| Objective: Under the clinical guideline of "patient-centered" diabetes,the Discrete Choice Experiment(DCE)was used to quantitatively analyze the preference of second-line hypoglycemic drugs in patients with Type 2 Diabetes Mellitus(T2DM).To compare the differences in second-line hypoglycemic drug preference between T2 DM patients in the north and south of China,and to provide a reference for improving the compliance and quality of life of T2 DM patients,as well as participating in clinical decision-making and pharmacoeconomic studies.Methods: This study used the DCE method to measure drug preferences of T2 DM patients in the North and South.Literature research and focus group interviews were used to determine the attributes of this study and their levels.Design for efficiency(D-efficiency)using SAS 9.4 software,creating a total of 48 pairs of solution sets.The survey was conducted using a combination of multi-stage random whole-group sampling and convenience sampling..Based on the geographical location and economic development level,the provincial capital city and another prefecture-level city in Hainan Province and Shanxi Province were randomly selected;in each city,one tertiary hospital,one secondary hospital,and two basic medical institutions were then randomly selected respectively,and the whole group of outpatients and inpatients who came to the clinic were surveyed in combination with convenience sampling.Data entry was performed using Epidata 3.1 software,and a mixed logit regression model and a conditional logit regression model were constructed by Stata 16.0 software for preference analysis.Results:(1)A total of 7 study attributes were finally included(glycemic control effect,risk of hypoglycemic events,risk of gastrointestinal side effects,weight change within six months,whether cardiovascular protection can be achieved,mode of taking medication,out-of-pocket cost/month).(2)A total of 1443 questionnaires were collected,of which 15 were invalid and 40 failed the DCE consistency test,1388 valid questionnaires were included,with an effective rate of 96.19%.(3)Each attribute of second-line medication in southern T2 DM patients was statistically significant except for weight change within six months,with the following utility weights in order: no risk of gastrointestinal side effects(β=1.732),strong glycemic control(β=1.717),no risk of hypoglycemic events(β=1.423),cardiovascular protection(β=0.956),and taking medication by mouth(β=0.687).The willingness-to-pay ranking was consistent with the attribute utility weighting.All attributes of second-line medication in northern T2 DM patients were statistically significant(P < 0.05),with utility weights in the order of: strong glycemic control(β=1.600),no risk of hypoglycemic events(β=1.325),cardiovascular protection(β=1.255),no risk of gastrointestinal side effects(β=1.141),taking medication by mouth(β=0.784),and 2kilogram reduction in weight change within six months(β=0.726).The willingness-to-pay ranking was consistent with the attribute utility weighting.(4)There were differences in second-line drug preference and willingness to pay between T2 DM patients in the north and south.Both northern and southern T2 DM patients preferred out-of-pocket costs/month,glycaemic control effectiveness,hypoglycaemic events and risk of gastrointestinal side effects,while weight change over six months had the least impact.In addition to out-of-pocket costs/month,the most preferred attribute among T2 DM patients in the South was no gastrointestinal side effects,and they were willing to pay 408.06 yuan per month(CI: 329.19～486.93)when switching the risk of gastrointestinal side effects from higher to no risk;The most preferred attribute of northern T2 DM patients was strong glycemic control,and they were willing to pay 435.98 yuan(CI: 339.55～532.41)per month when the glycemic control effect of hypoglycemic drugs was changed from very weak to very strong.(5)Subgroup results of second-line drug preference in T2 DM patients from North and South.Southern male T2 DM patients had the greatest preference for glycemic control outcomes,while northern male T2 DM patients traded off the two attributes of glycemic control outcomes and risk of incident hypoglycemia against out-of-pocket costs/month.Patients with urban T2 DM in the south preferred glycaemic control effectiveness,while those with urban T2 DM in the north preferred cardiovascular protection.Conclusion:(1)Out-of-pocket costs/month and glycemic control effects had a significant effect on the choice of drug preference for T2 DM patients in both the North and South.(2)The mode of drug taking and weight change within six months had a low degree of influence on T2 DM patients in both the north and the south.(3)The main influencing factor of second-line drug use in southern T2 DM patients is the occurrence of gastrointestinal side effects,and the larger influencing factor is the effect of glycemic control.(4)The main influencing factor of second-line drug choice in northern T2 DM patients is the occurrence of hypoglycemic events,and whether cardiovascular protection is the larger influencing factor.(5)The subgroup preferences of T2 DM patients differed between the North and South.The results of the study on the differences in T2 DM patient preferences will further update the evidence on T2 DM patient second-line drug preferences in the North and South,guide clinicians in medication decisions,promote patient participation in clinical decision-making,and improve patient compliance and quality of life.The recommendations are as follows:(1)Focus on health education for T2 DM patients.(2)Vigorously carry out "patient-centered" assessment of T2 DM drug preferences.(3)Clinical medication regimens should take into account T2 DM patient preferences and geographical factors.(4)Relevant departments of pharmaceutical companies should focus on patient preference evidence.(5)Strengthen health management services for T2 DM patients in the North and South.(6)Clinicians should change from "intensive glucose lowering" to "high quality glucose lowering". |
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