Capturing Adult Patient Preferences Toward Benefits and Risks of Second-Line Antihyperglycemic Medications Used in Type 2 Diabetes: A Discrete Choice Experiment

Abstract

Objectives: To estimate the strength of preferences, relative importance and trade-offs that patients with type 2 diabetes make between characteristics of antihyperglycemic medications.

Methods: We conducted a discrete choice experiment with a sample of Canadians with type 2 diabetes. Respondents completed 14 choice tasks and choose between 2 hypothetical drug alternatives, described by 8 characteristics (cost, efficacy, life expectancy, risk of macrovascular event, risk of microvascular event, risk of severe hypoglycemia, risk of minor side effects and risk of rare but serious side effects). An opt-out option was also provided. Characteristics used to describe the 2 drugs were identified using a literature review, focus groups and interviews. A multinomial mixed logit model was used to estimate choice probabilities. Willingness to pay (WTP) was used to assess trade-offs between characteristics.

Results: A total of 502 survey responses were included. The average age of participants was 59±12 years. Participants were 59% men, and 62% had diabetes for at least 6 years. All characteristics were found to significantly influence choice. On average, patients were willing to pay a monthly cost for their therapy of $134 to achieve 3 additional years of life; $49 and $36 for a 20% reduction in their risk of macrovascular and microvascular events, respectively; $34 for a 1% drop in glycated hemoglobin; $29 for a 50% less risk of severe hypoglycemia over 10 years; $29 for a 50% less risk of a minor side effect and $17 for a 50% less risk of a rare but serious side effect over 10 years.

Conclusions: All 8 characteristics were shown to significantly influence choice, with cost and life expectancy carrying the most weight and serious and minor side effects carrying the least weight.

Keywords: diabète de type 2; discrete choice experiment; expérimentation de choix discrets; medication therapy; patient preference; préférences des patients; thérapie médicamenteuse; type 2 diabetes.