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. 2023 Mar 22:17:793-805.
doi: 10.2147/PPA.S401465. eCollection 2023.

The Impact of Substantial Improvements in HbA1c and Weight Loss on the Medication Preferences of People with Type 2 Diabetes

Heather L Gelhorn  1 , Beatrice Osumili  2 , Katelyn Brown  2 , Melissa M Ross  1 , Andrea Schulz  1 , Gabriela Fernandez  1 , Kristina S Boye  2
Affiliations

The Impact of Substantial Improvements in HbA1c and Weight Loss on the Medication Preferences of People with Type 2 Diabetes

Heather L Gelhorn et al. Patient Prefer Adherence. .

Abstract

Purpose: To quantify the preferences of people with type 2 diabetes (T2D) for treatment attributes of a glucose-dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist (RA) versus an injectable GLP-1 RA medication profile.

Patients and methods: Injection-naive people taking oral medications for T2D in the US and UK completed a web survey including a discrete choice experiment to quantify patients' preferences for five treatment attributes: delivery system, frequency of nausea, frequency of hypoglycemia, HbA1c reduction, and weight reduction. Attributes and levels were based on head-to-head clinical trial data of tirzepatide 5mg, 10mg, and 15mg versus semaglutide 1mg. Preference data were analyzed separately by country using multinomial mixed logit (MXL) models. MXL parameters were used to estimate the predicted preference for each tirzepatide dose versus semaglutide 1mg. Direct preferences for each dose of tirzepatide versus semaglutide 1mg were elicited.

Results: Participants (N=620) in the US (N=301) and UK (N=319) were 50.8% and 50.5% female with mean ages of 60.7 years and 58.9 years, respectively. The order and magnitude of relative attribute importance (RAI) scores differed between countries. HbA1c reduction (26.3%) had the greatest impact on US participants' preferences, and hypoglycemia (32.8%) did among UK participants. Attribute-level marginal utility results indicated preferences for greater HbA1c improvements, the single-use pre-filled pen, lower hypoglycemia, greater weight reductions, and lower frequency of nausea. Assuming the availability of only tirzepatide or semaglutide 1mg, the predicted preference for tirzepatide (5, 10, and 15mg) in the US is 95.6% (vs 4.4% for semaglutide 1mg) and in the UK was 86.3% (vs 13.7% for semaglutide 1mg).

Conclusion: HbA1c reduction, frequency of hypoglycemia, and weight reduction are key drivers of preferences among people with T2D when considering medication options. Overall, people with T2D are likely to prefer the tirzepatide over the semaglutide 1mg medication profiles.

Keywords: discrete choice experiment; incretin; patient perspective; patient preferences.

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Conflict of interest statement

Heather L Gelhorn is an employee of Evidera, a consultancy that provides scientific consulting services to pharmaceutical companies. Melissa M Ross is an employee of Evidera, a consultancy that provides scientific consulting services to pharmaceutical companies. Andrea Schulz is an employee of Evidera, a consultancy that provides scientific consulting services to pharmaceutical companies. Gabriela Fernandez is an employee of Evidera, a consultancy that provides scientific consulting services to pharmaceutical companies. Beatrice Osumili is an employee and shareholder of Eli Lilly and Company. Katelyn Brown is an employee and shareholder of Eli Lilly and Company. Kristina S Boye is an employee and shareholder of Eli Lilly and Company. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Example DCE choice task (UK sample).
Figure 2
Figure 2
Relative attribute importance by country.
Figure 3
Figure 3
Marginal utilities by country. *p < 0.05; **p < 0.01; ***p < 0.001.
Figure 4
Figure 4
Predicted preference for tirzepatide and semaglutide.
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