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

2. 2 Acknowledgements This project was supported in part by grant HHSF2232010000072C - 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. 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. 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. 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. 6 Methods We searched the PubMed, EMBASE, CINAHL, and EconLit databases for articles published on or before January 23, 2013. 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. 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. 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. 9 Results 2,811 titles identified in the original search 10 articles met inclusion criteria for the systematic review

10. 10

11. 11 Example 1: Treatment satisfaction

12. 12 Example 2: Health status/Quality of life

13. 13 Example 3: Revealed preferences

14. 14 Example 4: Qualitative

15. 15 Example 5: Attributes of treatment

16. 16 Example 6: Trade-offs

17. 17

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

19. 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

20. 20 © 2012, Johns Hopkins University. All rights reserved.