부산대학교 도서관

Objective: To assess Spanish and Portuguese patients' and physicians' preferences regarding type 2 diabetes mellitus (T2DM) treatments and the monthly willingness to pay (WTP) to gain benefits or avoid side effects. Methods: An observational, multicenter, exploratory study focused on routine clinical practice in Spain and Portugal. Physicians were recruited from multiple hospitals and outpatient clinics, while patients were recruited from eleven centers operating in the public health care system in different autonomous communities in Spain and Portugal. Preferences were measured via a discrete choice experiment by rating multiple T2DM medication attributes. Data were analyzed using the conditional logit model. Results: Three-hundred and thirty (n=330) patients (49.7% female; mean age 62.4 [SD: 10.3] years, mean T2DM duration 13.9 [8.2] years, mean body mass index 32.5 [6.8] kg/[m.sup.2], 41.8% received oral + injected medication, 40.3% received oral, and 17.6% injected treatments) and 221 physicians from Spain and Portugal (62% female; mean age 41.9 [SD: 10.5] years, 33.5% endocrinologists, 66.5% primary-care doctors) participated. Patients valued avoiding a gain in bodyweight of 3 kg/6 months (WTP: 68.14 [euro] [95% confidence interval: 54.55-85.08]) the most, followed by avoiding one hypoglycemic event/month (WTP: 54.80 [euro] [23.29-82.26]). Physicians valued avoiding one hypoglycemia/week (WTP: 287.18 [euro] [95% confidence interval: 160.31-1,387.21]) the most, followed by avoiding a 3 kg/6 months gain in bodyweight and decreasing cardiovascular risk (WTP: 166.87 [euro] [88.63-843.09] and 154.30 [euro] [98.13-434.19], respectively). Physicians and patients were willing to pay 125.92 [euro] (73.30-622.75) and 24.28 [euro] (18.41-30.31), respectively, to avoid a 1% increase in glycated hemoglobin, and 143.30 [euro] (73.39-543.62) and 42.74 [euro] (23.89-61.77) to avoid nausea. Conclusion: Both patients and physicians in Spain and Portugal are willing to pay for the health benefits associated with improved diabetes treatment, the most important being to avoid hypoglycemia and gaining weight. Decreased cardiovascular risk and weight reduction became the third most valued attributes for physicians and patients, respectively. Keywords: diabetes, discrete choice model, preferences, willingness to pay, hypoglycemia, weight, cardiovascular risk, [HbA.sub.1c]
Introduction Diabetes mellitus is a complex chronic illness requiring continuous medical care with multifactorial risk reduction strategies beyond glycemic control. (1) It is one of the most common metabolic disorders [...]