Hostname: page-component-f554764f5-qhdkw Total loading time: 0 Render date: 2025-04-13T08:14:50.268Z Has data issue: false hasContentIssue false
  • English
  • Français

A valuation of patients' willingness-to-pay for insulin delivery in diabetes

Published online by Cambridge University Press:  21 July 2009

Camila Guimarães ,
Carlo A. Marra ,
Lindsey Colley ,
Sabrina Gill ,
Scot H. Simpson ,
Graydon S. Meneilly ,
Regina H. C. Queiroz  and
Larry D. Lynd
Camila Guimarães
Affiliation:
University of São Paulo
Carlo A. Marra
Affiliation:
University of British Columbia
Lindsey Colley
Affiliation:
University of British Columbia
Sabrina Gill
Affiliation:
University of British Columbia
Scot H. Simpson
Affiliation:
University of Alberta
Graydon S. Meneilly
Affiliation:
University of British Columbia
Regina H. C. Queiroz
Affiliation:
University of São Paulo
Larry D. Lynd
Affiliation:
University of British Columbia
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The aim of this study was to determine the insulin-delivery system and the attributes of insulin therapy that best meet patients' preferences, and to estimate patients' willingness-to-pay (WTP) for them.

Methods: This was a cross-sectional discrete choice experiment (DCE) study involving 378 Canadian patients with type 1 or type 2 diabetes. Patients were asked to choose between two hypothetical insulin treatment options made up of different combinations of the attribute levels. Regression coefficients derived using conditional logit models were used to calculate patients' WTP. Stratification of the sample was performed to evaluate WTP by predefined subgroups.

Results: A total of 274 patients successfully completed the survey. Overall, patients were willing to pay the most for better blood glucose control followed by weight gain. Surprisingly, route of insulin administration was the least important attribute overall. Segmented models indicated that insulin naïve diabetics were willing to pay significantly more for both oral and inhaled short-acting insulin compared with insulin users. Surprisingly, type 1 diabetics were willing to pay $C11.53 for subcutaneous short-acting insulin, while type 2 diabetics were willing to pay $C47.23 to avoid subcutaneous short-acting insulin (p < .05). These findings support the hypothesis of a psychological barrier to initiating insulin therapy, but once that this barrier has been overcome, they accommodate and accept injectable therapy as a treatment option.

Conclusions: By understanding and addressing patients' preferences for insulin therapy, diabetes educators can use this information to find an optimal treatment approach for each individual patient, which may ultimately lead to improved control, through improved compliance, and better diabetes outcomes.

Keywords

Willingness-to-payDiscrete choice experimentInsulin therapyDiabetesPatients' preferences
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 3 , July 2009 , pp. 359 - 366
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

1. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2003;27:SI–I52.Google Scholar
2. Cappelleri, JC, Gerber, RA, Kourides, IA, Gelfand, RA. Development and factor analysis of a questionnaire to measure patient satisfaction with injected and inhaled insulin for type 1 diabetes. Diabetes Care. 2000;23:1799–1803.CrossRefGoogle ScholarPubMed
3. Cefalu, WT. Optimizing glycemic control. The search for feasible noninvasive insulin delivery systems. Can J Diabetes. 2003;27:42–51.Google Scholar
4. Cefalu, WT, Skyler, JS, Kourides, IA, et al. Inhaled human insulin treatment in patients with type 2 diabetes mellitus. Ann Intern Med. 2001;134:203–207.Google Scholar
5. Clement, S, Still, JG, Kosutic, G, McAllister, RG. Oral insulin product hexyl-insulin monoconjugate 2 (HIM2) in type 1 diabetes mellitus: The glucose stabilization effects of HIM2. Diabetes Technol Ther. 2002;4:459–466.CrossRefGoogle ScholarPubMed
6. Dawson, KG, Gomes, D, Gerstein, H, Blanchard, JF, Kahler, KH. The economic cost of diabetes in Canada, 1998. Diabetes Care. 2002;25:1303–1307.CrossRefGoogle ScholarPubMed
7. Health Canada. Economic burden of illness in Canada, 1998. Catalogue. No. H21–136/1998. Ottawa: Health Canada; 2002.Google Scholar
8. International Diabetes Federation (IDF). Cost-effective approaches to diabetes care and prevention. IDF Task Force on Diabetes Health Economics. Brussels: IDF; 2003.Google Scholar
9. International Diabetes Federation (IDF). Diabetes atlas: Executive summary. 2nd ed. Brussels: IDF; 2003.Google Scholar
10. Keegan, A. Exit Exubera. Inhalable insulin is withdrawn due to weak sales. Diabetes Forecast. 2007;60:19.Google ScholarPubMed
11. Keegan, A. Weak pulls the first pulmonary insulin, but others are in the works. DOC News. 2007;4:5.Google Scholar
12. Kleinman, L, McIntosh, E, Ryan, M, et al. Willingness to pay for complete symptom relief of gastroesophageal reflux disease. Arch Intern Med. 2002;162:1361–1366.CrossRefGoogle ScholarPubMed
13. Korytkowski, M. When oral agents fail: Practical barriers to starting insulin. Int J Obes Relat Metab Disord. 2002;26 (Suppl 3):S18-S24.CrossRefGoogle ScholarPubMed
14. Lynd, LD, Sandford, AJ, Kelly, EM, et al. Reconcilable differences: A cross-sectional study of the relationship between socioeconomic status and the magnitude of short-acting beta-agonist use in asthma. Chest. 2004;126:1161–1168.CrossRefGoogle ScholarPubMed
15. Marra, CA, Esdaile, JM, Guh, D, et al. A comparison of four indirect methods of assessing utility values in rheumatoid arthritis. Med Care. 2004;42:1125–1131.CrossRefGoogle ScholarPubMed
16. Ryan, M, Bate, A, Eastmond, CJ, Ludbrook, A. Use of discrete choice experiments to elicit preferences. Qual Health Care. 2001;10 (Suppl 1):i55–i60.Google Scholar
17. Ryan, M, Scott, DA, Reeves, C, et al. Eliciting public preferences for healthcare: A systematic review of techniques. Health Technol Assess. 2001;5:1–186.Google Scholar
18. Sadri, H, MacKeigan, LD, Leiter, LA, Einarson, TR. Willingness to pay for inhaled insulin: A contingent valuation approach. Pharmacoeconomics. 2005;23:1215–1227.CrossRefGoogle ScholarPubMed
19. SAS Institute I. SAS Statistical software 9.1 ed. Cary, NC: SAS Institute; 2004.Google Scholar
20. Sawtooth Software Inc. CBC/SSI Web. 6.4.2 ed. Sequim: Sawtooth Software; 1999.Google Scholar
21. Sawtooth Software Inc. CBC user manual. Sequim: Sawtooth Software; 1999.Google Scholar
22. Sawtooth Software Inc. The CBC/Web v.6.0 technical paper. Sequim; 1999. http://www.sawtoothsoftware.com/techpap.shtml (accessed March 21, 2009).Google Scholar
23. Skyler, JS, Cefalu, WT, Kourides, IA, et al. Efficacy of inhaled human insulin in type 1 diabetes mellitus: A randomised proof-of-concept study. Lancet. 2001;357:331–335.Google Scholar
24. Smith, RD. The discrete-choice willingness-to-pay question format in health economics: Should we adopt environmental guidelines? Med Decis Making. 2000;20:194–206.Google Scholar
25. Telser, H, Zweifel, P. Measuring willingness-to-pay for risk reduction: An application of conjoint analysis. Health Econ. 2002;11:129–139.Google Scholar