Preferences of diabetes patients and physicians: a feasibility study to identify the key indicators for appraisal of health care values.
BACKGROUND
Evidence-based medicine, the Institute of Medicine (IOM) and the German Institute for Quality and Efficiency in Health Care (IQWiG), support the inclusion of patients' preferences in health care decisions. In fact there are not many trials which include an assessment of patient's preferences. The aim of this study is to demonstrate that preferences of physicians and of patients can be assessed and that this information may be helpful for medical decision making.


METHODS
One of the established methods for assessment of preferences is the conjoint analysis. Conjoint analysis, in combination with a computer assisted telephone interview (CATI), was used to collect data from 827 diabetes patients and 60 physicians, which describe the preferences expressed as levels of four factors in the management and outcome of the disease. The first factor described the main treatment effect (reduction of elevated HbA1c, improved well-being, absence of side effects, and no limitations of daily life). The second factor described the effect on the body weight (gain, no change, reduction). The third factor analyzed the mode of application (linked to meals or flexible application). The fourth factor addressed the type of product (original brand or generic product). Utility values were scaled and normalized in a way that the sum of utility points across all levels is equal to the number of attributes (factors) times 100.


RESULTS
The preference weights confirm that the reduction of body weight is at least as important for patients--especially obese patients--and physicians as the reduction of an elevated HbA1c. Original products were preferred by patients while general practitioners preferred generic products.


CONCLUSIONS
Using the example of diabetes, the difference between patients' and physicians' preferences can be assessed. The use of a conjoint analysis in combination with CATI seems to be an effective approach for generation of data which are needed for policy and medical decision making in health care.
Clinial Economics, University of Ulm, 89073 Ulm, Germany. franz.porzsolt@uniklinik-ulm.de
Franz
F
Porzsolt
Johannes
J
Clouth
Marc
M
Deutschmann
Hans-J
HJ
Hippler
D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D017076:Computer-Aided Design; D003920:Diabetes Mellitus / Q000523:psychology* / Q000628:therapy; D019468:Disease Management; D004704:Endocrinology; D005240:Feasibility Studies; D005260:Female; D058006:General Practice; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000523:psychology* / Q000706:statistics & numerical data; D012647:Self-Assessment; D016896:Treatment Outcome; D055815:Young Adult