A valuation of infusion therapy to preserve islet function in type 1 diabetes.
OBJECTIVE
Recent advances in monoclonal antibody therapies offer the prospect of the prevention or amelioration of type 1 diabetes mellitus (T1DM). The present study was designed to capture UK (English and Scottish) preference weights for the process of undergoing infusion therapy and the likely outcomes of treatment for children (8-12 years), adolescents (13-17 years), and adults.


METHODS
Vignette descriptions of T1DM health states (describing infusion therapy and reduced insulin need) were constructed based on qualitative interviews with people with type 1 diabetes, clinicians and findings from a literature review. Utilities were elicited for each health state using the standard gamble interview from the general public, adults with diabetes, and parents of children with diabetes. Participants also completed other outcome measures-EQ-5D, Pediatric Quality-of-Life Inventory, and Hyperglycemic Fear Survey. Mixed model analyses were used to estimate the influence on utility of different participant characteristics.


RESULTS
Self-report questionnaires indicated the nature and degree of impact of T1DM on adults', adolescents', and children's quality of life, with adolescents reporting the lowest health-related quality-of-life profile of all groups. The mixed model analysis indicated that each health state was a significant predictor of utility and the T1DM participants gave significantly higher utilities compared with the general public (P = 0.02).


CONCLUSIONS
The general public and people with diabetes (or parents of children with diabetes) all place significant value on reducing the need for insulin injections; also, all recognize the disutility of undergoing infusion cycles. These values are suitable for supporting estimates of cost-effectiveness of infusion therapies in T1DM.
Lloyd
Andrew
A
Oxford Outcomes Ltd, Oxford, UK. andrew.lloyd@oxfordoutcomes.com
Swinburn
Paul
P
Boye
Kristina S
KS
Curtis
Bradley
B
Sarpong
Eric
E
Goldsmith
Kim
K
Bode
Bruce
B
Aronoff
Stephen
S
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D016001:Confidence Intervals; D003657:Decision Making; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology*; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007260:Infusion Pumps; D007328:Insulin / Q000008:administration & dosage; D050417:Insulin-Secreting Cells / Q000187:drug effects* / Q000502:physiology; D008297:Male; D015999:Multivariate Analysis; D010865:Pilot Projects; D011594:Psychometrics; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires
D000911:Antibodies, Monoclonal; D007004:Hypoglycemic Agents; D007328:Insulin