title: Willingness to pay for improvements in chronic long-acting insulin therapy in individuals with type 1 or type 2 diabetes mellitus.
abstract: BACKGROUND
  Long-acting insulin treatments with varying clinical benefits are currently available for patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). The current evidence base demonstrates the efficacy of treatments, but it is critical also to understand patient preferences regarding treatments and how they are determined.
  
  
  OBJECTIVE
  This study aimed to measure the willingness to pay (WTP) of individuals with diabetes in the United Kingdom for different attributes of long-acting insulin therapy.
  
  
  METHODS
  A survey based on discrete choice experiment methodology was developed to elicit the preferences and values of adults with T1DM or insulin-dependent T2DM regarding different aspects of their therapy. Participants were presented with a series of 27 paired choices and asked which they preferred. WTP values were calculated for relevant attribute levels.
  
  
  RESULTS
  A total of 252 participants completed the questionnaire (52% response rate); 143 had T1DM and 109 had insulin-treated T2DM. The highest WTP values in participants with T1DM were avoiding 2-kg or 4-kg weight gain (£29 and £58, respectively), avoiding major difficulties with the injection device (£49), increasing the number of days per week when blood glucose levels are in the target range from 2 to 6 (£40), reducing the number of daily injections from 3 to 1 (£39), and avoiding nighttime hypoglycemia (£33). In participants with T2DM, similar factors had the highest WTP.
  
  
  CONCLUSIONS
  This is the first study to assess WTP for long-acting insulin therapy and could have implications for future guidelines on diabetes management, however some limitations, notably in sample selection, could affect generalizability of the results. In both T1DM and T2DM, the highest WTP values were for avoidance of weight gain, and reduction in the number of injections and hypoglycemia.
authors.affiliation: United BioSource Corporation, London, United Kingdom. andrew.lloyd@oxfordoutcomes.com
authors.forename: Andrew
authors.initials: A
authors.lastname: Lloyd
authors.forename: Beenish
authors.initials: B
authors.lastname: Nafees
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Barnett
authors.forename: Simon
authors.initials: S
authors.lastname: Heller
authors.forename: Uffe J
authors.initials: UJ
authors.lastname: Ploug
authors.forename: Morten
authors.initials: M
authors.lastname: Lammert
authors.forename: Mette
authors.initials: M
authors.lastname: Bøgelund
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005382:Financing, Personal; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting