Chancellor Jeremy, Aballéa Samuel, Lawrence Alison, Sheldon Rob, Cure Sandrine, Plun-Favreau Juliette, Marchant Nick
i3 Innovus, Uxbridge, Middlesex, UK.
Pharmacoeconomics. 2008;26(3):217-34. doi: 10.2165/00019053-200826030-00005.
In clinical trials, patients have expressed greater satisfaction with inhaled human insulin (EXUBERA, Pfizer) than with injectable insulin. No studies to date have attempted to quantify the strength of preferences for these alternative routes of administration.
To elicit health state preference values from people with diabetes mellitus for treatment with inhaled human insulin compared with injectable insulin.
A patient preference study.
Written descriptions were developed for five clinical scenarios: two for type 1 diabetes and three for type 2 diabetes. Each scenario required adjustment or initiation of insulin treatment because of poor glycaemic control. Two alternative insulin regimens were described for each scenario: injectable-only or inhaled human insulin to replace or reduce the number of daily injections. Equal efficacy was assumed within each of these scenario pairs.A total of 344 UK adults (66% male), 132 (mean age 49 years) with type 1 diabetes and 212 (mean age 63 years) with type 2 diabetes, rated scenario pairs corresponding to their own type of diabetes and rated their own health by time trade-off (TTO), by correspondence with EQ-5D health descriptions and on the EQ-5D visual analogue scale. Respondents stated their preference for, or indifference between, the injection-only or inhalation variant comprising each scenario pair. TTO utilities and EQ-5D utilities by UK community tariff were compared within each scenario pair, for the total sample rating, each scenario pair, and by subgroups of stated preference for each variant.
A majority, ranging from 63% to 81% across the scenarios, preferred inhalation. Mean differences in TTO scores were 0.074, 0.076, 0.088, 0.053 and 0.043 for the five scenarios, respectively (p < 0.005 for all). Mean EQ-5D differences were 0.043, 0.029, 0.037, 0.020 and 0.021 for the five scenarios, respectively (p < 0.05 for scenarios 1 and 3), driven mainly by differences on the pain/discomfort dimension of the EQ-5D. Differences in favour of inhalation among those preferring inhalation, were greater than differences in favour of injections among those preferring injections. Mean self-rated health was similar between respondents with type 1 and type 2 diabetes, at 0.83 (TTO) and 0.75 (EQ-5D). The TTO was more sensitive than EQ-5D. Self-rated health by EQ-5D compared closely with reported values from the UK Prospective Diabetes Study (UKPDS).
This study highlights the utility differences that people with diabetes perceive between the prospect of inhaled and injected routes of insulin administration, even under the assumption of no difference in efficacy. These differences are magnified when the comparison in utility scores is between the majority who prefer the inhaled route and the minority who prefer the injectable route.
在临床试验中，患者对吸入式人胰岛素（辉瑞公司的艾可拓）的满意度高于注射用胰岛素。迄今为止，尚无研究试图量化对这些不同给药途径的偏好强度。
获取糖尿病患者对于吸入式人胰岛素与注射用胰岛素治疗的健康状态偏好值。
一项患者偏好研究。
针对五种临床情景编写了书面描述：两种针对1型糖尿病，三种针对2型糖尿病。每种情景都因血糖控制不佳需要调整或开始胰岛素治疗。针对每种情景描述了两种替代胰岛素治疗方案：仅注射用胰岛素或吸入式人胰岛素以替代或减少每日注射次数。假设每组情景中的两种方案疗效相同。共有344名英国成年人（66%为男性），其中132名（平均年龄49岁）患有1型糖尿病，212名（平均年龄63岁）患有2型糖尿病，对与自身糖尿病类型对应的情景组进行评分，并通过时间权衡法（TTO）、与EQ-5D健康描述对应以及在EQ-5D视觉模拟量表上对自身健康状况进行评分。受访者表明他们对每组情景中仅注射或吸入方案的偏好或无差异。在每组情景中，比较了英国社区关税下的TTO效用值和EQ-5D效用值，包括总样本评分、每组情景以及对每种方案有明确偏好的亚组。
在所有情景中，63%至81%的人更喜欢吸入式治疗。五种情景的TTO评分平均差异分别为0.074、0.076、0.088、0.053和0.043（所有p<0.005）。五种情景的EQ-5D平均差异分别为0.043、0.029、0.037、0.020和0.021（情景1和3的p<0.05），主要由EQ-5D的疼痛/不适维度差异驱动。在偏好吸入式治疗的人群中，支持吸入式治疗的差异大于偏好注射式治疗人群中支持注射式治疗的差异。1型和2型糖尿病受访者的自我健康评分相似，分别为0.83（TTO）和0.75（EQ-5D）。TTO比EQ-5D更敏感。EQ-5D的自我健康评分与英国前瞻性糖尿病研究（UKPDS）报告的值密切相关。
本研究强调了糖尿病患者在胰岛素吸入和注射给药途径前景之间察觉到的效用差异，即使在假设疗效无差异的情况下也是如此。当效用评分比较在偏好吸入式途径的多数人群和偏好注射式途径的少数人群之间进行时，这些差异会被放大。
