Abstract
Purpose
The importance of patient-centered care in the management of type 2 diabetes mellitus (T2DM) is widely advocated. Understanding the attributes of T2DM medications important to patients is thus essential for effective management, in order to limit disease progression. This literature review aimed to identify studies comparing patient preferences, based on process and outcome attributes, between GLP1-receptor agonist (RA) profiles and between GLP1 RA and insulin profiles.
Methods
MEDLINE, Embase, PsycINFO, and the Cochrane Library (2005–present) were searched for studies in patients with T2DM or the general population that compared preferences for GLP1 RAs or GLP1 RAs versus insulin using contingent valuation, conjoint analysis (discrete-choice experiments [DCEs], willingness to pay), rating-based approaches of specific attributes, standard gamble, or time trade-off. Studies comparing drug A versus drug B without explicit attribute valuation were excluded.
Results
Ten records met eligibility criteria. Eight studies compared preferences for GLP1 RA– profile attributes, one compared GLP1 RA versus insulin glargine profiles, and one addressed both comparisons. Important attributes driving patient preferences in DCEs were dose frequency, type of device, needle size, change in glycated hemoglobin, and adverse-event profile. Time trade-off evaluations demonstrated that weekly GLP1 RA injection-device attributes (reconstitution, waiting during preparation, needle handling) had a measurable impact on preference. Willingness-to-pay analysis showed that patients were more willing to pay extra for attributes of once-daily liraglutide over twice-weekly exenatide or insulin. Direct preference elicitation in DCEs revealed that patients preferred medication profiles representing GLP1 RAs with less frequent dosing and preferred GLP1 RA profiles over insulin.
Conclusion
Process and outcome attributes are important drivers of patient preference for GLP1 RAs. Findings from patient-preference studies can inform clinical decision-making and help align care with patient values, which has the potential to improve medication adherence and outcomes.
Supplementary material
Box S1 MEDLINE search strategy
Acknowledgments
The authors thank Mick Arber (York Health Economic Consortium [YHEC]) for assistance with the literature search, and Sharon Raynor and Alison Terry for assistance with writing and editing, respectively. This study was funded by Eli Lilly and Company (Indianapolis, IN, USA).
Disclosure
KSB, LEGP, and VTT are full-time employees of Eli Lilly. SR and TKM are employees of KMHO, who received funding from Eli Lilly for time spent conducting this research. SR reports grants from Eli Lilly during the conduct of the study. TKM reports grants from Eli Lilly during the conduct of the study and outside the submitted work. The authors report no other conflicts of interest in this work.