Treatment options for patients with progressing type 2 diabetes: What are patients’ preferences in GERMANY when switching from oral to injectable antidiabetic treatment? [Umstellung von oralen auf injektable Antidiabetika bei fortschreitendem Typ-2-Diabetes: Welche Präferenzen haben die Patienten?]
Otto T.,Lilly Deutschland GmbH |
Stralka R.,Public Perception GmbH |
Schimmelpfennig H.,IfaD GmbH |
Jung H.,Lilly Deutschland GmbH |
Bruns K.,Lilly Deutschland GmbH
Gesundheitsokonomie und Qualitatsmanagement | Year: 2015
Aim: For patients with type 2 diabetes, switching from oral (OAD) to injectable (IAD) antidiabetic treatment marks the beginning of a disease phase which generally requires adaptations of lifestyle to more complex steps of treatment. As for any treatment change, patient preferences should therefore be considered. Current health care policy debates increasingly focus on the assessment of patient preferences with appropriate methods such as conjoint analysis. Thus, the aim of this study in adults with type 2 diabetes in Germany was to evaluate switching from OAD?to IAD?therapy and the effect of different IAD?treatments on patients’ subjective quality of life and living conditions by direct questioning, and to assess patient preferences for switching from OAD?to IAD?treatment using conjoint analysis. Method: Patients with type 2 diabetes recruited throughout Germany were surveyed. They were either still treated with OAD?(while expecting to be switched to IAD) or already switched to IAD?treatment within the last 1?–?3 years (age 50?–?65 years, BMI 29?–?36?kg/m2). The core of the descriptive questionnaire consisted of 28 key questions on 10 different aspects of patients’ current IAD?therapy (and for OAD?users the perceived expected impact of IAD) and 3 additional questions on subjective quality of life (subjective well-being). Upon analysis, index scores were formed for the different aspects. Patient preferences were assessed using a choice-based conjoint analysis with hypothetical patient profiles (10 attributes of 2?–?5 levels each). Results: A total of 291 patients with type 2 diabetes, classified into 6 different pre-specified treatment groups, participated in the direct quantitative survey: still on OAD?treatment (N?=?60), or already switched to once or twice daily (N?=?40) or once weekly (N?=?32) treatment with a GLP-1 receptor agonist, basal insulin-supported oral therapy (N?=?74), supplementary insulin therapy (N?=?40) or intensified insulin therapy (N?=?45). Here, the desire to lose weight received the highest rating in all 6 groups (mean index score 5.0 of 6.0), followed by high treatment flexibility during everyday life (4.3) and low efforts required for treatment (3.9), as well as a low rate of hypoglycemia (2.5). Based on the rating of the various IAD?treatment scenarios in the conjoint analysis (N?=?260), a minimum number of injections was rated as the most important preference (relative importance 33.1?%), followed by an intact attitude towards life (16.7?%), low rate of hypoglycemia (15.0?%), flexible participation in daily life (10.6?%), and treatment-triggered weight loss (10.0?%). The attributes of nausea, vomiting or diarrhea as side effect, requirement of snacks, options for blood glucose adjustment, type of antidiabetic agent (insulin or noninsulin), and circumstances of injection (at home or outside) were considered less important (all 8?%). Conclusion: The study shows that the preferences of patients with type 2 diabetes, when switching to injectable antidiabetic treatment, can be assessed by conjoint analysis, based on their treatment experiences so far. Overall, the patients’ main objective of injectable treatment is to maintain a “life as normal as possible” with maximum flexibility in daily life, and with a minimum number of injections as the most important decision. Copyright ©, Georg Thieme Verlag KG. All rights reserved.