Defining Patient Versus Provider Preferences in Type 2 Diabetes Medication Attributes

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According to R. Panchal and colleagues, the preferences towards specific products among drug classes for diabetes are largely based on efficacy and cost comparison. The researchers proposed, however, that “patient and provider perspectives may differ on the attributes they would be willing to pay more for.” They also identified a problem in that “payers rarely tie patient contribution and treatment value preferred by patients resulting in a misalignment of preferences among stakeholders and patients.” Panchal, and colleagues conducted a study to collect patient and provider preferences of value for type 2 diabetes medications. They ultimately concluded that “patients prioritized route of administration and dosing flexibility.” The providers corroborated the preferences towards A1c reduction, [cardiovascular (CV)] risk reduction, [heart failure (HF)] risk reduction, [out-of-pocket (OOP)] cost, and [gastrointestinal (GI)] side effects, but valued attributes related to hypoglycemia and weight change.

The study, awarded a platinum poster award medal at AMCP 2022, initially involved a literature search for studies on patient preference and a review of treatment guidelines to identify a starting list of clinical medication attributes. Out of 35 and 20 identified attributes, respectively, 13 were chosen by consensus among the investigators for a final list. Then, in qualitative interviews, the list was provided to three patients and three diabetes experts who were asked to identify, prioritize, and comment on which attributes of medications were most important to them.

The patients selected seven attributes out of the 13, which were: hemoglobin A1c reduction, HF risk reduction, CV risk reduction, OOP cost, route of administration, dosing flexibility, and GI side effects. Meanwhile, the providers selected the following attributes: hemoglobin A1c reduction, CV risk reduction, HF risk reduction, weight change, OOP cost, GI side effects, and hypoglycemia.

According to the article, the interviewed patients had a high degree of health literacy, were actively involved in managing their diabetes, and cost was not a concern. Notably, the study’s collaborators reported that “providers were surprised at the responses from the patients, possibly because they mostly treated specific patient populations (post-CV event or low-income families).” Regardless, Panchal and colleagues identified the shared and distinct preferences in their conclusions, and noted that the seven identified attributes in type 2 diabetes medication will be presented to a cohort of 400 patients to further define high and low value medications.