1
|
van Bruggen FH, de Haas EC, Zuidema SU, Luijendijk HJ. Time Gained to Cardiovascular Disease by Intensive Lipid-Lowering Therapy: Results of Individual Placebo-Controlled Trials and Pooled Effects. Am J Cardiovasc Drugs 2024:10.1007/s40256-024-00668-y. [PMID: 39143415 DOI: 10.1007/s40256-024-00668-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/16/2024]
Abstract
INTRODUCTION Despite the effect on blood lipid levels, the clinical benefits of intensive versus standard pharmacological lipid-lowering therapy remain unclear. Previous reviews have presented relative effects on the risk of clinical outcomes, but not the absolute risk reductions (ARRs) and the time gained to a clinical outcome, also called outcome postponement (OP). The aim of this study was to estimate the effect of intensive versus standard lipid-lowering therapy in terms of ARR and OP of major adverse cardiovascular events (MACE), myocardial infarction (MI), stroke, and all-cause mortality. METHODS We searched PubMed, Embase, and prior reviews to identify trials comparing intensive versus standard lipid-lowering therapy for the risk of cardiovascular disease. We extracted the number of patients with MACE, MI, stroke, and all-cause mortality. Risk of bias was assessed according to the five domains of the Cochrane Risk of Bias Tool 2.0. We calculated ARRs and OPs to assess the clinical benefits of intensive versus standard therapy for each outcome. We conducted meta-analyses standardizing the results to 2 and 5 years of follow-up. RESULTS We identified 11 double-blind, randomized, controlled trials (n = 101,357). The follow-up period ranged from 1.5 to 7.0 years, with an average follow-up duration of 3.7 years. Risk of bias was generally high. During an estimated 2 years of intensive versus standard lipid-lowering therapy, 1.1% (95% confidence interval [CI] 0.7-1.5) fewer patients had MACE and the OP of MACE was 4.1 days (95% CI 2.6-5.6). The effects were 0.7% (95% CI 0.4-0.8) and 2.5 days (95% CI 1.6-3.3) for MI, 0.2% (95% CI 0.1-0.3) and 0.9 days (95% CI 0.5-1.2) for stroke, and 0.2% (95% CI - 0.1 to 0.4) and 0.6 days (95% CI - 0.4 to 1.5) for all-cause death. During on average 5 years of intensive versus standard lipid-lowering therapy, 2.4% (95% CI 1.5-3.3) fewer patients had MACE and the time gained to MACE was 23.5 days (95% CI 14.9-32.0). The effects were 1.5% (95% CI 1.0-2.1) and 14.6 days (95% CI 9.3-20.0) for MI, 0.6% (95% CI 0.4-0.8) and 5.3 days (95% CI 3.3-7.4) for stroke, and 0.4% (95% CI -0.2 to 0.1) and 3.6 days (95% CI - 2.1 to 9.2) for all-cause death. CONCLUSION Intensive lipid-lowering therapy during 2 or 5 years did not lead to fewer deaths or lifetime gained, and the effects on MI and stroke were negligible. The largest effect was that MACE did not occur in two of 100 patients and was postponed 3-4 weeks after 5 years of intensive treatment. Given the small effect, patients should receive this information as part of shared decision making.
Collapse
Affiliation(s)
- Folkert H van Bruggen
- Department of Primary and Long-term Care, University of Groningen, University Medical Centre Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands
| | - Esther C de Haas
- Department of Primary and Long-term Care, University of Groningen, University Medical Centre Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands
| | - Sytse U Zuidema
- Department of Primary and Long-term Care, University of Groningen, University Medical Centre Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands
| | - Hendrika J Luijendijk
- Department of Primary and Long-term Care, University of Groningen, University Medical Centre Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands.
| |
Collapse
|
2
|
Ozdemir S, Gonzalez JM, Bansal P, Huynh VA, Sng BL, Finkelstein E. Getting it right with discrete choice experiments: Are we hot or cold? Soc Sci Med 2024; 348:116850. [PMID: 38608481 DOI: 10.1016/j.socscimed.2024.116850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/26/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Abstract
Discrete Choice Experiments (DCEs) are widely employed survey-based methods to assess preferences for healthcare services and products. While they offer an experimental way to represent health-related decisions, the stylized representation of scenarios in DCEs may overlook contextual factors that could influence decision-making. The aim of this paper was to evaluate the predictive validity of preferences elicited through a DCE in decisions likely influenced by a hot-cold empathy gap, and compare it to another commonly used method, a direct-elicitation question. We focused on preferences for pain-relief modalities, especially for an epidural during childbirth - a context where direct-elicitation questions have shown a preference for or intention to have a natural birth (representing the "cold" state), yet individuals often opt for an epidural during labor (representing the "hot" state). Leveraging a unique dataset collected from 248 individuals, we incorporated both the stated preferences collected through a survey administered upon hospital admission for childbirth and the actual pain-relief modality usage data documented in medical records. The DCE allowed for the evaluation of scenarios outside of those expected by respondents to simulate decision-making during childbirth. When we compared the predicted epidural use with the actual epidural use during labor, we observed a choice concordance of 71-60%, depending on the model specification. The concordance rate between the predicted and actual choices increased to 77-76% when accounting for the initial use of other ineffective modalities. In contrast, the direct-elicitation choices, relying solely on respondents' baseline expectations, yielded a lower concordance rate of 58% with actual epidural use. These findings highlight the flexibility of the DCE method in simulating complex decision contexts, including those involving hot-cold empathy gaps. The DCE proves valuable in assessing nuanced preferences, providing a more accurate representation of the decision-making processes in healthcare scenarios.
Collapse
Affiliation(s)
- Semra Ozdemir
- Department of Population Health Sciences, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Prateek Bansal
- Department of Civil and Environmental Engineering, National University of Singapore, Singapore
| | - Vinh Anh Huynh
- Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Eric Finkelstein
- Department of Population Health Sciences, Duke University, Durham, NC, USA; Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| |
Collapse
|
3
|
Kerr D, Rajpura JR, Namvar T. Evaluating Patient and Provider Preferences for a Once-Weekly Basal Insulin in Adults with Type 2 Diabetes. Patient Prefer Adherence 2024; 18:411-424. [PMID: 38375061 PMCID: PMC10875167 DOI: 10.2147/ppa.s436540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/28/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose The global burden of disease of type 2 diabetes (T2D) is significant, and insulin currently plays a central role in T2D management. This study sought to assess the preferences of patients with T2D and healthcare providers (HCPs) involved in T2D care regarding a hypothetical once-weekly basal insulin in comparison to current basal insulin options. Patients and Methods In a survey-based study in the United States that included a discrete choice experiment (DCE), patients with T2D (insulin naïve and current insulin users) and providers who treat individuals with T2D were asked to evaluate current basal insulins and identify attributes of importance regarding a hypothetical once-weekly basal insulin. A regression analysis was conducted to identify drivers of preference by relevant demographics, attitudes, and behaviors. Results Most respondents (91% of patients with T2D and 89% of HCPs in the base case scenario) would choose a once-weekly basal insulin product over another type of basal insulin. Both patients with T2D and HCPs rated insulin type and delivery method to be attributes of highest importance in the discrete choice exercise. Current basal insulin users ("insulin experienced") reported higher levels of confidence that a once-weekly insulin would help them to achieve their desired blood sugar levels compared to their current basal insulin (5.7 vs 5.2 on a 7-point Likert scale). Most insulin-experienced respondents (88%) were likely to inquire about once-weekly basal insulin, and most HCPs (85%) indicated willingness to educate patients on management of their T2D using a once-weekly basal insulin. Conclusion Discussing preferences for T2D medication management is important for patients and HCPs to ensure treatments are offered for patients based on their preferences. This study showed that patient and provider preferences are similar towards a once-weekly basal insulin over current basal insulin preparations.
Collapse
Affiliation(s)
- David Kerr
- Center for Health Systems Research, Sutter Health, Santa Barbara, CA, USA
| | - Jigar Ramesh Rajpura
- Department of US Health Economic and Outcomes Research – Rare Disease Portfolio, Novo Nordisk Inc, Plainsboro, NJ, USA
| | - Tarlan Namvar
- Department of Evidence Synthesis and Value Assessment, Novo Nordisk Inc, Plainsboro, NJ, USA
| |
Collapse
|
4
|
Golembiewski EH, Garcia Bautista AE, Polley E, Umpierrez GE, Galindo RJ, Brito JP, Montori VM, Gockerman JP, Tesulov M, Labatte B, Mickelson MM, McCoy RG. Outcomes and Attributes Patients Value When Choosing Glucose-Lowering Medications: A Mixed-Methods Study. Clin Diabetes 2024; 42:371-387. [PMID: 39015157 PMCID: PMC11247043 DOI: 10.2337/cd23-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
This mixed-methods study sought to identify pharmacotherapy preferences among 40 noninsulin-treated adults with type 2 diabetes receiving care at two U.S. health care systems. Participants ranked by relative importance various health outcomes and medication attributes and then contextualized their rankings. Most participants ranked blindness (63%), death (60%), heart attack (48%), and heart failure (48%) as the most important health outcomes and glucose-lowering efficacy (68%) as the most important medication attribute, followed by oral administration (45%) and lack of gastrointestinal side effects (38%).
Collapse
Affiliation(s)
| | | | - Eric Polley
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Guillermo E. Umpierrez
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Rodolfo J. Galindo
- Division of Endocrinology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Juan P. Brito
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Victor M. Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Mindy M. Mickelson
- Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Rozalina G. McCoy
- Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
- University of Maryland Institute for Health Computing, Bethesda, MD
| |
Collapse
|
5
|
Ozdemir S, Ansah J, Matchar D. Preferences for Enhanced Primary Care Services Among Older Individuals and Primary Care Physicians. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:785-797. [PMID: 37160566 PMCID: PMC10169155 DOI: 10.1007/s40258-023-00809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE We aimed to identify the factors that are most important for community-dwelling older individuals (i.e., users) and primary care (PC) providers to enhance PC services. METHODS Discrete choice experiment surveys were administered to 747 individuals aged ≥ 60 years and 242 PC physicians in Singapore between December 2020 and August 2021. Participants were asked to choose between two hypothetical PC clinics and their current clinic. Latent class models were used to estimate the relative attribute importance (RAI) and to calculate the predicted uptake for enhanced PC services. RESULTS Based on the attributes and levels used in this study, the out-of-pocket cost (RAI: 47%) and types of services offered (RAI: 25%) were the most important attributes for users while working hours (RAI: 28%) and patient load (RAI: 25%) were the most important for providers. For out-of-pocket visit costs ranging from Singapore dollars (S)$100 to S$5, users' predicted uptake for enhanced PC services ranged from 46 to 84%. For daily patient loads ranging from 60 to 20 patients, providers' predicted uptake ranged from 64 to 91%, assuming their income remains unchanged. CONCLUSIONS Our study provides timely insights for the development of strategies to support the government's new health care initiative (HealthierSG), which places PC at the center of Singapore's healthcare system. The ability to choose their preferred clinic, low out-of-pocket costs and types of services offered (for users), and reasonable working conditions (for providers) were the key factors for users and providers to participate in enhanced PC services.
Collapse
Affiliation(s)
- Semra Ozdemir
- Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - John Ansah
- Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - David Matchar
- Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| |
Collapse
|
6
|
Doshi K, Henderson SL, Seah DJL, De Silva DA, Lee JJ, Huynh VA, Ozdemir S. Stroke survivors' preferences for post-stroke self-management programs: A discrete choice experiment. J Stroke Cerebrovasc Dis 2023; 32:106993. [PMID: 36669373 DOI: 10.1016/j.jstrokecerebrovasdis.2023.106993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND PURPOSE Self-management programs enhance survival in stroke patients. However, they require patient-centered designs to be effective. The aim of this study was therefore to investigate the type of post-stroke self-management programs that appeal to stroke survivors, and to estimate their willingness to participate in such programs. METHODS A Discrete Choice Experiment was administered to patients who had either a transient ischemic attack (TIA) or stroke within the past 3 years and were cognitively intact (i.e., stroke survivors). Stroke survivors were presented with eight choice tasks and asked to choose between 'No Program' and two hypothetical post-stroke management programs that varied by six attributes: Topics covered by the program; schedule of the program; frequency and duration of the sessions; number of participants; out-of-pocket registration fee for the whole program; and rewards for completing the program. RESULTS The analysis involved 146 stroke survivors. Based on the mixed logit model, the predicted willingness to participate ranged from 53% to 76%. The most popular characteristics in a program were topics on health education and risk management, being scheduled during weekends as four sessions that are each 2 hours long and involve four participants, a registration fee of SGD50 (∼USD36), and SGD500 (∼USD359) reward for program completion. CONCLUSIONS Interest in post-stroke self-management programs was high, with at least half of the sample showing interest in participating in these programs. Program features such as focusing on health education and risk management, charging a low registration fee, and offering incentives helped to increase the demand.
Collapse
Affiliation(s)
- Kinjal Doshi
- Department of Psychology, Singapore General Hospital, Singapore.
| | | | | | - Deidre Anne De Silva
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital Campus, Singapore.
| | - Jia Jia Lee
- Signature Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - Vinh Anh Huynh
- Signature Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - Semra Ozdemir
- Signature Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| |
Collapse
|
7
|
Komine M, Kim H, Yi J, Zhong Y, Sakai Y, Crawford B, Habiro K, Hikichi Y, Feldman SR. A discrete choice experiment on oral and injection treatment preferences among moderate-to-severe psoriasis patients in Japan. J Dermatol 2023. [PMID: 36808765 DOI: 10.1111/1346-8138.16746] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 02/22/2023]
Abstract
Long-term psoriasis (PsO) management remains challenging. With growing variation in treatment efficacy, cost, and modes of administration, patient preferences for different treatment characteristics are not well understood. A discrete choice experiment (DCE), informed by qualitative patient interviews, was conducted to assess patient preferences for different attributes of PsO treatments; 222 adult patients with moderate-to-severe PsO receiving systemic therapy participated in the DCE web survey. Better long-term efficacy and lower cost were preferred (preference weights p < 0.05). Long-term efficacy had the highest relative importance (RI) and mode of administration was as important as the outcome attributes (efficacy and safety). Patients also preferred oral to injectable administration. In subgroup analyses by disease severity, residence, psoriatic arthritis as a comorbidity, and gender, the trends for each subgroup were the same as the overall population although the extent of RI for administration mode varied. Mode of administration was more important for patients with moderate versus severe disease, or rural versus urban residence. This DCE utilized attributes related to both oral and injectable treatment as well as a broad study population of systemic treatment users. Preferences were further stratified by patient characteristics to explore trends in different subgroups. Understanding the RI of treatment attributes and the attribute trade-offs acceptable to patients helps inform moderate-to-severe PsO systemic treatments decisions.
Collapse
Affiliation(s)
- Mayumi Komine
- Jichi Medical University Hospital, Tochigi, Shimotsuke, Japan
| | | | | | | | | | | | | | | | - Steven R Feldman
- Atrium Health Wake Forest Baptist, North Carolina, Winston-Salem, USA
| |
Collapse
|
8
|
Sim WS, Yeo SH, Choi C, Yeo TW, Lee JJ, Huynh VA, Finkelstein EA, Ozdemir S. Preferences for a non‐invasive prenatal test as first‐line screening for Down Syndrome: A discrete choice experiment. Prenat Diagn 2022; 42:1368-1376. [DOI: 10.1002/pd.6239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/15/2022] [Accepted: 09/07/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Wen Shan Sim
- Department of Maternal Fetal Medicine KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
- Antenatal Diagnostic Centre KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
| | - Seow Heong Yeo
- Department of Maternal Fetal Medicine KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
| | - Christina Choi
- Antenatal Diagnostic Centre KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
| | - Tai Wai Yeo
- Department of Pathology and Laboratory Medicine KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
| | - Jia Jia Lee
- Signature Programme in Health Services and Systems Research Duke‐NUS Medical School 8 College Road Singapore Singapore169857
| | - Vinh Anh Huynh
- Signature Programme in Health Services and Systems Research Duke‐NUS Medical School 8 College Road Singapore Singapore169857
| | - Eric Andrew Finkelstein
- Signature Programme in Health Services and Systems Research Duke‐NUS Medical School 8 College Road Singapore Singapore169857
- Duke Global Health Institute Duke University 310 Trent Drive Durham NC USA27710
| | - Semra Ozdemir
- Signature Programme in Health Services and Systems Research Duke‐NUS Medical School 8 College Road Singapore Singapore169857
- Saw Swee Hock School of Public Health National University of Singapore 12 Science Drive Singapore Singapore117549
| |
Collapse
|
9
|
Ozdemir S, Yeo SWJ, Lee JJ, Bhaskar A, Finkelstein E, Tong L. Patient Medication Preferences for Managing Dry Eye Disease: The Importance of Medication Side Effects. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:679-690. [PMID: 35697974 PMCID: PMC9192251 DOI: 10.1007/s40271-022-00586-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/28/2022]
Abstract
Objectives The side effects of dry eye medications can lead to medication non-adherence and, eventually, to poor outcomes. This study aimed to quantify to what extent the side effects of dry eye disease (DED) medications (burning/stinging sensation and blurring) are important to patients compared to medication benefits or costs. Methods Patients diagnosed with DED were recruited at a referral eye center in Singapore (n = 139). This study utilized a Discrete Choice Experiment where patients were presented with 10 choice tasks where they were asked to choose between their current medication (or no medication), and two hypothetical medications that varied based on five attributes: duration of burning/stinging, duration of blurring, time to medication effectiveness, medication frequency, and out-of-pocket cost. The main outcomes were relative attribute importance and predicted uptake. Results Latent class logistic regressions found two groups with distinct preferences. For both classes, duration of burning/stinging (Class 1 = 23%, Class 2 = 29%) and cost (Class 1 = 24%, Class 2 = 27%) were the most important attributes while duration of blurring (Class 1 = 15%, Class 2 = 9%) was the least important. The predicted uptake of a medication increased 18 percentage-points when burning/stinging duration decreased from 2 h to a few minutes. The predicted uptake for new medications was lowest for those on medication with well-controlled symptoms and highest for those who were not on medication and could not control their symptoms effectively. Conclusion This study showed that duration of burning/stinging was an important factor when choosing medications. Incorporating patient preferences in medication decisions can potentially improve patient acceptance of a treatment regimen. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-022-00586-8.
Collapse
Affiliation(s)
- Semra Ozdemir
- Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Sharon Wan Jie Yeo
- Ocular Surface Research Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Jia Jia Lee
- Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Adithya Bhaskar
- Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Eric Finkelstein
- Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Louis Tong
- Ocular Surface Research Group, Singapore Eye Research Institute, Singapore, Singapore
- Cornea and External Eye Disease Service, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
10
|
Liu S, Liu J, Yu Y, Si L, Tang C, Liu Z, Chen Y. What Is Valued Most by Patients With Type 2 Diabetes Mellitus When Selecting Second-Line Antihyperglycemic Medications in China. Front Pharmacol 2022; 12:802897. [PMID: 35002736 PMCID: PMC8733399 DOI: 10.3389/fphar.2021.802897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 11/14/2022] Open
Abstract
Objective: To estimate patient preferences for second-line antihyperglycemic medications in China. Methods: A face to face survey with the best-worst scaling (BWS) choices was administered in patients with diagnosed type 2 diabetes mellitus (T2DM). Study participants were asked to indicate which attribute they valued most and which attribute they valued least in 11 choice sets, each of which consisted of five alternatives out of 11 antihyperglycemic medication-specific attributes (treatment efficacy, weight change, hypoglycemic events, gastrointestinal side effects, cardiovascular health, urinary tract infection and genital infection side effects, edema, mode of administration, bone fracture, dosing frequency and out-of-pocket cost). A counting approach, a conditional logit model, and K-means clustering were used to estimate the relative importance of items and preference heterogeneity. Results: A total of 362 participants were included with a mean age of 63.6 (standard deviation: 11.8) years. There were 56.4% of participants were women, and 56.3% being diagnosed with diabetes for at least 5 years. Efficacy, cardiovascular health and hypoglycemic events were valued most, while dosing frequency, mode of administration and bone fracture were valued least. The K-means clustering further showed preference heterogeneity in out-of-pocket cost across the participants. Conclusion: Our study suggests that treatment efficacy, cardiovascular health and hypoglycemic events are valued most by Chinese patients with T2DM when selecting second-line antihyperglycemic medications. The study improves the understanding of patients’ preferences for second-line antihyperglycemic medications in China.
Collapse
Affiliation(s)
- Shimeng Liu
- School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Jing Liu
- School of Management, Hainan Medical University, Haikou, China
| | - Yijiang Yu
- Huai'an Hospital of Traditional Chinese Medicine, Huai'an, China
| | - Lei Si
- The George Institute for Global Health, UNSW Sydney, Kensington, NSW, Australia
| | - Chengxiang Tang
- School of Public Administration, Guangzhou University, Guangzhou, China
| | - Zhigang Liu
- School of Management, Hainan Medical University, Haikou, China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| |
Collapse
|
11
|
Gómez-Peralta F, Mareque M, Muñoz Á, Maderuelo M, Casado MÁ. Patient Preferences for Pharmacological Diabetes Treatment Among People with Diabetes in Spain: A Discrete Choice Experiment. Diabetes Ther 2022; 13:75-87. [PMID: 34796456 PMCID: PMC8776952 DOI: 10.1007/s13300-021-01178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/28/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The aim of the project was to describe the preferences related to the medication attributes of people with diabetes mellitus (DM) treated in Spain. METHODS The project was carried out in four different phases. In phase A, a Steering Committee defined and selected a total of 18 attributes for treating DM and grouped them into four categories: health outcomes, adverse events, treatment characteristics and cost of treatment. In phase B, a questionnaire according to a discrete choice experiment (DCE) methodology was developed. In phase C, the online DCE survey was sent to members of associations of people with DM from the Spanish Diabetes Federation (FEDE). Finally, in phase D, the results were discussed in a deliberative process. RESULTS Of the 238 participants who completed the questionnaire (May-September 2020), 231 were included (mean age, 58 years; males, 62%). The DCE results showed that the best-valued category was health outcomes (39.67%), followed by adverse events (26.85%), treatment characteristics (21.70%) and treatment costs (11.77%). Ten of 18 attributes had a significant effect on participants' choice (p < 0.05) and the highest relative importance value: blood pressure reduction (12.82%), hypoglycaemia (12.77%), HbA1c level reduction (8.54%), cost of the medication (8.13%), needle/tablet size (7.20%), weight change (6.72%), risk of genitourinary infections (6.36%), gastrointestinal problems (5.82%), improved kidney function (5.53%) and administration route (5.41%). CONCLUSIONS People with DM prefer a treatment that generates benefits in measurable health effects (reducing blood pressure and HbA1c level, while not risking hypoglycaemia) and a convenient route of administration. Considering the preferences of people with DM could generate better clinical results and therapeutic adherence, reducing morbidity, mortality and disease burden.
Collapse
Affiliation(s)
| | - María Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain.
| | - Álvaro Muñoz
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | | | | |
Collapse
|
12
|
Costa Gil JE, Garnica Cuéllar JC, Perez Terns P, Ferreira-Hermosillo A, Cetina Canto JA, Garduño Perez ÁA, Mendoza Martínez P, Rista L, Sosa-Caballero A, Vázquez-Mendez E, Tejado Gallegos LF, Chen H, Elizalde A, Tomatis VB. Patients' Preference Between DPP4i and SGLT2i for Type 2 Diabetes Treatment: A Cross-Sectional Evaluation. Patient Prefer Adherence 2022; 16:1201-1211. [PMID: 35592774 PMCID: PMC9112794 DOI: 10.2147/ppa.s355638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Despite newer type 2 diabetes (T2D) medications, patients do not always achieve metabolic targets, remaining at risk for cardiorenal complications. Therapeutic decisions are generally made by the healthcare team without considering patients' preferences. We aimed to evaluate patients' T2D treatment preference in two Latin-American countries between two different oral medication profiles, one resembling dipeptidyl peptidase-4 inhibitors (DPP4i) and another resembling sodium-glucose cotransporter-2 inhibitors (SGLT2i). PATIENTS AND METHODS In this cross-sectional, multicenter study from June to September 2020, patients with T2D from Argentina and Mexico (n = 390) completed a discrete choice experiment questionnaire to identify preferences between DPP4i (medication profile A) and SGLT2i (medication profile B). The reason behind patients' choice, and the association between their baseline characteristics and their preference were evaluated using logistic regression methods. RESULTS Most participants (88.2%) preferred SGLT2i's profile. Participants with older age (p = 0.0346), overweight or obesity (p < 0.0001), high blood pressure (BP; p < 0.0001), high total cholesterol (p = 0.0360), and glycosylated hemoglobin (HbA1c) <7% (p = 0.0001) were more likely to choose SGLT2i compared with DPP4i's profile. The most and least important reasons to choose either drug profile were HbA1c reduction and genital infection risk, respectively. The likelihood of selecting the SGLT2i's profile significantly increased in participants with increased body mass index (BMI; odds ratio [OR] = 8.9, 95% confidence interval [CI]: 3.5-22.5, p < 0.05), high BP (OR = 4.9, 95% CI: 1.9-12.4, p < 0.05), and lower education level (OR = 3.6, 95% CI: 1.0-12.6, p < 0.05). CONCLUSION Latin-American patients with T2D preferred medication with a profile resembling SGLT2i over one resembling DPP4i as a treatment option. A patient-centered approach may aid the healthcare team in decision-making for improved outcomes.
Collapse
Affiliation(s)
- José Esteban Costa Gil
- Departamento de Endocrinología, Instituto de Cardiología La Plata, La Plata, Buenos Aires, Argentina
- Correspondence: José Esteban Costa Gil, Costa Gil Departamento de Endocrinología, Instituto de Cardiología La Plata, Calle 6, número 212, La Plata, 1900, Buenos Aires, Argentina, Tel +54 9 2214 20-7359, Email
| | - Juan Carlos Garnica Cuéllar
- Departamento de Endocrinología del Centro Médico Nacional “20 de Noviembre”, ISSSTE, Ciudad de México, México
| | - Paula Perez Terns
- Dirección Médica, Cardiología Palermo - Centro de Investigaciones Clínicas, Buenos Aires, Argentina
| | - Aldo Ferreira-Hermosillo
- Unidad de Investigación Médica en Enfermedades Endócrinas. Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México
| | | | - Ángel Alfonso Garduño Perez
- Departamento de Endocrinología del Centro Médico Nacional “20 de Noviembre”, ISSSTE, Ciudad de México, México
| | | | - Lucas Rista
- Diabetes, Innovación e Investigación, Centro de Diabetes y Nutrición - Investigaciones Clínicas (CEDyN), Rosario, Santa Fé, Argentina
| | | | | | | | - Hungta Chen
- Global Medical & Payer Evidence Statistics, AstraZeneca, Gaithersburg, Maryland, USA
| | | | | |
Collapse
|
13
|
Mühlbacher AC. Science or Art? Reproducibility of Health Preference Research. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:829-830. [PMID: 32762983 DOI: 10.1016/j.jval.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Axel C Mühlbacher
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany.
| |
Collapse
|