Patient preferences in Italy: health state utilities associated with attributes of weekly injection devices for treatment of type 2 diabetes

Abstract

ObjectivesSeveral glucagon-like peptide-1 receptor agonists are administered as weekly injections for treatment of type 2 diabetes (T2D). These medications vary in their injection processes, and a recent study in the UK found that these differences had an impact on patient preference and health state utilities. The purpose of this study was to replicate the UK study in Italy to examine preferences of an Italian patient sample, while allowing for comparison between utilities in the UK and Italy.Materials and methodsParticipants with T2D in Italy valued health states in time trade-off interviews. All health states had the same description of T2D, but differed in description of the treatment process. As in the original UK study, the first health state described an oral treatment regimen, while additional health states added a weekly injection. The injection health states differed in three injection-related attributes: requirements for reconstituting the medication, waiting during medication preparation, and needle handling.ResultsInterviews were completed by 238 patients (58.8% male; mean age = 60.2 years; 118 from Milan, 120 from Rome). The oral treatment health state had a mean (SD) utility of 0.90 (0.10). The injection health states had significantly (p < 0.0001) lower utilities, which ranged from 0.87 (requirements for reconstitution, waiting, and handling) to 0.89 (weekly injection with none of these requirements). Differences in health state utility scores suggest that each administration requirement was associated with a disutility (ie, negative utility difference): −0.006 (reconstitution), −0.006 (needle handling), −0.011 (reconstitution, needle handling), and −0.022 (reconstitution, waiting, needle handling).ConclusionDisutilities associated with the injection device characteristics were similar to those reported with the UK sample. Results suggest that injection device attributes may be important to some patients with T2D, and it may be useful for clinicians to consider these attributes when choosing medication for patients initiating these weekly treatments.

Evaluating the Impact of Therapy on Quality of Life in Type 2 Diabetes: A Literature Review of Utilities Associated with Treatment-Related Attributes

“… 9 Two further studies conducted in people with T2D in the UK and Italy (both with identical methodology) used TTO methods to determine the QoL impact of process characteristics of a weekly injection including requirement for reconstitution, needle handling and waiting. 19 , 20 In the UK-based study, a weekly injection with no inconvenience was associated with a disutility of −0.010 relative to oral treatment alone. In contrast, a weekly injection that required reconstitution, needle handling and waiting time was associated with a disutility of −0.030 relative to oral treatment alone and −0.020 relative to a weekly injection with no inconvenience.…”

“… 19 Similar findings were reported in the Italian study where the disutility for a weekly injection with no inconvenience relative to oral treatment alone was −0.009 and the disutility for a weekly injection with reconstitution, needle handling and waiting was −0.032 relative to oral treatment alone and −0.022 relative to a weekly injection with no inconveniences. 20 Another further study by the same authors compared process characteristics associated with a concentrated formulation of insulin versus standard insulin with attributes of the concentrated formulation including less injection volume, less effort to press the injection button and fewer pens required. Matza et al used TTO methodology to determine mean utility (SD) values of 0.889 (0.103) with the concentrated insulin formulation versus 0.882 (0.104) with the standard insulin formulation.…”

Values, preferences and burden of treatment for the initiation of GLP-1 receptor agonists and SGLT-2 inhibitors in adult patients with type 2 diabetes: a systematic review

“…A total of 11 162 records were retrieved in the search and screened using the title and abstract. (figure 1) From these, 86 full-text articles were assessed for eligibility and 17 studies comprising 7296 patients were included in this review [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] (table 1). We did not identify studies reported values and preferences of SGLT-2i and all eligible studies evaluated GLP-1 RA.…”

“…[19][20][21][22][23] Furthermore, 12 studies comprising a total of 4634 patients evaluated preferences between, at least, two different GLP-1 RA medications or related injection devices, taking into account clinical attributes and/or device-related ones such as dosing, application frequency or characteristics of the application device. [24][25][26][27][28][29][30][31][32][33][34][35] Mean age of participants in the included studies ranged between 52.7 and 63.9 years. Most studies reporting duration of diabetes and included patients at least 1 year after diagnosis.…”