Olofsson Sara, Norrlid Hanna, Persson Ulf
a The Swedish Institute for Health Economics (IHE) , Lund , Sweden ;
b Department of Clinical Sciences, Malmö, Health Economics Unit , Lund University , Lund , Sweden ;
J Med Econ. 2016 Oct;19(10):945-58. doi: 10.1080/13696998.2016.1187152. Epub 2016 May 31.
Apart from improved health outcomes, treatment convenience per se may have a value to individuals. This is sometimes referred to as process utility and can be estimated in terms of willingness-to-pay (WTP) or quality-adjusted life-years (QALYs). Previous research has produced multiple studies on QALY gains and WTP estimates of insulin-related attributes. There are, however, significant variations between studies, and it is not clear to what extent the value is a reflection of the true preferences or a consequence of the methodological approach. The aim of this study is to estimate the preferences for treatment attributes associated with basal insulin (administration frequency, administration flexibility, and treatment-induced weight gain) using both QALYs-elicited using time trade-off (TTO) and WTP-among a sample of the Swedish general population and among a sample of the Swedish diabetes population.
Data was collected using web-based surveys which were distributed to members of internet panels. The WTP survey presented five hypothetical scenarios with an offer to pay the incremental cost to receive basal insulin with improved attributes. The TTO survey presented six hypothetical scenarios where the respondent could choose between living for the rest of his/her life with diabetes and receiving treatment with a basal insulin with certain attributes or live for a shorter time with full health. The scenarios were combined with either a basal or a basal-bolus treatment regimen. Results from the TTO analysis were translated into monetary estimates using a threshold value of SEK500,000 per QALY.
In total, 2012 responses were included. The ratings of the attributes were almost identical, irrespective of method for the general population, while it differed to some extent for the diabetes population. The methods produced the same value for flexibility, but the estimates generated with the TTO approach were higher for one less injection and avoided weight gain. The general population assigned a higher utility gain to convenience attributes, while the diabetes population assigned a higher utility gain to avoiding weight gain.
About a quarter of the respondents did not accept the scenario in the WTP survey, i.e. protesters.
The ranking of the attributes was generally independent of evaluation method, but the TTO method resulted in similar or higher values compared to the WTP method.
除了改善健康结果外，治疗便利性本身可能对个体具有价值。这有时被称为过程效用，可以通过支付意愿（WTP）或质量调整生命年（QALY）来估计。先前的研究已经对胰岛素相关属性的QALY增益和WTP估计进行了多项研究。然而，不同研究之间存在显著差异，目前尚不清楚该价值在多大程度上反映了真实偏好，还是方法学方法的结果。本研究的目的是在瑞典普通人群样本和瑞典糖尿病患者样本中，使用通过时间权衡（TTO）得出的QALY和WTP来估计与基础胰岛素相关的治疗属性（给药频率、给药灵活性和治疗引起的体重增加）的偏好。
通过基于网络的调查收集数据，这些调查分发给互联网面板的成员。WTP调查提出了五个假设情景，提供支付增量成本以获得具有改善属性的基础胰岛素。TTO调查提出了六个假设情景，受访者可以在余生患有糖尿病并接受具有某些属性的基础胰岛素治疗，或者在完全健康的情况下活较短时间之间进行选择。这些情景与基础或基础-餐时治疗方案相结合。TTO分析的结果使用每QALY 500,000瑞典克朗的阈值转换为货币估计值。
总共纳入了2012份回复。无论采用何种方法，普通人群对这些属性的评分几乎相同，而糖尿病患者人群的评分在一定程度上有所不同。两种方法对灵活性产生的价值相同，但TTO方法得出的估计值在减少一次注射和避免体重增加方面更高。普通人群对便利性属性赋予了更高的效用增益，而糖尿病患者人群对避免体重增加赋予了更高的效用增益。
在WTP调查中，约四分之一的受访者不接受情景，即抗议者。
属性的排名通常与评估方法无关，但与WTP方法相比，TTO方法得出的值相似或更高。
