title: A valuation of patients' willingness-to-pay for insulin delivery in diabetes.
abstract: OBJECTIVE
  The aim of this study was to determine the insulin-delivery system and the attributes of insulin therapy that best meet patients' preferences, and to estimate patients' willingness-to-pay (WTP) for them.
  
  
  METHODS
  This was a cross-sectional discrete choice experiment (DCE) study involving 378 Canadian patients with type 1 or type 2 diabetes. Patients were asked to choose between two hypothetical insulin treatment options made up of different combinations of the attribute levels. Regression coefficients derived using conditional logit models were used to calculate patients' WTP. Stratification of the sample was performed to evaluate WTP by predefined subgroups.
  
  
  RESULTS
  A total of 274 patients successfully completed the survey. Overall, patients were willing to pay the most for better blood glucose control followed by weight gain. Surprisingly, route of insulin administration was the least important attribute overall. Segmented models indicated that insulin naïve diabetics were willing to pay significantly more for both oral and inhaled short-acting insulin compared with insulin users. Surprisingly, type 1 diabetics were willing to pay $C11.53 for subcutaneous short-acting insulin, while type 2 diabetics were willing to pay $C47.23 to avoid subcutaneous short-acting insulin (p < .05). These findings support the hypothesis of a psychological barrier to initiating insulin therapy, but once that this barrier has been overcome, they accommodate and accept injectable therapy as a treatment option.
  
  
  CONCLUSIONS
  By understanding and addressing patients' preferences for insulin therapy, diabetes educators can use this information to find an optimal treatment approach for each individual patient, which may ultimately lead to improved control, through improved compliance, and better diabetes outcomes.
authors.affiliation: Department of Clinical, Toxicological and Bromatological Analysis, University of São Paulo - Faculty of Pharmaceutical Sciences of Ribeirão Preto, São Paulo, Brazil. milaguimaraes2@hotmail.com
authors.forename: Camila
authors.initials: C
authors.lastname: Guimarães
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Marra
authors.forename: Lindsey
authors.initials: L
authors.lastname: Colley
authors.forename: Sabrina
authors.initials: S
authors.lastname: Gill
authors.forename: Scot H
authors.initials: SH
authors.lastname: Simpson
authors.forename: Graydon S
authors.initials: GS
authors.lastname: Meneilly
authors.forename: Regina H C
authors.initials: RH
authors.lastname: Queiroz
authors.forename: Larry D
authors.initials: LD
authors.lastname: Lynd
mesh_terms: D000368:Aged; D001955:British Columbia; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005382:Financing, Personal; D006801:Humans; D007328:Insulin / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011795:Surveys and Questionnaires
chemical_list: D007328:Insulin