Patient preferences for anti-hyperglycaemic medication for type 2 diabetes mellitus in China: findings from a national survey

Abstract

ObjectiveThis study aimed to investigate the preferences regarding risks, benefits and other treatment attributes of patients with type 2 diabetes mellitus (T2DM) in China when selecting a second-line anti-hyperglycaemic medicine.MethodsA discrete choice experiment with hypothetical anti-hyperglycaemic medication profiles was performed using a face-to-face survey administered to patients with T2DM. The medication profile was described using seven attributes: treatment efficacy, hypoglycaemia risk, cardiovascular benefits, gastrointestinal (GI) adverse events, weight change, mode of administration and out-of-pocket cost. Participants chose between medication profiles by comparing attributes. Data were analysed using a mixed logit model with marginal willingness to pay (mWTP) and maximum acceptable risk (MAR) calculated. The preference heterogeneity within the sample was explored using a latent class model (LCM).ResultsA total of 3327 respondents from five major geographical regions completed the survey. Treatment efficacy, hypoglycaemia risk, cardiovascular benefits and GI adverse events were major concerns among the seven attributes measured. Weight change and mode of administration were of lesser concern. Regarding mWTP, respondents would pay ¥236.1 (US$36.6) for an anti-hyperglycaemic medication with an efficacy of 2.5% points reduction in HbA1c, while they were willing to accept a weight gain of 3 kg only if they received a compensation of ¥56.7 (US$8.8). Respondents were willing to accept a relatively large increase in hypoglycaemia risk (MAR=15.9%) to improve treatment efficacy from intermediate (1.0% points) to high (1.5% points). LCM identified the following four unobserved subgroups: trypanophobia, cardiovascular-benefits-focused, safety-focused and efficacy-focused and cost-sensitive.ConclusionPatients with T2DM prioritised free out-of-pocket costs, highest efficacy, no hypoglycaemia risk and cardiovascular benefits over weight change and mode of administration. There exists great preference heterogeneity among patients, which should be taken into account in healthcare decision-making processes.

Patient versus physician preferences for lipid‐lowering drug therapy: A discrete choice experiment

“…Our literature review on DCEs for drug treatment preferences revealed that these attributes commonly encompass outcome (e.g., efficacy and adverse effects), process (e.g., mode of administration) and cost. 9 , 10 , 14 , 15 , 16 , 17 , 18 Additionally, we conducted a literature review to gain insights into the characteristics of lipid‐lowering drugs, and the search strategy can be found in Supporting Information S1: Appendix 1 . Thus, we identified 10 candidate attributes based on the literature review (Supporting Information S1: Appendix 2 ).…”

“…Discrete choice experiment (DCE) is a quantitative approach which is used to elicit individual preferences through trade‐offs among alternatives. 13 It has gained popularity for quantifying preferences in drug therapy, including cancer treatment, 9 , 14 antiepileptic drugs, 10 antihyperglycemic medications, 15 asthma medications, 16 treatments for rheumatoid arthritis 17 and anticoagulant therapy. 18 These DCE studies have provided insights into the preferences of respondents for treatment options.…”

“…Conversely, out‐of‐pocket cost was a key factor influencing treatment decisions in China. 15 In addition, the study did not explore physician preferences.…”