title: Socioeconomic differences in preferences and willingness-to-pay for insulin delivery systems in type 1 and type 2 diabetes.
abstract: BACKGROUND
  An evaluation of patients' preferences is necessary to understand the demand for different insulin delivery systems. The aim of this study was to investigate the association between socioeconomic status (SES) and patients' preferences and willingness to pay (WTP) for various attributes of insulin administration for diabetes management.
  
  
  METHODS
  We conducted a discrete choice experiment (DCE) to determine patients; preferences and their WTP for hypothetical insulin treatments. Both self-reported annual household income and education completed were used to explore differences in treatment preferences and WTP for different attributes of treatment across different levels of SES.
  
  
  RESULTS
  The DCE questionnaire was successfully completed by 274 patients. Overall, glucose control was the most valued attribute by all socioeconomic groups, while route of insulin delivery was not as important. Patients with higher incomes were willing to pay significantly more for better glucose control and to avoid adverse events compared to lower income groups. In addition, they were willing to pay more for an oral short-acting insulin ($Can 71.65 [95% confidence interval, $40.68, $102.62]) compared to the low income group ($Can 9.85 [95% confidence interval, 14.86, 34.56; P < 0.01]). Conversely, there were no differences in preferences when the sample was stratified by level of education.
  
  
  CONCLUSIONS
  This study revealed that preferences and WTP for insulin therapy are influenced by income but not by level of education. Specifically, the higher the income, the greater desire for an oral insulin delivery system, whereas an inhaled route becomes less important for patients.
authors.affiliation: University of São Paulo, São Paulo, Brazil.
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
authors.initials: S
authors.lastname: Simpson
authors.forename: Graydon
authors.initials: G
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: D000280:Administration, Inhalation; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001786:Blood Glucose; D001955:British Columbia; D002755:Choice Behavior; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000191:economics; D004522:Educational Status; D005260:Female; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000191:economics / Q000523:psychology*; D018570:Risk Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D007328:Insulin