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Patients' with type 2 diabetes willingness to pay for insulin therapy and clinical outcomes
  1. Michael D Feher1,2,
  2. John Brazier3,
  3. Nicolaas Schaper4,
  4. Gabriela Vega-Hernandez5,
  5. Annie Nikolajsen5,
  6. Mette Bøgelund6
  1. 1Beta Cell Diabetes Centre, Chelsea and Westminster Hospital, London, UK
  2. 2Diabetes Therapies Evaluation Network, London, UK
  3. 3School of Health and Related Research, University of Sheffield, Sheffield, UK
  4. 4Department of Internal Medicine, CAPHRI School for Primary Care and Public Health and CARIM Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
  5. 5Novo Nordisk A/S, Soeborg, Denmark
  6. 6Incentive, Holte, Denmark
  1. Correspondence to Dr Annie Nikolajsen; aenk{at}


Objectives This study assessed patient preferences, using willingness to pay as a method to measure different treatment characteristics or attributes associated with injectable insulin therapy in patients with type 2 diabetes.

Research design and methods Adults with type 2 diabetes in 12 countries, diagnosed >6 months prior and receiving insulin for >3 months, were recruited through a representative online panel. Data were collected via online questionnaire and analyzed using a standard choice model for discrete choice experiment.

Results A total of 3758 patients from North America (n=646), South America (n=1537), and Europe (n=1575) completed the study. Mean glycated hemoglobin (HbA1c) levels in North America, South America, and Europe were 63 mmol/mol (7.9%), 75 mmol/mol (9.0%), and 64 mmol/mol (8.0%), respectively. In the three regions, monthly willingness to pay was US$116, US$74, and US$92, respectively, for a 1%-point decrease in HbA1c; US$99, US$80, and US$104 for one less major hypoglycemic event per year; and US$64, US$37 and US$60 for a 3 kg weight decrease. To avoid preinjection preparation of insulin, the respective values were US$47, US$18, and US$37, and US$25, US$25, and US$24 for one less injection per day. Among respondents on basal-only insulin who had previously tried a more intensive regimen, reasons for switching back included difficulty in handling multiple injections and risk of hypoglycemic events.

Conclusions Reducing HbA1c, frequency of major hypoglycemic events and weight decrease were the highest valued outcomes in each region. The administrative burden of injections was also considered important.

  • Type 2 Diabetes
  • Patient Preferences
  • Treatment With Insulin
  • Treatment Adherence/Compliance

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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