Which is more important for doctors in a middle-income country, a national guideline or the medical literature? An adherence survey of trastuzumab use for breast cancer in Iran
Which is more important for doctors in a middle-income country, a national guideline or the medical literature? An adherence survey of trastuzumab use for breast cancer in Iran
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DOI：
10.1016/j.jcpo.2016.05.005
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发表时间：
2016-09-01
影响因子：
1.3
通讯作者：
Redekop, William K.
中科院分区：
文献类型：
--
作者：
Ansaripour, Amir;Uyl-de Groot, Carin A.;Redekop, William K.
导言：世界上大多数国家标准治疗指南推荐使用52周曲妥珠单抗方案治疗乳腺癌。相比之下，伊朗卫生部发布的国家指南建议使用9周的养生法。由于指南在日常实践中不一定被遵循，我们评估了伊朗作为一个中等收入国家目前的常规实践与这些指南中的建议相匹配的程度。方法：128名伊朗肿瘤学家被要求完成一份在线匿名问卷。同时，使用覆盖伊朗约50%人口的健康保险公司社会保障组织的数据进行了为期3年的回顾性索赔数据库分析，以便与问卷结果进行比较。结果：41%(52/128)的应答率，医生报告对HER2受体检测指南的绝对依从率相对较高(86%)，但对曲妥珠单抗治疗持续时间指南的绝对依从率较低(6%)。医生表示，只有33%的患者计划持续9周；在大多数情况下，计划是52周治疗。接受9周治疗计划的患者平均接受曲妥珠单抗8.6周，而接受52周治疗计划的患者接受治疗29.2周。调查中发现的一般趋势在对1295名HER2阳性患者的索赔数据库分析中得到了证实。结论：在预算有限而无法容纳所有创新技术的中等收入国家，资源敏感指南可能是有益的。然而，伊朗医生似乎更多地依赖于医学文献，而不是关于曲妥珠单抗使用的国家指南。政策制定者、医生和其他利益相关者需要就治疗患者的最佳方式达成一些共识。国家指导方针需要伴随着针对具体国家的经济评估。(C)2016爱思唯尔有限公司。保留所有权利。
Introduction: Most national standard therapeutic guidelines in the world recommend a 52-week trastuzumab regimen for breast cancer treatment. In contrast, the national guideline published by the Iranian Ministry of Health recommends a nine-week regimen. Since guidelines are not necessarily followed in daily practice, we assessed the extent to which current routine practice in Iran as a middle-income country matches the recommendations found in these guidelines.Methods: 128 Iranian oncologists were asked to complete an online anonymous questionnaire. Concurrently, a 3-year retrospective claims database analysis was conducted using data from the Social Security Organization, a health insurer which covers approximately 50% of the Iranian population, to enable comparisons with the questionnaire results.Results: With a 41% (52/128) response rate, doctors reported a relatively high absolute adherence (86%) to the guideline for HER2 receptor testing but a low rate of absolute adherence (6%) to the guideline for duration of trastuzumab treatment. Doctors indicated that the planned duration was 9 weeks in only 33% of patients; in most cases, the plan was 52-week treatment. Patients with a 9-week treatment plan received trastuzumab for 8.6 weeks on average while patients with 52-week plans received treatment for 29.2 weeks. The general trends found in the survey were confirmed in the claims database analysis of 1295 HER2-positive patients.Conclusions: Resource-sensitive guidelines may be beneficial in middle-income countries where limited budgets cannot accommodate all innovative technologies. However, Iranian physicians appear to rely more on the medical literature than on national guidelines regarding trastuzumab use. Policymakers, doctors and other stakeholders need to reach some consensus about the optimal way to treat patients. A national guideline needs to be accompanied with country-specific economic evaluations. (C) 2016 Elsevier Ltd. All rights reserved.