[PR4] Preferences of people with diabetes for inhaled and injectable insulin regimens

[PR4] Preferences of people with diabetes for inhaled and injectable insulin regimens

2006 Value in health

Chancellor, J. | Aballea, S. | Lawrence, A. | Sheldon, R. | Cure, S. | Plun-Favreau, J. | Volume: 9, Issue: 6, Pages: A195-A196, Insulin, methods,

OBJECTIVE: To elicit single-index preferences from people
with diabetes for treatment with inhaled insulin compared to
injectable insulin. METHODS: Written descriptions were developed
for five clinical scenarios in Type 1 and Type 2 diabetes
(T1D and T2D): 1) pre-mixed insulin in T1D; 2) basal-bolus
insulin in T1D; 3) pre-mixed insulin in T2D; 4) oral treatment
in T2D; and 5) oral treatment plus basal insulin in T2D. In each
scenario, adjustment or initiation of insulin treatment was
required due to poor glycaemic control. Two alternative insulin
regimens were described for each scenario: injectable-only or
inhaled insulin to replace or reduce the number of daily injections.
Only the characteristics of treatment varied; equal efficacy
was assumed. Computer-assisted personal interviews were conducted
at six UK locations with people with diabetes aged over
18 years. After demonstration of the inhalation and pen injection
devices, 344 respondents (66% male), 132 (mean age 49
years) with T1D and 212 (mean age 63 years) with T2D, rated
scenarios by time trade-off (TTO) and EQ-5D. RESULTS: A
majority of respondents preferred inhalation variants; the proportions
ranging from 63% to 81% across the scenarios, with
generally less than 10% indifferent between variants. Mean differences
between variants in TTO scores were 0.074, 0.076,
0.088, 0.053 and 0.043 for the 5 scenarios respectively (p < 0.005 for all comparisons). Mean EQ-5D differences between variants were 0.043, 0.029, 0.037, 0.020, 0.021 for the 5 scenarios respectively (p < 0.05 for scenarios 1 and 3), driven mainly by differences in pain/discomfort. Mean self-rated health was similar between T1D and T2D respondents, at 0.83 (TTO) and 0.75 (EQ-5D). CONCLUSIONS: Inhaled insulin may offer the prospect for improved patient satisfaction when a patient's injectable insulin regimen requires adjustment. TTO was more sensitive than EQ-5D to differences between scenarios and differences between treatment variants within scenarios.