Abstract
Purpose
Diabetes is a chronic condition that is more prevalent among people with lower educational attainment. This study assessed the treatment preferences of patients with type 2 diabetes by educational attainment.
Methods
Patients with type 2 diabetes were recruited from a national online panel in the US. Treatment preferences were assessed using a discrete-choice experiment. Participants completed 16 choice tasks in which they compared pairs of treatment profiles composed of six attributes: A1c decrease, stable blood glucose, low blood glucose, nausea, treatment burden, and out-of-pocket cost. Choice models and willingness-to-pay (WTP) estimates were estimated using a conditional logit model and were stratified by educational status.
Results
A total of 231 participants with a high school diploma or less education, 156 participants with some college education, and 165 participants with a college degree or more completed the survey. Participants with a college degree or more education were willing to pay more for A1c decreases ($58.84, standard error [SE]: 10.6) than participants who had completed some college ($28.47, SE: 5.53) or high school or less ($17.56, SE: 3.55) (p≤0.01). People with a college education were willing to pay more than people with high school or less to avoid nausea, low blood glucose events during the day/night, or two pills per day.
Conclusion
WTP for aspects of diabetes medication differed for people with a college education or more and a high school education or less. Advanced statistical methods might overcome limitations of stratification and advance understanding of preference heterogeneity for use in patient-centered benefit–risk assessments and personalized care approaches.
Acknowledgments
The authors sincerely thank the Johns Hopkins Institute for Clinical and Translational Research (ICTR) Community Research Advisory Council (C-RAC) and members of the Diabetes Action Board (DAB) for their valuable contributions and engagement in the research study. This work was supported by a Patient-Centered Outcomes Research Institute (PCORI) Methods Award (ME-1303-5946) and by the Center for Excellence in Regulatory Science and Innovation (CERSI) (1U01FD004977-01). The funders had no role in the design and conduct of the study, interpretation of the data, or preparation of the manuscript.
Disclosure
The authors report no conflicts of interest in this work.