Fifer Simon, Rose John, Hamrosi Kim K, Swain Dan
Community and Patient Preference Research (CaPPRe), Level 5, 478 George St, Sydney, NSW, 2000, Australia.
Community and Patient Preference Research Pty Ltd, PO Box 1156, Darlinghurst, NSW, 1300, Australia.
BMC Health Serv Res. 2018 Aug 30;18(1):675. doi: 10.1186/s12913-018-3484-0.
Multiple pharmacotherapy options are available to control blood glucose in Type 2 Diabetes Mellitus (T2DM). Patients and prescribers may have different preferences for T2DM treatment attributes, such as mode and frequency of administration, based on their experiences and beliefs which may impact adherence. As adherence is a pivotal issue in diabetes therapy, it is important to understand what patients value and how they trade-off the risks and benefits of new treatments. This study aims to investigate the key drivers of choice for T2DM treatments, with a focus on injection frequency, and explore patients' associated willingness-to-pay.
A discrete choice experiment (DCE) was used to present patients with a series of trade-offs between different treatment options, injectable and oral medicines that were made up of 10 differing levels of attributes (frequency and mode of administration, weight change, needle type, storage, nausea, injection site reactions, hypoglycaemic events, instructions with food and cost). A sample of 171 Australian consenting adult T2DM patients, of which 58 were receiving twice-daily injections of exenatide and 113 were on oral glucose-lowering treatments, completed the national online survey. An error components model was used to estimate the relative priority and key drivers of choice patients place on different attributes and to estimate their willingness to pay for new treatments.
Injection frequency, weight change, and nausea were shown to be important attributes for patients receiving injections. Within this cohort, a once-weekly injection generated an additional benefit over a twice-daily injection, equivalent to a weighted total willingness to pay of AUD$22.35 per month.
Based on the patient preferences, the importance of frequency of administration and other non-health benefits can be valued. Understanding patient preferences has an important role in health technology assessment, as the identification of the value as well as the importance weighting for each treatment attribute may assist with funding decisions beyond clinical trial outcomes.
2型糖尿病（T2DM）患者有多种药物治疗方案可用于控制血糖。患者和开处方者基于自身经验和信念，可能对T2DM治疗属性（如给药方式和频率）有不同偏好，这可能会影响依从性。由于依从性是糖尿病治疗中的关键问题，了解患者重视什么以及他们如何权衡新治疗的风险和益处非常重要。本研究旨在调查T2DM治疗选择的关键驱动因素，重点关注注射频率，并探讨患者相应的支付意愿。
采用离散选择实验（DCE）向患者展示不同治疗方案（注射药物和口服药物）之间的一系列权衡，这些方案由10种不同水平的属性组成（给药频率和方式、体重变化、针头类型、储存、恶心、注射部位反应、低血糖事件、饮食说明和成本）。171名同意参与的澳大利亚成年T2DM患者完成了全国在线调查，其中58名患者每天接受两次艾塞那肽注射，113名患者接受口服降糖治疗。使用误差成分模型估计患者对不同属性的相对优先级和选择的关键驱动因素，并估计他们对新治疗的支付意愿。
注射频率体重变化和恶心被证明是接受注射治疗患者的重要属性。在该队列中，每周一次注射比每日两次注射产生了额外益处相当于每月加权总支付意愿为22.35澳元。
基于患者偏好给药频率和其他非健康益处的重要性可以得到重视。了解患者偏好对卫生技术评估具有重要作用，因为确定每种治疗属性的价值以及重要性权重可能有助于做出超出临床试验结果的资金决策。
