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Comparing the Preferences of Patients and the General Public for Treatment Outcomes in Type 2 Diabetes Mellitus

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A Correction to this article was published on 04 November 2020

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Abstract

Background

Healthcare treatments and interventions are traditionally evaluated from the societal perspective, but a more patient-centric perspective has been proposed in recent years. We sought to compare preferences of patients and the general public for treatment outcomes of type 2 diabetes using both best–worst scaling (BWS) and rating approaches.

Methods

A survey evaluating the treatment priorities for type 2 diabetes was conducted in the United States. Members of the general public and patients with type 2 diabetes were recruited from a nationally sampled panel. Participants indicated the importance of seven potential treatment outcomes (hypoglycemic events, glycated hemoglobin [A1c], weight loss, mental health, functioning, glycemic stability, and cardiovascular health) using (1) BWS case 1 and (2) a rating task. Preference differences from BWS prioritizations were explored using mixed logistic regression (BWS preference weights were probability re-scaled so that the weightings of the seven items collectively summed to 100). The consistency of scale between samples was explored using heteroskedastic conditional logistic regression of BWS data. Spearman rank correlation was used to compare standardized BWS preference weights and rating scores for each group. Both groups evaluated the BWS and rating activities using debriefing questions.

Results

The public and patient samples included 314 and 313 respondents, respectively. The public was on average 16 years younger than patients (48 vs 64 years, P < 0.001). In BWS, patients and the public both ranked A1c, glycemic stability, and cardiovascular health within their top three outcomes. Patients valued the outcome A1c most highly and found it twice as important as did the public (41.0 vs 20.2, P < 0.001). The public valued cardiovascular health most highly, and found it to be twice as important than did patients (31.3 vs 17.4, P < 0.001). Patients were more consistent in their preferences than the public (λ = 1.66, P = 0.01). Preferences elicited using BWS and rating approaches were highly correlated for both patients (ρ = 0.96) and the public (ρ = 0.92). Patients were more likely than the public to endorse the BWS as easy to answer (P < 0.001), easy to understand (P < 0.001), consistent with preferences (P < 0.001), and relevant (P < 0.001). Both patients and the public found the rating activity easier to answer and understand, and more consistent with their preferences, than the BWS (P < 0.001).

Conclusions

We provide some of the first evidence demonstrating a difference in patient and public treatment priorities for diabetes. That patients were more consistent in their preferences than the public and found the BWS and Likert rating instruments more relevant suggests that patient priorities may be more appropriate than those of the general public in some medical decision-making contexts.

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Change history

  • 04 November 2020

    For instance, experience-based time trade-off and visual analog scale value sets for the EQ-5D-3L were recently published [16].

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Acknowledgements

We would like to acknowledge co-investigators on the grant, including Mo Zhou, Lee Bone, Jodi B Segal, Tanjala Purnell, Daniel R Longo, and Albert Wu.

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Authors and Affiliations

  1. Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Drive, Columbus, OH, 43210, USA

    Norah L. Crossnohere, Sarah Janse & John F. P. Bridges

  2. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA

    Norah L. Crossnohere & John F. P. Bridges

  3. Center for Medical Technology Policy, World Trade Center Baltimore, 401 East Pratt Street, Suite 631, Baltimore, MD, 21202, USA

    Ellen Janssen

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  1. Norah L. Crossnohere
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Correspondence to Norah L. Crossnohere.

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Funding

This work was funded through a Patient-Centered Outcomes Research Institute (PCORI) award (ME-1303-5946). The statements in this work are solely the responsibility of the authors and do not necessarily represent the views of the PCORI, its Board of Governors or Methodology Committee. Research reported in this work was also supported by the Johns Hopkins Center of Excellence in Regulatory Science and Innovation and the Food and Drug Administration (FDA) (UO1FD004977). The purpose of this funding is to enhance regulatory science through a unique FDA-academic partnership.

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Authors have no conflicts of interest to declare.

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Data are available from JFPB upon reasonable request.

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Author contributions

JFPB and EJ were involved in study design. NLC and SJ participated in analysis. NLC, SJ, EJ, and JFPB participated in critical revision and drafting of the manuscript.

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Crossnohere, N.L., Janse, S., Janssen, E. et al. Comparing the Preferences of Patients and the General Public for Treatment Outcomes in Type 2 Diabetes Mellitus. Patient 14, 89–100 (2021). https://doi.org/10.1007/s40271-020-00450-7

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