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The Patient Perspective of Diabetes Care: A Systematic Review of Stated Preference Research

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Abstract

Background

The importance of understanding the perspective of patients towards their own care is increasingly recognized, both in clinical practice and in pharmaceutical drug development. Stated preference methods to assess the preference of patients towards different aspects of diabetes treatment have now been applied for over a decade.

Objective

Our goal was to examine how stated preference methods are applied in diabetes care, and to evaluate the value of this information in developing the patient perspective in clinical and policy decisions.

Methods

A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The information sources were MEDLINE, EMBASE, Biosis, Current Contents, Web of Science, CINAHL, PsycINFO, and EconLit.

Results

Three contingent valuation studies and 11 discrete choice experiments were retrieved. The majority of studies were conducted from 2009 onwards, but some date back to 1998. The reasons provided for applying the stated preference methods were to help differentiate between products, or to enable inclusion of the patient’s perspective in treatment decisions. The main aspects of treatment examined were related to glucose control, adverse events, and drug administration. The majority of patients preferred glucose control over avoiding minor hypoglycemic events. Patient willingness to pay was above $US100/month for glucose control, avoiding immediate health hazards such as nausea, and oral or inhaled drug administration. Preference towards drug administration was highly associated with previous experience with injectable diabetes medicine.

Conclusions

The ability of a drug to lower glucose levels plays a decisive role in the choice between alternative treatments. Future research should strive to develop questionnaire designs relevant for the decision context of the study. That is, if the aim is to foster shared decision making, in clinical practice or drug development, this should guide the study design. Furthermore, concise reporting of all study dimensions—from the qualitative prework to the analysis stage—is warranted.

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Acknowledgments

Funding for this study was provided as part of a research grant co-funded by the Danish Ministry of Education and Novo Nordisk A/S. The funders did not have a role in the conduct or report of the review. Publication of the study results was not dependent on the approval of either of the sponsors. Lill-Brith von Arx is an industrial PhD employee at Novo Nordisk A/S and is a shareholder in the company. Trine Kjær has no conflicts of interests to declare. Lill-Brith von Arx contributed to conceptualizing the paper, developing a search strategy, executing the systematic literature review, writing the draft manuscript, and revising the final manuscript. Trine Kjær contributed to conceptualizing the paper and to writing and reviewing the drafts and final manuscript. Lill-Brith von Arx acts as a guarantor for the content of the article.

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von Arx, LB., Kjær, T. The Patient Perspective of Diabetes Care: A Systematic Review of Stated Preference Research. Patient 7, 283–300 (2014). https://doi.org/10.1007/s40271-014-0057-0

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