Patient Preference and Adherence (Apr 2019)
Patient preferences for glucagon-like peptide-1 receptor–agonist treatment attributes
Abstract
Vivian T Thieu,1 Susan Robinson,2 Tessa Kennedy-Martin,2 Kristina S Boye,1 Luis-Emilio Garcia-Perez1 1Global Patient Outcomes and Real-World Evidence, Eli Lilly and Company, Indianapolis, IN, USA; 2Kennedy-Martin Health Outcomes (KMHO), Brighton, UK Purpose: The importance of patient-centered care in the management of type 2 diabetes mellitus (T2DM) is widely advocated. Understanding the attributes of T2DM medications important to patients is thus essential for effective management, in order to limit disease progression. This literature review aimed to identify studies comparing patient preferences, based on process and outcome attributes, between GLP1-receptor agonist (RA) profiles and between GLP1 RA and insulin profiles. Methods: MEDLINE, Embase, PsycINFO, and the Cochrane Library (2005–present) were searched for studies in patients with T2DM or the general population that compared preferences for GLP1 RAs or GLP1 RAs versus insulin using contingent valuation, conjoint analysis (discrete-choice experiments [DCEs], willingness to pay), rating-based approaches of specific attributes, standard gamble, or time trade-off. Studies comparing drug A versus drug B without explicit attribute valuation were excluded. Results: Ten records met eligibility criteria. Eight studies compared preferences for GLP1 RA–profile attributes, one compared GLP1 RA versus insulin glargine profiles, and one addressed both comparisons. Important attributes driving patient preferences in DCEs were dose frequency, type of device, needle size, change in glycated hemoglobin, and adverse-event profile. Time trade-off evaluations demonstrated that weekly GLP1 RA injection-device attributes (reconstitution, waiting during preparation, needle handling) had a measurable impact on preference. Willingness-to-pay analysis showed that patients were more willing to pay extra for attributes of once-daily liraglutide over twice-weekly exenatide or insulin. Direct preference elicitation in DCEs revealed that patients preferred medication profiles representing GLP1 RAs with less frequent dosing and preferred GLP1 RA profiles over insulin. Conclusion: Process and outcome attributes are important drivers of patient preference for GLP1 RAs. Findings from patient-preference studies can inform clinical decision-making and help align care with patient values, which has the potential to improve medication adherence and outcomes. Keywords: T2D mellitus, discrete-choice experiment, GLP1 RA, insulin
