Zhongguo quanke yixue (Jan 2024)
Second-line Medication Preference in Patients with Type 2 Diabetes: a Study Based on a Discrete Choice Experiment
Abstract
Background With the continuous improvement of diabetes prevention and treatment strategies, clinical guidelines recommend first-line hypoglycemic agents while emphasizing a "patient-centered", and the selection of appropriate second-line hypoglycemic agents based on patients' clinical characteristics and preferences. Objective To quantitatively analyze second-line hypoglycemic agents selection preferences in patients with type 2 diabetes mellitus (T2DM) by using a discrete choice experiment, so as to provide reference for clinical diagnosis and treatment for T2DM patients. Methods This study conducted a questionnaire survey on T2DM patients selected from Hainan and Shanxi provinces from October 2021 to January 2022 by using a combination of multi-stage random cluster sampling. The questionnaire included basic personal information of the respondents, information related to disease treatment and discrete choice experimental choice set (seven attributes of glycemic control, risk of hypoglycemic events, risk of gastrointestinal adverse events, body mass change within six months, cardiovascular protection, mode of medication administration, and out-of-pocket/monthly costs, each of which included a various levels were included through the literature review, focus group discussion, and pre-tests). A mixed Logit regression model was used to quantify the preference of T2DM patients for second-line hypoglycemic agents, and the regression coefficients reflected the direction and magnitude of the preference for second-line hypoglycemic agents among T2DM patients. Willingness to pay (WTP) reflected the monetary value of patients' willingness to pay or receive compensation after the changes in different attribute levels. Results A total of 1 443 questionnaires were distributed and 1 388 valid questionnaires were recovered, with an effective recovery rate of 96.2%. All seven attributes had an effect on medication preference of T2DM patients (P<0.05), the top three influences on medication preference were the effect of glycemic control, the risk of gastrointestinal adverse reactions, and the risk of hypoglycemic events, respectively. The change in body mass within six months had the lowest impact. Patients with T2DM were willing to pay 411.16 yuan per month when the blood glucose reduction increased from 0.5% to 2.5%, while patients with T2DM were willing to pay only 96.78 yuan per month when the change in body mass switched from an increase of 3 000 g to a decrease of 2 000 g over six months. Conclusion T2DM patients preferred second-line hypoglycemic drugs with good glycemic control, no risk of gastrointestinal adverse reactions, no risk of hypoglycemic events, cardiovascular protection, oral mode of administration, and a body mass reduction of 2 000 g within six months.
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