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Preferences for improvements in attributes associated with basal insulin : a time trade-off and willingness-to-pay survey of a diabetic and non-diabetic population in Sweden

Olofsson, Sara LU ; Norrlid, Hanna and Persson, Ulf (2016) In Journal of Medical Economics 19(10). p.945-958
Abstract

Objective: Apart from improved health outcomes, treatment convenience per se may have a value to individuals. This is sometimes referred to as process utility and can be estimated in terms of willingness-to-pay (WTP) or quality-adjusted life-years (QALYs). Previous research has produced multiple studies on QALY gains and WTP estimates of insulin-related attributes. There are, however, significant variations between studies, and it is not clear to what extent the value is a reflection of the true preferences or a consequence of the methodological approach. The aim of this study is to estimate the preferences for treatment attributes associated with basal insulin (administration frequency, administration flexibility, and treatment-induced... (More)

Objective: Apart from improved health outcomes, treatment convenience per se may have a value to individuals. This is sometimes referred to as process utility and can be estimated in terms of willingness-to-pay (WTP) or quality-adjusted life-years (QALYs). Previous research has produced multiple studies on QALY gains and WTP estimates of insulin-related attributes. There are, however, significant variations between studies, and it is not clear to what extent the value is a reflection of the true preferences or a consequence of the methodological approach. The aim of this study is to estimate the preferences for treatment attributes associated with basal insulin (administration frequency, administration flexibility, and treatment-induced weight gain) using both QALYs—elicited using time trade-off (TTO) and WTP—among a sample of the Swedish general population and among a sample of the Swedish diabetes population. Methods: Data was collected using web-based surveys which were distributed to members of internet panels. The WTP survey presented five hypothetical scenarios with an offer to pay the incremental cost to receive basal insulin with improved attributes. The TTO survey presented six hypothetical scenarios where the respondent could choose between living for the rest of his/her life with diabetes and receiving treatment with a basal insulin with certain attributes or live for a shorter time with full health. The scenarios were combined with either a basal or a basal–bolus treatment regimen. Results from the TTO analysis were translated into monetary estimates using a threshold value of SEK500,000 per QALY. Results: In total, 2012 responses were included. The ratings of the attributes were almost identical, irrespective of method for the general population, while it differed to some extent for the diabetes population. The methods produced the same value for flexibility, but the estimates generated with the TTO approach were higher for one less injection and avoided weight gain. The general population assigned a higher utility gain to convenience attributes, while the diabetes population assigned a higher utility gain to avoiding weight gain. Limitations: About a quarter of the respondents did not accept the scenario in the WTP survey, i.e. protesters. Conclusions: The ranking of the attributes was generally independent of evaluation method, but the TTO method resulted in similar or higher values compared to the WTP method.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Diabetes, insulin, preferences, quality-adjusted life-years, time trade-off, willingness-to-pay
in
Journal of Medical Economics
volume
19
issue
10
pages
14 pages
publisher
Informa Healthcare
external identifiers
  • Scopus:84973176494
  • WOS:000383914500004
ISSN
1369-6998
DOI
10.1080/13696998.2016.1187152
language
English
LU publication?
yes
id
d6bd421b-aa01-41df-b2f6-6a6f2303f7bb
date added to LUP
2016-07-04 10:15:21
date last changed
2017-01-09 14:31:10
@article{d6bd421b-aa01-41df-b2f6-6a6f2303f7bb,
  abstract     = {<p>Objective: Apart from improved health outcomes, treatment convenience per se may have a value to individuals. This is sometimes referred to as process utility and can be estimated in terms of willingness-to-pay (WTP) or quality-adjusted life-years (QALYs). Previous research has produced multiple studies on QALY gains and WTP estimates of insulin-related attributes. There are, however, significant variations between studies, and it is not clear to what extent the value is a reflection of the true preferences or a consequence of the methodological approach. The aim of this study is to estimate the preferences for treatment attributes associated with basal insulin (administration frequency, administration flexibility, and treatment-induced weight gain) using both QALYs—elicited using time trade-off (TTO) and WTP—among a sample of the Swedish general population and among a sample of the Swedish diabetes population. Methods: Data was collected using web-based surveys which were distributed to members of internet panels. The WTP survey presented five hypothetical scenarios with an offer to pay the incremental cost to receive basal insulin with improved attributes. The TTO survey presented six hypothetical scenarios where the respondent could choose between living for the rest of his/her life with diabetes and receiving treatment with a basal insulin with certain attributes or live for a shorter time with full health. The scenarios were combined with either a basal or a basal–bolus treatment regimen. Results from the TTO analysis were translated into monetary estimates using a threshold value of SEK500,000 per QALY. Results: In total, 2012 responses were included. The ratings of the attributes were almost identical, irrespective of method for the general population, while it differed to some extent for the diabetes population. The methods produced the same value for flexibility, but the estimates generated with the TTO approach were higher for one less injection and avoided weight gain. The general population assigned a higher utility gain to convenience attributes, while the diabetes population assigned a higher utility gain to avoiding weight gain. Limitations: About a quarter of the respondents did not accept the scenario in the WTP survey, i.e. protesters. Conclusions: The ranking of the attributes was generally independent of evaluation method, but the TTO method resulted in similar or higher values compared to the WTP method.</p>},
  author       = {Olofsson, Sara and Norrlid, Hanna and Persson, Ulf},
  issn         = {1369-6998},
  keyword      = {Diabetes,insulin,preferences,quality-adjusted life-years,time trade-off,willingness-to-pay},
  language     = {eng},
  month        = {05},
  number       = {10},
  pages        = {945--958},
  publisher    = {Informa Healthcare},
  series       = {Journal of Medical Economics},
  title        = {Preferences for improvements in attributes associated with basal insulin : a time trade-off and willingness-to-pay survey of a diabetic and non-diabetic population in Sweden},
  url          = {http://dx.doi.org/10.1080/13696998.2016.1187152},
  volume       = {19},
  year         = {2016},
}