neurologists showed that the attributes with the greatest influence on DAT selection were surgery requirement (relative importance of 28%), average increase in the duration of daily “on” time without dyskinesia which affects daily activities (15%), average change in cognitive function related to treatment introduction (15%), device management frequency (14%), average number of pills of oral PD medication after treatment introduction (13%), average influence of treatment on symptoms of depression (12%), and type of device (large/small) (3%). All attributes significantly influenced respondents’ choices, except for external device type. Experience with DATs did not influence the directions of preferences. Out of treatment profiles representing DATs, continuous subcutaneous infusion of levodopa-carbidopa had a higher preference score than levodopa-carbidopa intestinal gel infusion and deep brain stimulation. Our findings suggest that Japanese neurologists would prefer a DAT without surgery requirement. Other factors related to efficacy, safety, and administration mode have a significant, but a smaller influence on prescription choices.

本研究从日本神经内科医师的视角出发，针对晚期帕金森病（Parkinson’s Disease, PD）的辅助器械治疗（device-aided therapies, DATs），量化评估其各项属性的相对偏好。研究通过文献调研与对具备辅助器械治疗临床经验的持证神经内科医师开展访谈，确定了本次研究的属性及其水平层级。本研究开发了包含离散选择实验（discrete choice experiment, DCE）的在线调查问卷，完成预试验后，通过在线面板平台向收治晚期帕金森病患者的神经内科医师发放该问卷。参与者需在多组选择方案中进行抉择：每组方案包含两款仅通过属性描述的假想辅助器械治疗方案，或不接受辅助器械治疗（维持口服药物治疗）。本研究构建了基于贝叶斯框架的条件Logit模型，以估算各属性水平的边际效用，并评估了日本境内现有或正在研发的、针对晚期帕金森病患者的治疗方案的相对效用。共有308名神经内科医师完成了本次离散选择实验问卷，结果显示，对辅助器械治疗选择影响最大的属性依次为：是否需要手术（相对重要性占比28%）、不伴影响日常活动的异动症的每日“开期”时长平均增幅（15%）、与治疗启动相关的认知功能平均变化（15%）、器械维护频率（14%）、治疗启动后帕金森病口服药物平均服药片数（13%）、治疗对抑郁症状的平均影响程度（12%），以及器械类型（大型/小型，3%）。除外置器械类型外，其余所有属性均对受访者的选择产生了显著影响。是否具备辅助器械治疗的临床经验，并未影响受访者的偏好倾向。在代表辅助器械治疗的治疗方案中，左旋多巴-卡比多巴持续皮下输注的偏好得分高于左旋多巴-卡比多巴肠凝胶输注与脑深部电刺激。本研究结果表明，日本神经内科医师更倾向于无需手术的辅助器械治疗方案。其余与疗效、安全性及给药方式相关的因素，虽对处方选择存在显著影响，但影响力相对较小。