Patients' with type 2 diabetes willingness to pay for insulin therapy and clinical outcomes

Abstract

ObjectivesThis study assessed patient preferences, using willingness to pay as a method to measure different treatment characteristics or attributes associated with injectable insulin therapy in patients with type 2 diabetes.Research design and methodsAdults with type 2 diabetes in 12 countries, diagnosed >6 months prior and receiving insulin for >3 months, were recruited through a representative online panel. Data were collected via online questionnaire and analyzed using a standard choice model for discrete choice experiment.ResultsA total of 3758 patients from North America (n=646), South America (n=1537), and Europe (n=1575) completed the study. Mean glycated hemoglobin (HbA1c) levels in North America, South America, and Europe were 63 mmol/mol (7.9%), 75 mmol/mol (9.0%), and 64 mmol/mol (8.0%), respectively. In the three regions, monthly willingness to pay was US$116, US$74, and US$92, respectively, for a 1%-point decrease in HbA1c; US$99, US$80, and US$104 for one less major hypoglycemic event per year; and US$64, US$37 and US$60 for a 3 kg weight decrease. To avoid preinjection preparation of insulin, the respective values were US$47, US$18, and US$37, and US$25, US$25, and US$24 for one less injection per day. Among respondents on basal-only insulin who had previously tried a more intensive regimen, reasons for switching back included difficulty in handling multiple injections and risk of hypoglycemic events.ConclusionsReducing HbA1c, frequency of major hypoglycemic events and weight decrease were the highest valued outcomes in each region. The administrative burden of injections was also considered important.

Cost-effectiveness of multidisciplinary collaborative care versus usual care in the management of high-risk patients with diabetes in Singapore: Short-term results from a randomized controlled trial

“…Ten thousand Monte Carlo simulations were performed and the results were presented as a cost‐effectiveness acceptability curve (CEAC) and ICER scatterplot. The CEACs were constructed to determine the probability that the intervention arm was cost‐effective over different values of willingness to pay (WTP), ranging from US$165.21 to US$5000.00 per improvement in glycaemia . The ICER scatterplots were used to illustrate the overall uncertainty in the cost‐effectiveness of the intervention arm.…”

“…The CEACs were constructed to determine the probability that the intervention arm was cost-effective over different values of willingness to pay (WTP), ranging from US$165.21 to US$5000.00 per improvement in glycaemia. [29][30][31][32] The ICER scatterplots were used to illustrate the overall uncertainty in the cost-effectiveness of the intervention arm.…”

Using a Discrete-Choice Experiment Involving Cost to Value a Classification System Measuring the Quality-of-Life Impact of Self-Management for Diabetes

“…Typically, cost levels used in the literature reflect a range around mean cost that includes either a low cost or zero cost. In terms of wording the cost attribute, previous DCE experiments with a cost attribute in diabetes have used "personal cost to you each month" [27], "payment per month out of pocket," [2] and "cost of diabetes medicines each month" [28].…”

“…DCEs have usually been used to value the process of health care (either in isolation of or in combination with health outcomes) using bespoke or study-specific attributes developed for individual studies [1]. Recent DCE applications in diabetes include, for example, an investigation of patient preferences for insulin therapy and clinical outcomes in type 2 diabetes [2]. Recent work has extended the use of DCE to valuing classification systems for measuring health-related quality of life (HRQOL) such as the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) [3] and the six-dimensional health state short form (SF-6D) [4,5] on the 0 to 1 quality-adjusted life-year (QALY) scale by adding an additional attribute for duration.…”

“…DCE methods may also be applied to obtain willingness-to-pay (WTP) estimates indirectly [15][16][17] by including cost as an additional attribute in the DCE. As mentioned previously, this approach has been applied recently in diabetes (e.g., in the study by Feher et al [2]). Nevertheless, to our knowledge, to date this methodology has not been used to value a pre-existing classification system.…”