title: Patients' with type 2 diabetes willingness to pay for insulin therapy and clinical outcomes.
abstract: OBJECTIVE
  This study assessed patient preferences, using willingness to pay as a method to measure different treatment characteristics or attributes associated with injectable insulin therapy in patients with type 2 diabetes.
  
  
  METHODS
  Adults with type 2 diabetes in 12 countries, diagnosed >6 months prior and receiving insulin for >3 months, were recruited through a representative online panel. Data were collected via online questionnaire and analyzed using a standard choice model for discrete choice experiment.
  
  
  RESULTS
  A total of 3758 patients from North America (n=646), South America (n=1537), and Europe (n=1575) completed the study. Mean glycated hemoglobin (HbA1c) levels in North America, South America, and Europe were 63 mmol/mol (7.9%), 75 mmol/mol (9.0%), and 64 mmol/mol (8.0%), respectively. In the three regions, monthly willingness to pay was US$116, US$74, and US$92, respectively, for a 1%-point decrease in HbA1c; US$99, US$80, and US$104 for one less major hypoglycemic event per year; and US$64, US$37 and US$60 for a 3 kg weight decrease. To avoid preinjection preparation of insulin, the respective values were US$47, US$18, and US$37, and US$25, US$25, and US$24 for one less injection per day. Among respondents on basal-only insulin who had previously tried a more intensive regimen, reasons for switching back included difficulty in handling multiple injections and risk of hypoglycemic events.
  
  
  CONCLUSIONS
  Reducing HbA1c, frequency of major hypoglycemic events and weight decrease were the highest valued outcomes in each region. The administrative burden of injections was also considered important.
authors.affiliation: Beta Cell Diabetes Centre, Chelsea and Westminster Hospital, London, UK; Diabetes Therapies Evaluation Network, London, UK.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Feher
authors.affiliation: School of Health and Related Research, University of Sheffield , Sheffield , UK.
authors.forename: John
authors.initials: J
authors.lastname: Brazier
authors.affiliation: Department of Internal Medicine , CAPHRI School for Primary Care and Public Health and CARIM Institute, Maastricht University Medical Centre , Maastricht , The Netherlands.
authors.forename: Nicolaas
authors.initials: N
authors.lastname: Schaper
authors.affiliation: Novo Nordisk A/S , Soeborg , Denmark.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Vega-Hernandez
authors.affiliation: Novo Nordisk A/S , Soeborg , Denmark.
authors.forename: Annie
authors.identifier: 0000-0001-8674-6134
authors.initials: A
authors.lastname: Nikolajsen
authors.affiliation: Incentive , Holte , Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Bøgelund
keywords: Patient Preferences; Treatment Adherence/Compliance; Treatment With Insulin; Type 2 Diabetes