Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2015 Jun;79(6):978-87.
doi: 10.1111/bcp.12566.

Understanding drug preferences, different perspectives

Peter G M Mol  1   2 , Arna H Arnardottir  1 , Sabine M J Straus  2   3 , Pieter A de Graeff  1   2 , Flora M Haaijer-Ruskamp  1 , Elise H Quik  4 , Paul F M Krabbe  4 , Petra Denig  1
Affiliations
Comparative Study

Understanding drug preferences, different perspectives

Peter G M Mol et al. Br J Clin Pharmacol. 2015 Jun.

Abstract

Aims: To compare the values regulators attach to different drug effects of oral antidiabetic drugs with those of doctors and patients.

Methods: We administered a 'discrete choice' survey to regulators, doctors and patients with type 2 diabetes in The Netherlands. Eighteen choice sets comparing two hypothetical oral antidiabetic drugs were constructed with varying drug effects on glycated haemoglobin, cardiovascular risk, bodyweight, duration of gastrointestinal complaints, frequency of hypoglycaemia and risk of bladder cancer. Responders were asked each time which drug they preferred.

Results: Fifty-two regulators, 175 doctors and 226 patients returned the survey. Multinomial conditional logit analyses showed that cardiovascular risk reduction was valued by regulators positively (odds ratio 1.98, 95% confidence interval 1.11-3.53), whereas drug choices were negatively affected by persistent gastrointestinal problems (odds ratio 0.24, 95% confidence interval 0.14-0.41) and cardiovascular risk increase (odds ratio 0.49, 95% confidence interval 0.27-0.87). Doctors and patients valued these effects in a similar manner to regulators. The values that doctors attached to large changes in glycated haemoglobin and that both doctors and patients attached to hypoglycaemia and weight gain also reached statistical significance. No group's drug choice was affected by a small absolute change in risk of bladder cancer when presented in the context of other drug effects. When comparing the groups, the value attached by regulators to less frequent hypoglycaemic episodes was significantly smaller than by patients (P = 0.044).

Conclusions: Regulators may value major benefits and risks of drugs for an individual diabetes patient mostly in the same way as doctors and patients, but differences may exist regarding the value of minor or short-term drug effects.

Keywords: benefit-risk assessment; drug preference; oral antidiabetes drug; survey.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Example of a discrete choice task
Figure 2
Figure 2
Percentage of respondents preferring the hypothetical drug A for each choice set per group of respondents. The underlined percentage is the average of all responders preferring the hypothetical drug A in a given choice set. ▪, regulators; formula image, doctors; formula image, patients
Figure 3
Figure 3
Perceived value of drug effects by regulators, doctors and patients (odds ratios and 95% confidence intervals). An odds ratio >1 indicates that responders are more inclined to choose a drug with a specific drug effect and level. Vice versa, responders are less inclined to choose drug effects and levels with an odds ratio <1
See this image and copyright information in PMC

References

    1. Gale EA. GLP-1 based agents and acute pancreatitis: drug safety falls victim to the three monkey paradigm. BMJ. 2013;346:f1263. - PubMed
    1. Godlee F. Rosiglitazone: a cautionary tale. BMJ. 2010;341:c4896.
    1. Cohen D. Rosiglitazone: what went wrong? BMJ. 2010;341:c4848. - PubMed
    1. Prescrire International. New drugs and indications in 2010: inadequate assessment; patients at risk. Rev Prescrire. 2011;31:134–141. - PubMed
    1. Eichler HG, Bloechl-Daum B, Brasseur D, Breckenridge A, Leufkens H, Raine J, Salmonson T, Schneider CK, Rasi G. The risks of risk aversion in drug regulation. Nat Rev Drug Discov. 2013;12:907–916. - PubMed

Publication types

MeSH terms