Morillas Carlos, Feliciano Rosa, Catalina Pablo Fernández, Ponte Carla, Botella Marta, Rodrigues João, Esmatjes Enric, Lafita Javier, Lizán Luis, Llorente Ignacio, Morales Cristóbal, Navarro-Pérez Jorge, Orozco-Beltran Domingo, Paz Silvia, Ramirez de Arellano Antonio, Cardoso Cristina, Tribaldos Causadias Maribel
Hospital Universitario Dr Peset, Valencia, Spain.
USF São Domingos, Santarém, Portugal.
Patient Prefer Adherence. 2015 Oct 14;9:1443-58. doi: 10.2147/PPA.S88022. eCollection 2015.
To 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.
An 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.
Three-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/m(2), 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.
Both 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.
评估西班牙和葡萄牙患者及医生对2型糖尿病（T2DM）治疗方法的偏好，以及为获得益处或避免副作用每月愿意支付的费用（WTP）。
一项观察性、多中心、探索性研究，聚焦于西班牙和葡萄牙的常规临床实践。从多家医院和门诊诊所招募医生，从西班牙和葡萄牙不同自治区公共医疗系统中的11个中心招募患者。通过对多种T2DM药物属性进行评分的离散选择实验来衡量偏好。使用条件logit模型分析数据。
330名（n = 330）患者（女性占49.7%；平均年龄62.4[标准差：10.3]岁，平均T2DM病程13.9[8.2]年，平均体重指数32.5[6.8]kg/m²，41.8%接受口服+注射药物治疗，40.3%接受口服治疗，17.6%接受注射治疗）以及来自西班牙和葡萄牙的221名医生（女性占62%；平均年龄41.9[标准差：10.5]岁，33.5%为内分泌科医生，66.5%为初级保健医生）参与了研究。患者最看重避免6个月体重增加3千克（意愿支付：68.14欧元[95%置信区间：54.55 - 85.08]），其次是避免每月发生一次低血糖事件（意愿支付：54.80欧元[23.29 - 82.26]）。医生最看重避免每周发生一次低血糖（意愿支付：287.18欧元[95%置信区间：160.31 - 1387.21]），其次是避免6个月体重增加3千克以及降低心血管风险（意愿支付分别为：166.87欧元[88.63 - 843.09]和154.30欧元[98.13 - 434.19]）。医生和患者为避免糖化血红蛋白升高1%分别愿意支付125.92欧元（73.30 - 622.75）和24.28欧元（18.41 - 30.31），为避免恶心分别愿意支付143.30欧元（73.39 - 543.62）和42.74欧元（23.89 - 61.77）。
西班牙和葡萄牙的患者及医生都愿意为与改善糖尿病治疗相关的健康益处付费，其中最重要的是避免低血糖和体重增加。降低心血管风险和减轻体重分别成为医生和患者第三看重的属性。
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