Patient preferences for attributes of type 2 diabetes mellitus treatments in Germany
Background and aims: Understanding T2DM patients’ preferences for attributes of T2DM treatments may help to explain how each of these attributes differentially affect patients’ perception and behavior. Our aim was to quantify the relative preferences of a set of attributes describing T2DM treatments for T2DM patients in Germany.
Materials and methods: A stated-preference discrete-choice experiment (DCE) survey was designed to elicit preferences for T2DM treatment attributes among patients in Germany taking a prescription T2DM medication for>2 years. The survey collected background characteristics and information on respondent demographics, health history, current health status (EQ-5D), and experience with T2DM and T2DM treatments. The DCE included a series of 8 choices between pairs of hypothetical T2DM treatments defined by these seven attributes: chance of reaching target HbA1c (A1c), reduction in risk of serious heart attack or stroke, frequency of hypoglycemia, risk of gastrointestinal side effects (GI SEs), weight change, mode of administration (MoAdmin; pill or injection), and dosing frequency. Random-parameters logit was used to analyze the DCE data. Interactions between patient characteristics and preference estimates were explored and results for prespecified subgroups analyzed. A preference for an attribute was dominant if a respondent always selected the medicine with the better level of that attribute. Minimum additional benefit (MAB) was defined as the minimum increase in probability of reaching target HbA1c for which respondents would accept a worse level of another attribute.
Results: Of 1,198 individuals that responded to the survey, 531 (44.3%) were eligible to participate, and 474 consented and completed the survey and were included in this analysis. Mean age was 61 years, 58% male, and 54% with T2DM diagnosed>7 yrs ago. Based on the DCE analysis, Figure 1 below, GI SEs were most important to patients, followed by weight changes, MoAdmin and A1c. Eighteen percent of respondents always selected the treatment administered by pills, 7% dominated on weight change, and 4% on A1c. Based on the DCE, the MAB analysis found that patients would require that the probability of reaching their target HbA1c is 56 additional percentage points higher to change from a 0% to 30% risk of having GI SEs. Other high MAB levels were reported by moving from 2-kg weight loss to 2-kg weight gain (MAB of 44), moving from 0% to 20% risk of GI SEs (43) and moving from pill to injection (42).
Conclusion: Our findings suggest that this sample of German T2DM patients was willing to trade-off efficacy for improved GI SEs and a better mode of administration (pills). Patients focused on reduction in the risk ofT2DM-related GI-SEs, weight changes and mode of administration as key attributes that they value highly. Given the variety of T2DM medications available, the results suggest that careful discussion about patient preferences could help improve patient satisfaction with T2DM drugs.