Identifying the treatment preferences of patients with type 2 diabetes: A systematic review Jodi Segal, MD, MPH 1 Acknowledgements • This project was supported in part by grant HHSF2232010000072C - Partnership in Applied Comparative Effectiveness Science (PACES) – PI Jodi Segal • The views expressed here do not represent the official views of the FDA or AHRQ. • Investigators – Sonal Singh, MD MPH – John FP Bridges, PhD – Nisa M Maruthur, MD MHS – Emily Little, BA – Susan Joy, MPH, MA – Tanjula Purnell, PhD 2 Diabetes decision tree model 3 Maruthur, NM, Bridges, JFP, Joy, SM, Little, E, Singh, S. Modeling decision-making for therapy for type 2 diabetes using the Analytic Hierarchy Process. Economics, Modeling and Diabetes: The Mt Hood 2012 Challenge, June 7, 2012. To inform the decision model, the team began with a systematic review of patient preferences for noninsulin diabetes medications in adults with type 2 diabetes 4 Systematic review: Key questions • To identify the preferences of adult patients with type 2 diabetes for diabetes medications. • The key questions are: – What attributes of treatment are weighted as most important? – What are the sources of heterogeneity of patient preferences (e.g. age, sex, race/ethnicity, severity of diabetes, prior treatment)? – What are the major gaps in the evidence base? – How can the quality of the evidence base be assessed? 5 Methods • We searched the PubMed, EMBASE, CINAHL, and EconLit databases for articles published on or before January 23, 2013. • English-language studies of adult patients with type 2 diabetes assessing patient preferences for diabetes medication treatment. • Titles, abstracts, and articles were reviewed by at least two independent reviewers. • Study data and quality were abstracted 6 Selection criteria Population Inclusion •Adults with type 2 diabetes Interventions •None required Comparison •None required Outcome measures •Preferences for treatment-related outcomes including complications, symptom control, and treatment burden •Any appropriate measure Timing •Short or long term •Any dates 7 Exclusion •Type 1 diabetes only •Gestational diabetes •Pre-diabetes or metabolic syndrome •Physicians or caregivers only •General public •Treatments for complications of type 2 diabetes •Health status measures, QALYs and quality of life measures •Preferences for treatments for diabetes complications or co-morbidities •Preferences for non-treatment aspects of diabetes management •Measures from secondary analyses Search strategy (PubMed) • "diabetes mellitus, type 2"[mh] OR diabet*[tiab] OR"non-insulin dependent"[tiab] OR type-2[tiab] OR "type II"[tiab] OR "type 2"[tiab]“Ketosis-Resistant Diabetes Mellitus”[tw] OR“Non-Insulin-Dependent Diabetes Mellitus”[tw] OR “Type 2 Diabetes Mellitus”[tw] OR “Stable Diabetes Mellitus”[tw] OR “Maturity-Onset Diabetes Mellitus” [tw] OR “Maturity Onset Diabetes Mellitus”[tw] OR “MODY”[tw] OR “NIDDM”[tw] OR“Adult-Onset Diabetes Mellitus”[tw] AND • Treatment[tiab] OR management[tiab] OR pharmaceutical[tiab] OR drug therapy[mesh] OR medication[tiab] AND • "conjoint analysis" OR "satisfaction" OR "choice model" OR "stated preference" OR "discrete choice" OR DCE OR "decision analysis" OR preferences OR "multicriteria decision analysis" OR MCDA OR "multi-attribute utility" OR "analytic hierarchy process" OR "trade off" OR "self-explicated" OR "best-worst scaling" OR utilities OR "preference weight" OR “willingness to pay” OR WTP OR “willingness to accept” OR “contingent valuation” OR priorities[tiab] OR valuation[tiab] 8 Results • 2,811 titles identified in the original search • 10 articles met inclusion criteria for the systematic review 9 10 Example 1: Treatment satisfaction 11 Example 2: Health status/Quality of life 12 Example 3: Revealed preferences 13 Example 4: Qualitative 14 Example 5: Attributes of treatment 15 Example 6: Trade-offs 16 17 17 Relative Importance of Treatment Benefits versus Treatment Burden and Side Effects When Assessing Patient Preferences for Diabetes Medications (Other than Insulin) 18 18 Conclusions • Weight loss/control and glycemic control appear to be the treatment-related benefits which drive patient preferences when compared to treatment-related burden and side effects • Risk of gastrointestinal effects was an important attribute associated with treatment preferences. • Preference elicitation provides a necessary stepping stone in the path to individualized care and patient-centered decision-making in type 2 diabetes 19 19 20 © 2012, Johns Hopkins University. All rights reserved.