Patients' and physicians' preferences for type 2 diabetes mellitus treatments in Spain and Portugal: a discrete choice experiment.
OBJECTIVE
To assess Spanish and Portuguese patients' and physicians' preferences regarding type 2 diabetes mellitus (T2DM) treatments and the monthly willingness to pay (WTP) to gain benefits or avoid side effects.


METHODS
An observational, multicenter, exploratory study focused on routine clinical practice in Spain and Portugal. Physicians were recruited from multiple hospitals and outpatient clinics, while patients were recruited from eleven centers operating in the public health care system in different autonomous communities in Spain and Portugal. Preferences were measured via a discrete choice experiment by rating multiple T2DM medication attributes. Data were analyzed using the conditional logit model.


RESULTS
Three-hundred and thirty (n=330) patients (49.7% female; mean age 62.4 [SD: 10.3] years, mean T2DM duration 13.9 [8.2] years, mean body mass index 32.5 [6.8] kg/m(2), 41.8% received oral + injected medication, 40.3% received oral, and 17.6% injected treatments) and 221 physicians from Spain and Portugal (62% female; mean age 41.9 [SD: 10.5] years, 33.5% endocrinologists, 66.5% primary-care doctors) participated. Patients valued avoiding a gain in bodyweight of 3 kg/6 months (WTP: €68.14 [95% confidence interval: 54.55-85.08]) the most, followed by avoiding one hypoglycemic event/month (WTP: €54.80 [23.29-82.26]). Physicians valued avoiding one hypoglycemia/week (WTP: €287.18 [95% confidence interval: 160.31-1,387.21]) the most, followed by avoiding a 3 kg/6 months gain in bodyweight and decreasing cardiovascular risk (WTP: €166.87 [88.63-843.09] and €154.30 [98.13-434.19], respectively). Physicians and patients were willing to pay €125.92 (73.30-622.75) and €24.28 (18.41-30.31), respectively, to avoid a 1% increase in glycated hemoglobin, and €143.30 (73.39-543.62) and €42.74 (23.89-61.77) to avoid nausea.


CONCLUSIONS
Both patients and physicians in Spain and Portugal are willing to pay for the health benefits associated with improved diabetes treatment, the most important being to avoid hypoglycemia and gaining weight. Decreased cardiovascular risk and weight reduction became the third most valued attributes for physicians and patients, respectively.
Hospital Universitario Dr Peset, Valencia, Spain.
Carlos
C
Morillas
USF São Domingos, Santarém, Portugal.
Rosa
R
Feliciano
Hospital Montecelo de Pontevedra, Galicia, Spain.
Pablo Fernández
PF
Catalina
USF Porta do Sol, Matosinhos, Portugal.
Carla
C
Ponte
Hospital Universitario Principe de Asturias, Madrid, Spain.
Marta
M
Botella
USF Serra da Lousã, Lousã, Portugal.
João
J
Rodrigues
Hospital Clinic, Barcelona, Spain.
Enric
E
Esmatjes
Hospital de Navarra, Navarra, Spain.
Javier
J
Lafita
Outcomes'10, Universidad Jaume I, Castellón, Spain.
Luis
L
Lizán
Hospital Universitario Nuestra Señora de la Candelaria, Canarias, Spain.
Ignacio
I
Llorente
Hospital Universitario Virgen de la Macarena, Sevilla, Spain.
Cristóbal
C
Morales
INCLIVA, CIBERESP, Universidad de Valencia, Valencia, Spain.
Jorge
J
Navarro-Pérez
Sociedad Española de Medicina Familiar y Comunitaria, Valencia, Spain.
Domingo
D
Orozco-Beltran
Outcomes'10, Universidad Jaume I, Castellón, Spain.
Silvia
S
Paz
Novo Nordisk EU-HEOR Europe, Madrid, Spain.
Antonio
A
Ramirez de Arellano
Novo Nordisk, Lisbon, Portugal.
Cristina
C
Cardoso
Outcomes'10, Universidad Jaume I, Castellón, Spain.
Maribel
M
Tribaldos Causadias
HbA1c; cardiovascular risk; diabetes; discrete choice model; hypoglycemia; preferences; weight; willingness to pay