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Patients’ and physicians’ preferences for type 2 diabetes mellitus treatments in Spain and Portugal: a discrete choice experiment

Authors Morillas C, Feliciano R, Fernández Catalina P, Ponte C, Botella M, Rodrigues J, Esmatjes E, Lafita J, Lizán L, Llorente I, Morales C, Navarro-Pérez J, Orozco-Beltran D, Paz S, Ramirez de Arellano A, Cardoso C, Causadias MT

Received 6 May 2015

Accepted for publication 26 August 2015

Published 14 October 2015 Volume 2015:9 Pages 1443—1458


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 9

Editor who approved publication: Dr Johnny Chen

Carlos Morillas,1 Rosa Feliciano,2 Pablo Fernández Catalina,3 Carla Ponte,4 Marta Botella,5 João Rodrigues,6 Enric Esmatjes,7 Javier Lafita,8 Luis Lizán,9 Ignacio Llorente,10 Cristóbal Morales,11 Jorge Navarro-Pérez,12 Domingo Orozco-Beltran,13 Silvia Paz,9 Antonio Ramirez de Arellano,14 Cristina Cardoso,15 Maribel Tribaldos Causadias9

1Hospital Universitario Dr Peset, Valencia, Spain; 2USF São Domingos, Santarém, Portugal; 3Hospital Montecelo de Pontevedra, Galicia, Spain; 4USF Porta do Sol, Matosinhos, Portugal; 5Hospital Universitario Principe de Asturias, Madrid, Spain; 6USF Serra da Lousã, Lousã, Portugal; 7Hospital Clinic, Barcelona, Spain; 8Hospital de Navarra, Navarra, Spain; 9Outcomes’10, Universidad Jaume I, Castellón, Spain; 10Hospital Universitario Nuestra Señora de la Candelaria, Canarias, Spain; 11Hospital Universitario Virgen de la Macarena, Sevilla, Spain; 12INCLIVA, CIBERESP, Universidad de Valencia, Valencia, Spain; 13Sociedad Española de Medicina Familiar y Comunitaria, Valencia, Spain; 14Novo Nordisk EU-HEOR Europe, Madrid, Spain; 15Novo Nordisk, Lisbon, Portugal

Objective: To assess Spanish and Portuguese patients’ and physicians’ preferences regarding type 2 diabetes mellitus (T2DM) treatments and the monthly willingness to pay (WTP) to gain benefits or avoid side effects.
Methods: An observational, multicenter, exploratory study focused on routine clinical practice in Spain and Portugal. Physicians were recruited from multiple hospitals and outpatient clinics, while patients were recruited from eleven centers operating in the public health care system in different autonomous communities in Spain and Portugal. Preferences were measured via a discrete choice experiment by rating multiple T2DM medication attributes. Data were analyzed using the conditional logit model.
Results: Three-hundred and thirty (n=330) patients (49.7% female; mean age 62.4 [SD: 10.3] years, mean T2DM duration 13.9 [8.2] years, mean body mass index 32.5 [6.8] kg/m2, 41.8% received oral + injected medication, 40.3% received oral, and 17.6% injected treatments) and 221 physicians from Spain and Portugal (62% female; mean age 41.9 [SD: 10.5] years, 33.5% endocrinologists, 66.5% primary-care doctors) participated. Patients valued avoiding a gain in bodyweight of 3 kg/6 months (WTP: €68.14 [95% confidence interval: 54.55–85.08]) the most, followed by avoiding one hypoglycemic event/month (WTP: €54.80 [23.29–82.26]). Physicians valued avoiding one hypoglycemia/week (WTP: €287.18 [95% confidence interval: 160.31–1,387.21]) the most, followed by avoiding a 3 kg/6 months gain in bodyweight and decreasing cardiovascular risk (WTP: €166.87 [88.63–843.09] and €154.30 [98.13–434.19], respectively). Physicians and patients were willing to pay €125.92 (73.30–622.75) and €24.28 (18.41–30.31), respectively, to avoid a 1% increase in glycated hemoglobin, and €143.30 (73.39–543.62) and €42.74 (23.89–61.77) to avoid nausea.
Conclusion: Both patients and physicians in Spain and Portugal are willing to pay for the health benefits associated with improved diabetes treatment, the most important being to avoid hypoglycemia and gaining weight. Decreased cardiovascular risk and weight reduction became the third most valued attributes for physicians and patients, respectively.

Keywords: diabetes, discrete choice model, preferences, willingness to pay, hypoglycemia, weight, cardiovascular risk, HbA1c

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