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The European Journal of Health Economics

, Volume 12, Issue 3, pp 219–230 | Cite as

Utilities and disutilities for attributes of injectable treatments for type 2 diabetes

  • Kristina S. Boye
  • Louis S. MatzaEmail author
  • Kimberly N. Walter
  • Kate Van Brunt
  • Andrew C. Palsgrove
  • Aodan Tynan
Original Paper

Abstract

Introduction

Although cost-utility models are frequently used to estimate treatment outcomes for type 2 diabetes, utilities are not available for key attributes of injectable treatments. The purpose of this study was to identify the utility or disutility of three injection-related attributes (dose frequency, dose flexibility, injection site reaction) that may influence patient preference.

Methods

Patients with type 2 diabetes in Scotland completed standard gamble (SG) interviews to assess the utility of hypothetical health states and their own current health state. The EQ-5D, PGWB, IWQOL-Lite, and QIDS were also administered. Construct validity and differences among health states were examined.

Results

A total of 151 patients completed interviews. Of the three injection-related attributes, dose frequency was the only attribute with a statistically significant impact on utility (in a multiple regression model, p = 0.01). Weekly injections were associated with an average added utility of 0.023 in comparison to everyday injections. Flexible dosing and injection site reactions resulted in somewhat smaller utility shifts that were in the expected directions (+0.006 and −0.011, respectively). SG utility of current health (mean = 0.897) demonstrated construct validity through statistically significant correlations with patient-reported outcome measures.

Discussion

The three injection attributes were associated with small utility shifts in the expected directions. Dose frequency appears to be the most important of the three attributes from the patients’ perspective. The vignette-based SG approach was feasible and useful for assessing added utility or disutility of injection-related attributes associated with treatments for type 2 diabetes.

Keywords

Utilities Type 2 diabetes Injection Dose frequency Patient preference Standard gamble 

JEL Classification

I00 I10 I19 

Notes

Acknowledgments

The authors would like to thank Ray Hsieh for statistical programming; Julie Meilak for production assistance; Anne Brooks and Thomas Albert for assistance with participant recruitment and data collection; Terri Kim, Robert Brodows, and Dennis Revicki for expert consultation. Permission to use all patient-reported outcome measures was granted by the instrument developers. Funding for the study was provided by Eli Lilly and Company. Publication of this study was not dependent on the results.

References

  1. 1.
    Arulmozhi, D.K., Portha, B.: GLP-1 based therapy for type 2 diabetes. Eur. J. Pharm. Sci. 28, 96–108 (2006)PubMedCrossRefGoogle Scholar
  2. 2.
    Pratley, R.E., Gilbert, M.: Targeting incretins in type 2 diabetes: role of GLP-1 receptor agonists and DPP-4 inhibitors. Rev. Diabet. Stud. 5, 73–94 (2008)PubMedCrossRefGoogle Scholar
  3. 3.
    Srinivasan, B.T., Jarvis, J., Khunti, K., Davies, M.J.: Recent advances in the management of type 2 diabetes mellitus: a review. Postgrad. Med. J. 84, 524–531 (2008)PubMedCrossRefGoogle Scholar
  4. 4.
    Torrance, G.W.: Measurement of health state utilities for economic appraisal. J. Health Econ. 5, 1–30 (1986)PubMedCrossRefGoogle Scholar
  5. 5.
    Torrance, G.W.: Designing and conducting cost-utility analysis. In: Spilker, B. (eds.) Quality of Life and Pharmacoeconomics in Clinical Trials. Lippincott-Raven, Philadelphia (1996)Google Scholar
  6. 6.
    Clarke, P.M., Gray, A.M., Briggs, A., Stevens, R.J., Matthews, D.R., Holman, R.R.: Cost-utility analyses of intensive blood glucose and tight blood pressure control in type 2 diabetes (UKPDS 72). Diabetologia 48, 868–877 (2005)PubMedCrossRefGoogle Scholar
  7. 7.
    Matza, L.S., Boye, K.S., Yurgin, N., et al.: Utilities and disutilities for type 2 diabetes treatment-related attributes. Qual. Life Res. 16, 1251–1265 (2007)PubMedCrossRefGoogle Scholar
  8. 8.
    McEwan, P., Peters, J.R., Bergenheim, K., Currie, C.J.: Evaluation of the costs and outcomes from changes in risk factors in type 2 diabetes using the Cardiff stochastic simulation cost-utility model (DiabForecaster). Curr. Med. Res. Opin. 22, 121–129 (2006)PubMedCrossRefGoogle Scholar
  9. 9.
    Palmer, A.J., Roze, S., Valentine, W.J., et al.: The CORE diabetes model: projecting long-term clinical outcomes, costs and cost-effectiveness of interventions in diabetes mellitus (types 1 and 2) to support clinical and reimbursement decision-making. Curr. Med. Res. Opin. 20, S5–S26 (2004)PubMedCrossRefGoogle Scholar
  10. 10.
    Warren, E., Weatherley-Jones, E., Chilcott, J., Beverley, C.: Systematic review and economic evaluation of a long-acting insulin analogue, insulin glargine. Health Technol. Assess. 8(iii), 1–57 (2004)Google Scholar
  11. 11.
    Zhou, H., Isaman, D.J., Messinger, S., et al.: A computer simulation model of diabetes progression, quality of life, and cost. Diabetes Care 28, 2856–2863 (2005)PubMedCrossRefGoogle Scholar
  12. 12.
    Bretzel, R.G., Nuber, U., Landgraf, W., Owens, D.R., Bradley, C., Linn, T.: Once-daily basal insulin glargine versus thrice-daily prandial insulin lispro in people with type 2 diabetes on oral hypoglycaemic agents (APOLLO): an open randomised controlled trial. Lancet 371, 1073–1084 (2008)PubMedCrossRefGoogle Scholar
  13. 13.
    HOE 901/2004 Study Investigators Group: Safety and efficacy of insulin glargine (HOE 901) versus NPH insulin in combination with oral treatment in Type 2 diabetic patients. Diabet. Med. 20, 545–551 (2003)CrossRefGoogle Scholar
  14. 14.
    Vilsboll, T., Brock, B., Perrild, H., et al.: Liraglutide, a once-daily human GLP-1 analogue, improves pancreatic B-cell function and arginine-stimulated insulin secretion during hyperglycaemia in patients with Type 2 diabetes mellitus. Diabet. Med. 25, 152–156 (2008)PubMedCrossRefGoogle Scholar
  15. 15.
    Balena, R., Ratner, R., Berria, R., et al.: Eight weeks of treatment with the long acting, human GLP-1 analogue R1583 improves glycemic control and lowers body weight in subjects with type 2 diabetes mellitus (T2DM) treated with metformin: a double-blind placebo-controlled phase 2 study. Presented at the 68th Scientific Session of the American Diabetes Association, San Francisco (2008)Google Scholar
  16. 16.
    Drucker, D.J., Buse, J.B., Taylor, K., et al.: Exenatide once weekly versus twice daily for the treatment of type 2 diabetes: a randomised, open-label, non-inferiority study. Lancet 372, 1240–1250 (2008)PubMedCrossRefGoogle Scholar
  17. 17.
    Hoffmann-La Roche Ltd: Roche Moves Investigational Diabetes Drug, Taspoglutide, into Phase III Clinical Trials: Positive Phase II Results of Roche and Ipsen’s First Once-weekly Human GLP-1 Presented at the American Diabetes Association Congress. Hoffmann-La Roche, Basel (2008)Google Scholar
  18. 18.
    Kim, D., MacConell, L., Zhuang, D., et al.: Effects of once-weekly dosing of a long-acting release formulation of exenatide on glucose control and body weight in subjects with type 2 diabetes. Diabetes Care 30, 1487–1493 (2007)PubMedCrossRefGoogle Scholar
  19. 19.
    Ratner, R., Nauck, M., Asnaghi, V., et al.: Safety and tolerability of high doses of the long acting, human GLP-1 analogue R1583 in diabetic subjects treated with metformin: a double-blind, placebo-controlled phase 2 study. Presented at the 68th Scientific Session of the American Diabetes Association, San Francisco (2008)Google Scholar
  20. 20.
    Greenberg, R.N.: Overview of patient compliance with medication dosing: a literature review. Clin. Ther. 6, 592–599 (1984)PubMedGoogle Scholar
  21. 21.
    Morris, A.D.: Addressing dosing frequency in diabetes: a simple approach to improving adherence to therapy and clinical outcomes. Diabetes Educ. 29, 440–446, 448, 450 (2003)Google Scholar
  22. 22.
    Paes, A.H.P., Bakker, A., Soe-Agnie, C.J.: Impact of dosage frequency on patient compliance. Diabetes Care 20, 1512–1517 (1997)PubMedCrossRefGoogle Scholar
  23. 23.
    Shi, L., Hodges, M., Yurgin, N., Boye, K.S.: Impact of dose frequency on compliance and health outcomes: a literature review (1966–2006). Expert Rev. Pharmacoecon. Outcomes Res. 7, 187–202 (2007)PubMedCrossRefGoogle Scholar
  24. 24.
    Zambanini, A., Newson, R.B., Maisey, M., Feher, M.D.: Injection related anxiety in insulin-treated diabetes. Diabetes Res. Clin. Pract. 46, 239–246 (1999)PubMedCrossRefGoogle Scholar
  25. 25.
    Anderson Jr., J.H., Brunelle, R.L., Keohane, P., et al.: Mealtime treatment with insulin analog improves postprandial hyperglycemia and hypoglycemia in patients with non-insulin-dependent diabetes mellitus. Arch. Intern. Med. 157, 1249–1255 (1997)PubMedCrossRefGoogle Scholar
  26. 26.
    Anderson Jr., J.H., Brunelle, R.L., Koivisto, V.A., et al.: Reduction of postprandial hyperglycemia and frequency of hypoglycemia in IDDM patients on insulin-analog treatment. Diabetes 46, 265–270 (1997)PubMedCrossRefGoogle Scholar
  27. 27.
    Ashwell, S.G., Bradley, C., Stephens, J.W., Witthaus, E., Home, P.D.: Treatment satisfaction and quality of life with insulin glargine plus insulin lispro compared with NPH insulin plus unmodified human insulin in individuals with type 1 diabetes. Diabetes Care 31, 1112–1117 (2008)PubMedCrossRefGoogle Scholar
  28. 28.
    Linnebjerg, H., Kothare, P.A., Skrivanek, Z., et al.: Exenatide: effect of injection time on postprandial glucose in patients with Type 2 diabetes. Diabet. Med. 23, 240–245 (2006)PubMedCrossRefGoogle Scholar
  29. 29.
    Rex, J., Jensen, K.H., Lawton, S.A.: A review of 20 years’ experience with the NovoPen (registered trademark) family of insulin injection devices. Clin. Drug Inves. 26, 367–401 (2006)CrossRefGoogle Scholar
  30. 30.
    Dunn, C.J., Plosker, G.L., Keating, G.M., McKeage, K., Scott, L.J.: Insulin glargine: an updated review of its use in the management of diabetes mellitus. Drugs 63, 1743–1778 (2003)PubMedCrossRefGoogle Scholar
  31. 31.
    Bradley, C., Gilbride, C.J.: Improving treatment satisfaction and other patient-reported outcomes in people with type 2 diabetes: the role of once-daily insulin glargine. Diabetes Obes. Metab. 10(Suppl 2), 50–65 (2008)PubMedCrossRefGoogle Scholar
  32. 32.
    Howorka, K., Pumprla, J., Wagner-Nosiska, D., Grillmayr, H., Schlusche, C., Schabmann, A.: Empowering diabetes out-patients with structured education: short-term and long-term effects of functional insulin treatment on perceived control over diabetes. J. Psychosom. Res. 48, 37–44 (2000)PubMedCrossRefGoogle Scholar
  33. 33.
    Shen, W., Kotsanos, J.G., Huster, W.J., Mathias, S.D., Andrejasich, C.M., Patrick, D.L.: Development and validation of the Diabetes Quality of Life Clinical Trial Questionnaire. Med. Care 37, AS45–AS66 (1999)PubMedCrossRefGoogle Scholar
  34. 34.
    Anderson, R.T., Skovlund, S.E., Marrero, D., et al.: Development and validation of the insulin treatment satisfaction questionnaire. Clin. Ther. 26, 565–578 (2004)PubMedCrossRefGoogle Scholar
  35. 35.
    Jorgensen, L.N., Nielsen, F.S.: Timing of pre-meal insulins in diabetic patients on a multiple daily injection regimen: a questionnaire study. Diabetologia 33, A116 (1990)Google Scholar
  36. 36.
    Nauck, M.A., Hompesch, M., Filipczak, R., Le, T.D.T., Zdravkovic, M., Gumprecht, J.: Five weeks of treatment with the GLP-1 analogue liraglutide improves glycaemic control and lowers body weight in subjects with type 2 diabetes. Exp. Clin. Endocrinol. Diabetes 114, 417–423 (2006)PubMedCrossRefGoogle Scholar
  37. 37.
    Schwartz, S., Hassman, D., Shelmet, J., et al.: A multicenter, open-label, randomized, two-period crossover trial comparing glycemic control, satisfaction, and preference achieved with a 31 gauge × 6 mm needle versus a 29 gauge × 12.7 mm needle in obese patients with diabetes mellitus. Clin. Ther. 26, 1663–1678 (2004)PubMedCrossRefGoogle Scholar
  38. 38.
    Gonzalez, J.L., Verrips, G.H., Fekkes, M., Hirasing, R.A., Groth, M.: Psychological responses to the needle-free injection of insulin with the disposable front-end Medi-Jector (MJ-6). Today’s Ther. Trends 16, 53–72 (1998)Google Scholar
  39. 39.
    Richardson, T., Kerr, D.: Skin-related complications of insulin therapy: epidemiology and emerging management strategies. Am. J. Clin. Dermatol. 4, 661–667 (2003)PubMedCrossRefGoogle Scholar
  40. 40.
    Chokrungvaranon, N., Chentanez, T., Arakaki, R.F.: Clinical experience with exenatide in predominantly Asian and Pacific Islander patients with type 2 diabetes. Endocrine 32, 311–316 (2007)PubMedCrossRefGoogle Scholar
  41. 41.
    Gafni, A.: The standard gamble method: what is being measured and how it is interpreted. Health Serv. Res. 29, 207–224 (1994)PubMedGoogle Scholar
  42. 42.
    Torrance, G.W., Furlong, W., Feeny, D.: Health utility estimation. Expert Rev. Pharmacoecon. Res. 2, 99–108 (2002)CrossRefGoogle Scholar
  43. 43.
    Matza, L.S., Secnik, K., Rentz, A.M., et al.: Assessment of health state utilities for attention-deficit/hyperactivity disorder in children using parent proxy report. Qual. Life Res. 14, 735–747 (2005)PubMedGoogle Scholar
  44. 44.
    Revicki, D.A., Wood, M.: Patient-assigned health state utilities for depression-related outcomes: differences by depression severity and antidepressant medications. J. Affect. Disord. 48, 25–36 (1998)PubMedCrossRefGoogle Scholar
  45. 45.
    Secnik, K., Matza, L.S., Cottrell, S., Edgell, E., Tilden, D., Mannix, S.: Health state utilities for childhood attention-deficit/hyperactivity disorder based on parent preferences in the United Kingdom. Med. Decis. Making 25, 56–70 (2005)PubMedCrossRefGoogle Scholar
  46. 46.
    Torrance, G.W., Feeny, D.: Utilities and quality-adjusted life years. Int. J. Technol. Assess. Health Care 5, 559–575 (1989)PubMedCrossRefGoogle Scholar
  47. 47.
    Bass, E.B., Steinberg, E.P., Pitt, H.A., et al.: Comparison of the rating scale and the standard gamble in measuring patient preferences for outcomes of gallstone disease. Med. Decis. Making 14, 307–314 (1994)PubMedCrossRefGoogle Scholar
  48. 48.
    Cook, J., Richardson, J., Street, A.: A cost utility analysis of treatment options for gallstone disease: methodological issues and results. Health Econ. 3, 157–168 (1994)PubMedCrossRefGoogle Scholar
  49. 49.
    Feeny, D.H., Torrance, G.W.: Incorporating utility-based quality-of-life assessment measures in clinical trials. Two examples. Med. Care 27, S190–S204 (1989)PubMedCrossRefGoogle Scholar
  50. 50.
    Johnston, K., Brown, J., Gerard, K., O’Hanlon, M., Morton, A.: Valuing temporary and chronic health states associated with breast screening. Soc. Sci. Med. 47, 213–222 (1998)PubMedCrossRefGoogle Scholar
  51. 51.
    Mauskopf, J.: Utility assessment. In: Chumney, E.C.G., Simpson, K.N. (eds.) Methods and Designs for Outcomes Research. American Society of Health-System Pharmacists, Bethesda (2006)Google Scholar
  52. 52.
    Stalmeier, P.F.: Discrepancies between chained and classic utilities induced by anchoring with occasional adjustments. Med. Decis. Making 22, 53–64 (2002)PubMedGoogle Scholar
  53. 53.
    Rutten-van Molken, M.P., Bakker, C.H., van Doorslaer, E.K., van der Linden, S.: Methodological issues of patient utility measurement. Experience from two clinical trials. Med. Care 33, 922–937 (1995)PubMedCrossRefGoogle Scholar
  54. 54.
    Brooks, R., Rabin, R., de Charro, F. (eds.): The Measurement and Valuation of Health Status Using EQ-5D: A European Perspective. Kluwer, Dordrecht (2003)Google Scholar
  55. 55.
    McDowell, I., Newell, C.: Measuring Health: A Guide to Rating Scales and Questionnaires, 2nd edn. Oxford University Press, New York (1996)Google Scholar
  56. 56.
    Kolotkin, R.L., Crosby, R.D., Kosloski, K.D., Williams, G.R.: Development of a brief measure to assess quality of life in obesity. Obes. Res. 9, 102–111 (2001)PubMedCrossRefGoogle Scholar
  57. 57.
    Albu, J., Raja-Khan, N.: The management of the obese diabetic patient. Prim. Care 30, 465–491 (2003)PubMedGoogle Scholar
  58. 58.
    Heller, S.: Weight gain during insulin therapy in patients with type 2 diabetes mellitus. Diabetes Res. Clin. Pract. 65, S23–S27 (2004)PubMedCrossRefGoogle Scholar
  59. 59.
    Scheen, A.J.: Treatment of diabetes in patients with severe obesity. Biomed. Pharmacother. 54, 74–79 (2000)PubMedCrossRefGoogle Scholar
  60. 60.
    Diabetes Control Complications Trial (DCCT) Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 329, 977–986 (1993)CrossRefGoogle Scholar
  61. 61.
    UK Prospective Diabetes Study (UKPDS) Group: A 6-year, randomized, controlled trial comparing sulfonylurea, insulin, and metformin therapy in patients with newly diagnosed type 2 diabetes that could not be controlled with diet therapy (UKPDS 24). Ann. Intern. Med. 128, 165–175 (1998)Google Scholar
  62. 62.
    Dupuy, H.J.: In: Wenger, N.K., Mattson, M.E., Furberg, C.D., et al. (eds.) Assessment of Quality of Life in Clinical Trials of Cardiovascular Therapies, pp. 170–183. Le Jacq, Washington (1984)Google Scholar
  63. 63.
    Rush, A.J., Trivedi, M.H., Ibrahim, H.M., et al.: The 16-item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol. Psychiatry 54, 573–583 (2003)PubMedCrossRefGoogle Scholar
  64. 64.
    IDS/QIDS: Instruments in English and multiple translations. http://www.ids-qids.org/index.html. Accessed Mar 17 2009 (2009)
  65. 65.
    Cohen, J.: Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum, Hillsdale, NJ (1988)Google Scholar
  66. 66.
    Garrow, J.S., Webster, J.: Quetelet’s index (W/H2) as a measure of fatness. Int J Obes 9, 147–153 (1985)PubMedGoogle Scholar
  67. 67.
    Koopmanschap, M.: Coping with type II diabetes: the patient’s perspective. Diabetologia 45, S18–S22 (2002)PubMedGoogle Scholar
  68. 68.
    Kolotkin, R.L., Crosby, R.D., Williams, G.R.: Assessing weight-related quality of life in obese persons with type 2 diabetes. Diabetes Res. Clin. Pract. 61, 125–132 (2003)PubMedCrossRefGoogle Scholar
  69. 69.
    Blumenschein, K., Johannesson, M.: Relationship between quality of life instruments, health state utilities, and willingness to pay in patients with asthma. Ann. Allergy Asthma Immunol. 80, 189–194 (1998)PubMedCrossRefGoogle Scholar
  70. 70.
    Green, C., Kiebert, G., Murphy, C., et al.: Patients’ health-related quality-of-life and health state values for motor neurone disease/amyotrophic lateral sclerosis. Qual. Life Res. 12, 565–574 (2003)PubMedCrossRefGoogle Scholar
  71. 71.
    Juniper, E.F., Norman, G.R., Cox, F.M., Roberts, J.N.: Comparison of the standard gamble, rating scale, AQLQ and SF-36 for measuring quality of life in asthma. Eur. Respir. J. 18, 38–44 (2001)PubMedCrossRefGoogle Scholar
  72. 72.
    Kartman, B., Gatz, G., Johannesson, M.: Health state utilities in gastroesophageal reflux disease patients with heartburn: a study in Germany and Sweden. Med. Decis. Making 24, 40–52 (2004)PubMedCrossRefGoogle Scholar
  73. 73.
    Ohsawa, I., Ishida, T., Oshida, Y., Yamanouchi, K., Sato, Y.: Subjective health values of individuals with diabetes in Japan: comparison of utility values with the SF-36 scores. Diabetes Res. Clin. Pract. 62, 9–16 (2003)PubMedCrossRefGoogle Scholar
  74. 74.
    Stavem, K.: Quality of life in epilepsy: comparison of four preference measures. Epilepsy Res. 29, 201–209 (1998)PubMedCrossRefGoogle Scholar
  75. 75.
    Sullivan, S.D., Lew, D.P., Devine, E.B., Hakim, Z., Reiber, G.E., Veenstra, D.L.: Health state preference assessment in diabetic peripheral neuropathy. Pharmacoeconomics 20, 1079–1089 (2002)PubMedCrossRefGoogle Scholar
  76. 76.
    Torrance, G.W.: Preferences for health outcomes and cost-utility analysis. Am. J. Manag. Care 3, S8–S20 (1997)PubMedGoogle Scholar
  77. 77.
    Drummond, M.F., O’Brien, B., Stoddart, G.L., Torrance, G.W.: Methods for the Economic Evaluation of Health Care Programmes, 2nd edn. Oxford University Press, Oxford (2000)Google Scholar
  78. 78.
    National Institute for Clinical Excellence (NICE): guide to the methods of technology appraisal. NICE, London (2003)Google Scholar
  79. 79.
    Stein, K., Fry, A., Round, A., Milne, R., Brazier, J.: What value health? A review of health state values used in early technology assessments for NICE. Appl. Health Econ. Health Policy 4, 219–228 (2005)PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Kristina S. Boye
    • 1
  • Louis S. Matza
    • 2
    Email author
  • Kimberly N. Walter
    • 2
  • Kate Van Brunt
    • 2
  • Andrew C. Palsgrove
    • 2
  • Aodan Tynan
    • 1
  1. 1.Eli Lilly and CompanyIndianapolisUSA
  2. 2.Center for Health Outcomes ResearchUnited BioSource CorporationBethesdaUSA

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