Health Utility Decrement of Injection Treatment-Related Attributes Among Type 2 Diabetes Patients in China

OBJECTIVES: To identify health utility decrement (i.e., disutilities) of four injection treatment-related attributes (hypoglycemia, injection site reaction, dose frequency, flexibility) that may influence type 2 diabetes (T2DM) patient preference.

METHODS: Four attributes were identified through published literature and interviews with clinicians (N=7) and patients (N=16), among which the two attributes of dose frequency and flexibility had a binding relationship. The two levels of flexibility were whether they needed to be carried for short trips. The four levels of treatment frequency were set as three times daily, twice daily, once daily and once weekly injection, with the first three levels corresponding to short trips required to be carried, and once weekly corresponding to short trips not required to be carried. A representative sample of the Chinese T2DM patients was recruited and stratified by age and sex. Respondents completed seven time trade off (TTO) tasks during face-to-face interviews. Random-effect model was used for TTO data. In subgroup analysis, subgroups were differentiated based on whether injection treatment was currently used.

RESULTS: Interviews were completed by 300 patients (52.67% male, mean [SD] age 50.43 [12.01] years). The mean disutilities for severe versus non-severe hypoglycemia and with versus without injection site reaction were 0.0212 (P<0.001) and 0.0167 (P<0.001). Compared with once weekly injection not required to be carried, once daily, twice daily and three times daily injection required to be carried associated with a disutility of 0.0094, 0.0161 and 0.0204, respectively. In subgroup analysis, patients currently receiving non-injectable treatment (N=103) showed a greater disutility across all dimensions than patients receiving injectable treatment (N=197).

CONCLUSIONS: Our study provides disutilities associated with different injection treatment-related attributes in Chinese T2DM patients. Hypoglycemia appears to be the most important attributes, followed by dose frequency and flexibility, injection site reaction. Patient’s current treatment also influences disutilities of injection treatment-related attributes.