Abstract
Introduction
Although cost-utility analyses are frequently used to estimate treatment outcomes for type 2 diabetes, utilities are not available for key medication-related attributes. The purpose of this study was to identify the utility or disutility of diabetes medication-related attributes (weight change, gastrointestinal side effects, fear of hypoglycemia) that may influence patient preference.
Methods
Patients with type 2 diabetes in Scotland and England completed standard gamble (SG) interviews to assess utility of hypothetical health states and their own current health state. The EQ-5D, PGWB, and Appraisal of Diabetes Symptoms were administered. Construct validity and differences among health states were examined with correlations, t-tests, and ANOVAs.
Results
A total of 129 patients (51 Scotland; 78 England) completed interviews. Mean utility of diabetes without complications was 0.89. Greater body weight was associated with disutility, and lower body weight with added utility (e.g., 3% higher = −0.04; 3% lower = +0.02). Gastrointestinal side effects and fear of hypoglycemia were associated with significant disutility (p < 0.001). SG utility of current health (mean = 0.87) demonstrated construct validity through correlations with patient-reported outcome measures (r = 0.08–0.31).
Discussion
The vignette-based approach was feasible and useful for assessing added utility or disutility of medication-related attributes.
Similar content being viewed by others
References
Feeny, D., Barr, R. D., Furlong, W., et al. (1991). Quality of life of the treatment process in pediatric oncology: An approach to measurement. In D. Osaba (Ed.), Effect of cancer on quality of life. Boca Raton, FL: CRC Press.
Torrance, G. W., Furlong, W., & Feeny, D. (2002). Health utility estimation. Expert Review of Pharmacoeconomics Research, 2(2), 99–108.
Torrance, G. W. (1986). Measurement of health state utilities for economic appraisal. Journal of Health Economics, 5(1), 1–30.
Torrance, G. W. (1996). Designing and conducting cost-utility analyses. In B. Spilker (Ed.), Quality of life and pharmacoeconomics in clinical trials (2nd ed.). Philadelphia, PA: Lippincott-Raven Publishers.
Clarke, P. M., Gray, A. M., Briggs, A., et al. (2005). Cost-utility analyses of intensive blood glucose and tight blood pressure control in type 2 diabetes (UKPDS 72). Diabetologia, 48(5), 868–877.
Eddy, D. M., Schlessinger, L., & Kahn, R. (2005). Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for diabetes. Annals of Internal Medicine, 143(4), 251–264.
McEwan, P., Peters, J. R., Bergenheim, K., et al. (2006). Evaluation of the costs and outcomes from changes in risk factors in type 2 diabetes using the Cardiff stochastic simulation cost-utility model (DiabForecaster). Current Medical Research and Opinion, 22(1), 121–129.
Palmer, A. J., Roze, S., Valentine, W. J., et al. (2004). The CORE Diabetes Model: Projecting long-term clinical outcomes, costs and cost-effectiveness of interventions in diabetes mellitus (types 1 and 2) to support clinical and reimbursement decision-making. Current Medical Research and Opinion, 20(Suppl 1), S5–S26.
Warren, E., Weatherley-Jones, E., Chilcott, J., et al. (2004). Systematic review and economic evaluation of a long-acting insulin analogue, insulin glargine. Health Technology Assessment, 8(45), iii, 1–57.
Zhou, H., Isaman, D. J., Messinger, S., et al. (2005). A computer simulation model of diabetes progression, quality of life, and cost. Diabetes Care, 28(12), 2856–2863.
DeFronzo, R. A., Ratner, R. E., Han, J., et al. (2005). Effects of exenatide (exendin-4) on glycemic control and weight over 30 weeks in metformin-treated patients with type 2 diabetes. Diabetes Care, 28(5), 1092–1100.
Heller, S. (2004). Weight gain during insulin therapy in patients with type 2 diabetes mellitus. Diabetes Research and Clinical Practice, 65(Suppl 1), S23–S27.
Purnell, J. Q., & Weyer, C. (2003). Weight effect of current and experimental drugs for diabetes mellitus: From promotion to alleviation of obesity. Treatments in Endocrinology, 2(1), 33–47.
Albu, J., & Raja-Khan, N. (2003). The management of the obese diabetic patient. Primary Care, 30(2), 465–491.
The Diabetes Control, Complications Trial (DCCT) Research Group. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine, 329(14), 977–986.
Scheen, A. J. (2000). Treatment of diabetes in patients with severe obesity. Biomedicine & Pharmacotherapy, 54(2), 74–79.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). (1998). UK Prospective Diabetes Study (UKPDS) Group. Lancet, 352(9131), 837–853.
Blonde, L., Dailey, G. E., Jabbour, S. A., et al. (2004). Gastrointestinal tolerability of extended-release metformin tablets compared to immediate-release metformin tablets: Results of a retrospective cohort study. Current Medical Research and Opinion, 20(4), 565–572.
Heine, R. J., Van Gaal, L. F., Johns, D., et al. (2005). Exenatide versus insulin glargine in patients with suboptimally controlled type 2 diabetes: A randomized trial. Annals of Internal Medicine, 143(8), 559–569.
Marshall, V., Wilton, L., & Shakir S. (2006). Safety profile of repaglinide as used in general practice in England: Results of a prescription-event monitoring study. Acta Diabetologica, 43(1), 6–13.
Warren, E., Weatherley-Jones, E., Chilcott, J., et al. (2006) Assessment report: The clinical and cost-effectiveness of long-acting insulin analogue, insulin glargine. [Online]. Available at: http://www.nice.org.uk/pdf/Insulin_Analogues.pdf. Accessed 2006, January 26.
de Galan, B. E., Schouwenberg, B. J., Tack, C. J., et al. (2006). Pathophysiology and management of recurrent hypoglycaemia and hypoglycaemia unawareness in diabetes. The Netherlands Journal of Medicine, 64(8), 269–279.
McQueen, J. (2005). Pramlintide acetate. American Journal of Health-System Pharmacy, 62(22), 2363–2372.
Costea, M., Ionescu-Tirgoviste, C., Cheta, D., et al. (1993). Fear of hypoglycemia in type 1 (insulin-dependent) diabetic patients. Romanian Journal of Internal Medicine, 31(4), 291–295.
de Grauw, W. J., van de Lisdonk, E. H., van Gerwen, W. H., et al. (2001). Insulin therapy in poorly controlled type 2 diabetic patients: Does it affect quality of life? The British Journal of General Practice, 51(468), 527–532.
Irvine, A. A., Cox, D., & Gonder-Frederick, L. (2002). Fear of hypoglycemia: Relationship to physical and psychological symptoms in patients with insulin-dependent diabetes mellitus. Health Psychology, 11, 135–138.
Marrero, D. G., Guare, J. C., Vandagriff, J. L., et al. (1997). Fear of hypoglycemia in the parents of children and adolescents with diabetes: Maladaptive or healthy response? The Diabetes Educator, 23(3), 281–286.
Weinberger, M., Kirkman, M. S., Samsa, G. P., et al. (1994). The relationship between glycemic control and health-related quality of life in patients with non-insulin-dependent diabetes mellitus. Medical Care, 32(12), 1173–1181.
Bagust, A., & Beale S. (2005). Modelling EuroQol health-related utility values for diabetic complications from CODE-2 data. Health Economics, 14(3), 217–230.
Clarke, P., Gray, A., & Holman, R. (2002). Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). Medical Decision Making, 22(4), 340–349.
Koopmanschap, M. (2002). Coping with Type II diabetes: The patient’s perspective. Diabetologia, 45(7), S18–S22.
Lee, A. J., Morgan, C. L., Morrissey, M., et al. (2005). Evaluation of the association between the EQ-5D (health-related utility) and body mass index (obesity) in hospital-treated people with Type 1 diabetes, Type 2 diabetes and with no diagnosed diabetes. Diabetic Medicine, 22(11), 1482–1486.
Redekop, W. K., Koopmanschap, M. A., Stolk, R. P., et al. (2002). Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes. Diabetes Care, 25(3), 458–463.
Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). (1999). UK Prospective Diabetes Study Group. Diabetes Care, 22(7), 1125–1136.
Coffey, J. T., Brandle, M., Zhou, H., et al. (2002). Valuing health-related quality of life in diabetes. Diabetes Care, 25(12), 2238–2243.
Maddigan, S. L., Feeny, D. H., & Johnson, J. A. (2003). A comparison of the health utilities indices Mark 2 and Mark 3 in type 2 diabetes. Medical Decision Making, 23(6), 489–501.
Maddigan, S. L., Majumdar, S. R., Toth, E. L., et al. (2003). Health-related quality of life deficits associated with varying degrees of disease severity in type 2 diabetes. Health and Quality of Life Outcomes, 1(1), 78.
Brazier, J., Roberts, J., Tsuchiya, A., et al. (2004). A comparison of the EQ-5D and SF-6D across seven patient groups. Health Economics, 13(9), 873–884.
Brazier, J., Jones, N., & Kind, P. (1993). Testing the validity of the EuroQol and comparing it with the SF-36 health survey questionnaire. Quality of Life Research, 2(3), 169–180.
Hinz, A., Klaiberg, A., Brahler, E., et al. (2006). The Quality of Life Questionnaire EQ-5D: modelling and norm values for the general population. Psychotherapie, Psychosomatik, Medizinische Psychologie, 56(2), 42–48.
Kaarlola, A., Pettila, V., & Kekki, P. (2004). Performance of two measures of general health-related quality of life, the EQ-5D and the RAND-36 among critically ill patients. Intensive Care Medicine, 30(12), 2245–2252.
Stein, K., Fry, A., Round, A., et al. (2005). What value health?: A review of health state values used in early technology assessments for NICE. Applied Health Economics and Health Policy, 4(4), 219–228.
Gafni, A. (1994). The standard gamble method: What is being measured and how it is interpreted. Health Services Research, 29(2), 207–224.
Torrance, G. W., & Feeny, D. (1989). Utilities and quality-adjusted life years. International Journal of Technology Assessment in Health Care, 5(4), 559–575.
Revicki, D. A., & Wood, M. (1998). Patient-assigned health state utilities for depression-related outcomes: Differences by depression severity and antidepressant medications. Journal of Affective Disorders, 48(1), 25–36.
Matza, L. S., Secnik, K., Rentz, A. M., et al. (2005). Assessment of health state utilities for attention-deficit/hyperactivity disorder in children using parent proxy report. Quality of Life Research, 14, 735–747.
Secnik, K., Matza, L. S., Cottrell, S., et al. (2005). Health state utilities for childhood attention-deficit/hyperactivity disorder based on parent preferences in the United Kingdom. Medical Decision Making, 25(1), 56–70.
Bass, E. B., Steinberg, E. P., Pitt, H. A., et al. (1994). Comparison of the rating scale and the standard gamble in measuring patient preferences for outcomes of gallstone disease. Medical Decision Making, 14(4), 307–314.
Cook, J., Richardson, J., & Street, A. (1994). A cost utility analysis of treatment options for gallstone disease: Methodological issues and results. Health Economics, 3(3), 157–168.
Feeny, D. H., & Torrance, G. W. (1989). Incorporating utility-based quality-of-life assessment measures in clinical trials. Two examples. Medical Care, 27(3 Suppl), S190–S204.
Johnston, K., Brown, J., Gerard, K., et al. (1998). Valuing temporary and chronic health states associated with breast screening. Social Science & Medicine, 47(2), 213–222.
Stalmeier, P. F. (2002). Discrepancies between chained and classic utilities induced by anchoring with occasional adjustments. Medical Decision Making, 22(1), 53–64.
Mauskopf, J. (2006). Utility assessment. In E. C. G. Chumney, & K. N. Simpson (Eds.), Methods and designs for outcomes research. Bethesda, MD: American Society of Health-System Pharmacists.
Rutten-van Molken, M. P., Bakker, C. H., van Doorslaer, E. K., et al. (1995). Methodological issues of patient utility measurement. Experience from two clinical trials. Medical Care, 33(9), 922–937.
Carey, M. P., Jorgensen, R. S., Weinstock, R. S., et al. (1991). Reliability and validity of the appraisal of diabetes scale. Journal of Behavioral Medicine, 14(1), 43–51.
Brooks, R., Rabin, R., & de Charro, F. (Eds.) (2003). The measurement and valuation of health status using EQ-5D: A European perspective. Dordrecht: Kluwer Academic Publishers.
EuroQol Group. (1990). EuroQol—a new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199–208.
Krabbe, P., & Weijnen, T. (2003). Guidelines for analysing and reporting EQ-5D outcomes. In R. Brooks, R. Rabin, & F. de Charro (Eds.), The measurement and valuation of health status using EQ-5D: A European perspective. Dordrecht: Kluwer Academic Publishers.
McDowell, I., & Newell C. (1996). Measuring health: A guide to rating scales and questionnaires (2nd ed.). New York: Oxford University Press.
Jia, H., & Lubetkin, E. I. (2005). The impact of obesity on health-related quality-of-life in the general adult US population. Journal of Public Health (Oxford, England), 27(2), 156–164.
Dupuy, H. J. (1984). The Psychological General Well-Being (PGWB) index. In N. K. Wenger, M. E. Mattson, C. D. Furberg, et al. (Eds.), Assessment of quality of life in clinical trials of cardiovascular therapies (pp 170–183). Washington, DC: Le Jacq Publishing.
Chassany, O., Dimenas, E., Dubois, D., et al. (2004). PGWBI user manual. Lyon, France: MAPI Research Institute.
Leonardson, G. R., Daniels, M. C., Ness, F. K., et al. (2003). Validity and reliability of the general well-being schedule with northern plains American Indians diagnosed with type 2 diabetes mellitus. Psychological Reports, 93(1), 49–58.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
Garrow, J. S., & Webster, J. (1985). Quetelet’s index (W/H2) as a measure of fatness. International Journal of Obesity, 9(2), 147–153.
Foxcroft, D. R., & Milne, R. (2000). Orlistat for the treatment of obesity: Rapid review and cost-effectiveness model. Obesity Reviews, 1(2), 121–126.
Groessl, E. J., Kaplan, R. M., Barrett-Connor, E., et al. (2004). Body mass index and quality of well-being in a community of older adults. American Journal of Preventive Medicine, 26(2), 126–129.
Hakim, Z., Wolf, A., & Garrison, L. P. (2002). Estimating the effect of changes in body mass index on health state preferences. Pharmacoeconomics, 20(6), 393–404.
Brohan, E. M., Wild, D. J., Wittrup-Jensen, K. U., et al. (2005). Fear of hypoglycemia: A review of the literature. Poster presented at the Annual Meeting of the International Society for Quality of Life Research (ISOQOL); October 19–22, San Francisco, CA.
Blumenschein, K., & Johannesson, M. (1998). Relationship between quality of life instruments, health state utilities, and willingness to pay in patients with asthma. Annals of Allergy, Asthma & Immunology, 80(2), 189–194.
Green, C., Kiebert, G., Murphy, C., et al. (2003). Patients’ health-related quality-of-life and health state values for motor neurone disease/amyotrophic lateral sclerosis. Quality of Life Research, 12(5), 565–574.
Juniper, E. F., Norman, G. R., Cox, F. M., et al. (2001). Comparison of the standard gamble, rating scale, AQLQ and SF-36 for measuring quality of life in asthma. The European Respiratory Journal, 18(1), 38–44.
Kartman, B., Gatz, G., & Johannesson, M. (2004). Health state utilities in gastroesophageal reflux disease patients with heartburn: A study in Germany and Sweden. Medical Decision Making, 24(1), 40–52.
Ohsawa, I., Ishida, T., Oshida, Y., et al. (2003). Subjective health values of individuals with diabetes in Japan: Comparison of utility values with the SF-36 scores. Diabetes Research and Clinical Practice, 62(1), 9–16.
Stavem, K. (1998). Quality of life in epilepsy: Comparison of four preference measures. Epilepsy Research, 29(3), 201–209.
Sullivan, S. D., Lew, D. P., & Devine, E. B., et al. (2002). Health state preference assessment in diabetic peripheral neuropathy. Pharmacoeconomics, 20(15), 1079–1089.
Jansen, S. J., Stiggelbout, A. M., Wakker, P. P., et al. (1998). Patients’ utilities for cancer treatments: A study of the chained procedure for the standard gamble and time tradeoff. Medical Decision Making, 18(4), 391–399.
Bleichrodt, H., Pinto, J. L., & Abellan-Perpinan, J. M. (2003). A consistency test of the time trade-off. Journal of Health Economics, 22(6), 1037–1052.
Torrance, G. W. (1997). Preferences for health outcomes and cost-utility analysis. The American Journal of Managed Care, 3(Suppl), S8–S20.
National Institute for Clinical Excellence (NICE). (2003). Guide to the methods of technology appraisal. London: NICE.
Drummond, M. F., O’Brien, B., Stoddart, G. L., et al. (2000). Methods for the economic evaluation of health care programmes (2nd ed.). Oxford University Press.
Acknowledgements
The authors would like to thank Karen Malley for thoughtful statistical programming and Shay Almaroof for production assistance. We would also like to thank Drs. Robert Brodows, Michael Trautmann, Andreas Festa, and Dennis Revicki for expert consultation. Permission to use all patient-reported outcome measures was granted by the instrument developers. This study was funded by Eli Lilly and Company.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Matza, L.S., Boye, K.S., Yurgin, N. et al. Utilities and disutilities for type 2 diabetes treatment-related attributes. Qual Life Res 16, 1251–1265 (2007). https://doi.org/10.1007/s11136-007-9226-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-007-9226-0