What matters in type 2 diabetes mellitus oral treatment? A discrete choice experiment to evaluate patient preferences

Eur J Health Econ. 2016 Dec;17(9):1125-1140. doi: 10.1007/s10198-015-0750-5. Epub 2015 Dec 18.


Aims: The aim of this empirical study is to evaluate patient preferences for different characteristics of oral type 2 diabetes mellitus (T2DM) treatment. As T2DM treatment requires strict adherence, patient needs and preferences should be taken into consideration.

Methods: Based on a qualitative and quantitative analysis, a discrete choice experiment (DCE) was applied to identify patient preferences. Apart from six identical attributes (adjustment of glycated hemoglobin [HbA1c], prevention of hypoglycemia, risk of genital infection, risk of gastrointestinal problems, risk of urinary tract infection, and weight change), one continuous variable of either "additional healthy life years" (AHY) or "additional costs" attribute (AC) was included. The DCE was conducted using a fractional factorial design, and the statistical data analysis used random effect logit models.

Results: In total, N = 626 (N = 318 AHY + N = 308 AC) T2DM patients participated in the survey. The estimation revealed a clear dominance for prevention of hypoglycemia (coefficient 0.937) and adjustment of HbA1c (coefficient 0.541). The attributes, "additional healthy life years" (coefficient 0.458) or "additional costs" (coefficient 0.420), were in the middle rank and both of significant impact. The side effects, risk of genital infection (coefficient 0.301), risk of gastrointestinal problems (coefficient 0.296), and risk of urinary tract infection (coefficient 0.241) followed in this respective order. Possible weight change (coefficient 0.047) was of less importance (last rank) to the patients in this evaluation.

Conclusions: These survey results demonstrate how much a (hypothetical) T2DM oral treatment characteristic affects the treatment decision. The preference data can be used for risk-benefit assessment, cost-benefit assessment, and the establishment of patient-oriented evidence. Understanding how patients perceive and value different aspects of diabetes oral treatment is vital to the optimal design and evaluation of treatment options. The present results can be an additional source of information for design, assessment, and decision in T2DM treatment regimes. As such, more effective and efficient care of patients can be achieved, thereby increasing adherence.

Keywords: Discrete choice experiment; Oral treatment; Patient preferences; Type 2 diabetes mellitus.

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Choice Behavior*
  • Cost-Benefit Analysis
  • Diabetes Complications
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / economics
  • Diabetes Mellitus, Type 2 / psychology*
  • Female
  • Germany
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Hypoglycemia / prevention & control*
  • Hypoglycemic Agents / economics
  • Hypoglycemic Agents / therapeutic use
  • Interviews as Topic
  • Linear Models
  • Male
  • Medication Adherence / psychology*
  • Middle Aged
  • Patient Preference


  • Hypoglycemic Agents