1 Identifying the treatment preferences of patients with type 2 diabetes: A systematic review Jodi Segal, MD, MPH

2 Acknowledgements This project was supported in part by grant HHSF C - 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

3 Diabetes decision tree model 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.

4 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

5 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?

6 Methods We searched the PubMed, EMBASE, CINAHL, and EconLit databases for articles published on or before January 23, 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

7 Selection criteria InclusionExclusion PopulationAdults with type 2 diabetesType 1 diabetes only Gestational diabetes Pre-diabetes or metabolic syndrome Physicians or caregivers only General public InterventionsNone requiredTreatments for complications of type 2 diabetes ComparisonNone required Outcome measures Preferences for treatment-related outcomes including complications, symptom control, and treatment burden Any appropriate measure 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 TimingShort or long term Any dates

8 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 "multi- criteria 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]

9 Results 2,811 titles identified in the original search 10 articles met inclusion criteria for the systematic review

10

11 Example 1: Treatment satisfaction

12 Example 2: Health status/Quality of life

13 Example 3: Revealed preferences

14 Example 4: Qualitative

15 Example 5: Attributes of treatment

16 Example 6: Trade-offs

17

18 Relative Importance of Treatment Benefits versus Treatment Burden and Side Effects When Assessing Patient Preferences for Diabetes Medications (Other than Insulin) 18

19 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 Conclusions

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