title: Type 2 diabetes patients' preferences and willingness to pay for lifestyle programs: a discrete choice experiment.
abstract: BACKGROUND
  Participation rates of lifestyle programs among type 2 diabetes mellitus (T2DM) patients are less than optimal around the globe. Whereas research shows notable delays in the development of the disease among lifestyle program participants. Very little is known about the relative importance of barriers for participation as well as the willingness of T2DM patients to pay for participation in such programs. The aim of this study was to identify the preferences of T2DM patients with regard to lifestyle programs and to calculate participants' willingness to pay (WTP) as well as to estimate the potential participation rates of lifestyle programs.
  
  
  METHODS
  A Discrete Choice Experiment (DCE) questionnaire assessing five different lifestyle program attributes was distributed among 1250 Dutch adults aged 35-65 years with T2DM, 391 questionnaires (31%) were returned and included in the analysis. The relative importance of the program attributes (i.e., meal plan, physical activity (PA) schedule, consultation structure, expected program outcome and out-of-pocket costs) was determined using panel-mixed logit models. Based on the retrieved attribute estimates, patients' WTP and potential participation rates were determined.
  
  
  RESULTS
  The out-of-pocket costs (β = -0.75, P < .001), consultation structure (β = -0.46, P < .001) and expected outcome (β =0.72, P < .001) were the most important factors for respondents when deciding whether to participate in a lifestyle program. Respondents were willing to pay €128 per year for individual instead of group consultation and €97 per year for 10 kilograms anticipated weight loss. Potential participation rates for different lifestyle-program scenarios ranged between 48.5% and 62.4%.
  
  
  CONCLUSIONS
  When deciding whether to participate in a lifestyle program, T2DM patients are mostly driven by low levels of out-of-pocket costs. Thereafter, they prefer individual consultation and high levels of anticipated outcomes with respect to weight loss.
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, PO Box 1 (101), Bilthoven, BA 3720, The Netherlands. Jorien.Veldwijk@rivm.nl.
authors.forename: Jorien
authors.initials: J
authors.lastname: Veldwijk
authors.forename: Mattijs S
authors.initials: MS
authors.lastname: Lambooij
authors.forename: Paul F
authors.initials: PF
authors.lastname: van Gils
authors.forename: Jeroen N
authors.initials: JN
authors.lastname: Struijs
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Smit
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
mesh_terms: D000328:Adult; D000368:Aged; D002755:Choice Behavior; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D005260:Female; D005382:Financing, Personal; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D057240:Patient Preference / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011795:Surveys and Questionnaires