Abstract
Objectives
Several glucagon-like peptide-1 receptor agonists are administered as weekly injections for treatment of type 2 diabetes (T2D). These medications vary in their injection processes, and a recent study in the UK found that these differences had an impact on patient preference and health state utilities. The purpose of this study was to replicate the UK study in Italy to examine preferences of an Italian patient sample, while allowing for comparison between utilities in the UK and Italy.
Materials and methods
Participants with T2D in Italy valued health states in time trade-off interviews. All health states had the same description of T2D, but differed in description of the treatment process. As in the original UK study, the first health state described an oral treatment regimen, while additional health states added a weekly injection. The injection health states differed in three injection-related attributes: requirements for reconstituting the medication, waiting during medication preparation, and needle handling.
Results
Interviews were completed by 238 patients (58.8% male; mean age = 60.2 years; 118 from Milan, 120 from Rome). The oral treatment health state had a mean (SD) utility of 0.90 (0.10). The injection health states had significantly (p < 0.0001) lower utilities, which ranged from 0.87 (requirements for reconstitution, waiting, and handling) to 0.89 (weekly injection with none of these requirements). Differences in health state utility scores suggest that each administration requirement was associated with a disutility (ie, negative utility difference): −0.006 (reconstitution), −0.006 (needle handling), −0.011 (reconstitution, needle handling), and −0.022 (reconstitution, waiting, needle handling).
Conclusion
Disutilities associated with the injection device characteristics were similar to those reported with the UK sample. Results suggest that injection device attributes may be important to some patients with T2D, and it may be useful for clinicians to consider these attributes when choosing medication for patients initiating these weekly treatments.
Acknowledgments
This study was funded by Eli Lilly and Company (Indianapolis, IN, USA). The authors would like to thank staff members from G&G Associated (Flavia Severin and Marina Deiana) for assistance with patient recruitment and data collection; Gianfranco Salvi and Nuria Uggetti for assistance with data collection; study interviewers (Paula Matte Bon, Valeria Carlodalatri, David Vittoria, Cristina Mazzoletti, Manuela Re); Benjamin Arnold and the FACITtrans team for performing the translations; Julie McCormack for assistance with data collection forms; and Ren Yu for statistical programming. Parts of this paper were included in a poster presentation at the International Society For Pharmacoeconomics and Outcomes Research 19th Annual European Congress, October 29 to November 2, 2016 in Vienna, Austria: https://www.ispor.org/ScientificPresentationsDatabase/Presentation/58898.
Disclosure
This study was funded by Eli Lilly and Company (Indianapolis, IN, USA). Five of the study authors are employed by the sponsor: KS Boye, K Norrbacka, R Gentilella, M Orsini Federici, and G Biricolti. Five of the authors are employed by Evidera, a company that received funding from Lilly for time spent conducting this research: LS Matza, J Jordan, A Tiebout, C Browne, and KD Stewart. The authors report no other conflicts of interest in this work.