Patients’ and physicians’ preferences for type 2 diabetes mellitus treatments in Spain and Portugal: a discrete choice experiment

Abstract

ObjectiveTo assess Spanish and Portuguese patients’ and physicians’ preferences regarding type 2 diabetes mellitus (T2DM) treatments and the monthly willingness to pay (WTP) to gain benefits or avoid side effects.MethodsAn observational, multicenter, exploratory study focused on routine clinical practice in Spain and Portugal. Physicians were recruited from multiple hospitals and outpatient clinics, while patients were recruited from eleven centers operating in the public health care system in different autonomous communities in Spain and Portugal. Preferences were measured via a discrete choice experiment by rating multiple T2DM medication attributes. Data were analyzed using the conditional logit model.ResultsThree-hundred and thirty (n=330) patients (49.7% female; mean age 62.4 [SD: 10.3] years, mean T2DM duration 13.9 [8.2] years, mean body mass index 32.5 [6.8] kg/m2, 41.8% received oral + injected medication, 40.3% received oral, and 17.6% injected treatments) and 221 physicians from Spain and Portugal (62% female; mean age 41.9 [SD: 10.5] years, 33.5% endocrinologists, 66.5% primary-care doctors) participated. Patients valued avoiding a gain in bodyweight of 3 kg/6 months (WTP: €68.14 [95% confidence interval: 54.55–85.08]) the most, followed by avoiding one hypoglycemic event/month (WTP: €54.80 [23.29–82.26]). Physicians valued avoiding one hypoglycemia/week (WTP: €287.18 [95% confidence interval: 160.31–1,387.21]) the most, followed by avoiding a 3 kg/6 months gain in bodyweight and decreasing cardiovascular risk (WTP: €166.87 [88.63–843.09] and €154.30 [98.13–434.19], respectively). Physicians and patients were willing to pay €125.92 (73.30–622.75) and €24.28 (18.41–30.31), respectively, to avoid a 1% increase in glycated hemoglobin, and €143.30 (73.39–543.62) and €42.74 (23.89–61.77) to avoid nausea.ConclusionBoth patients and physicians in Spain and Portugal are willing to pay for the health benefits associated with improved diabetes treatment, the most important being to avoid hypoglycemia and gaining weight. Decreased cardiovascular risk and weight reduction became the third most valued attributes for physicians and patients, respectively.

Quantified patient preferences for lifestyle intervention programs for diabetes prevention—a protocol for a systematic review

“…For most conditions, physicians underestimated the impact of intervention characteristics on patients’ decision-making. Especially for type 2 diabetes mellitus (T2DM) medication treatment, there seems to be a high preference agreement for the main health benefits, but the order between patients and physicians differed [ 38 ]. But even transferred to the research agenda, views of diabetic patients and their relatives regarding their preferred research fields may differ when compared to current scientific activity in diabetology, leading to a plea to involve diabetic patients and their relatives in the weighting and selection of research topics more often [ 39 , 40 ].…”

Comparison of benefit–risk preferences of patients and physicians regarding cyclooxygenase-2 inhibitors using discrete choice experiments

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Identifying patient preferences for diabetes care: A protocol for implementing a discrete choice experiment in Samoa

“…The review included 45 papers, 22.2% of which focused specifically on DCEs. Attributes identified as important for and/or influencing diabetes care adherence included: intervention/treatment setting [34]; type of provider (i.e., doctors, nurses, educators, case managers, community health workers) [34][35][36][37]; provider/healthcare interactions (i.e., service dissatisfaction [38], as well as providers' cultural competency, consistency of communication, transparency, respect, and compassion) [37][38][39][40][41][42][43][44][45]; shared decision-making [36,44]; levels of diabetes education and knowledge provided [39,41,[45][46][47][48]; treatments that improve quality of life [44,49,50]; medication/treatment side effects [23,[50][51][52][53][54][55][56]; treatment outcomes/goals [9,23,49,52,53,[56][57][58]; un-and under-coordinated care [39,59]; types of selfmanagement and regimen frequency/complexity…”