Diminishing Marginal Disutility of Hypoglycaemic Events: Results from a Time Trade-off Survey in Five Countries

Overview

Journal Qual Life Res

Specialties Pharmacology
Rehabilitation Medicine

Date 2014 May 20

PMID 24838908

Citations 28

Authors

Jorgen T Lauridsen

Jonas Lonborg

Jens Gundgaard

Henrik Holm Jensen

Affiliations

Soon will be listed here.

Abstract

Introduction: The negative impact of hypoglycaemic events on health-related quality of life (HRQoL) may be evaluated by attaching published disutilities to these events. It is suggested that the marginal negative impact of individual hypoglycaemic events on HRQoL may decrease as the overall frequency increases.

Methods: Using disutility values from a large-scale (>8,000 respondents), time trade-off (TTO) study, nonlinear regression curves were fitted to the total disutility of different frequencies of non-severe daytime and nocturnal hypoglycaemic events. Nonparametric bootstrapping was applied to characterise the uncertainty of the marginal disutility.

Results: Power function regression curves were estimated at U d = 0.0141x (0.3393) and U d = 0.0221x (0.3277). An increase from 0 to 1 hypoglycaemic event per year produced a utility decrease of 0.0141 and 0.0221 for non-severe daytime and nocturnal events, respectively. An increase from 25 to 26 events per year produced a marginal impact of 0.0006 and 0.0008 for non-severe daytime and nocturnal events, respectively.

Discussion: These data concur with the noted phenomenon of "first being worst" as regards hypoglycaemic events. This finding may reflect a coping mechanism on the part of patients, a maximum limit for trading off remaining lifetime or the nature of the study.

Conclusion: Applying nonlinear functions to the TTO data might improve the precision of the measured impact of hypoglycaemic events.

Citing Articles

Hybrid closed-loop systems for managing blood glucose levels in type 1 diabetes: a systematic review and economic modelling.

Asgharzadeh A, Patel M, Connock M, Damery S, Ghosh I, Jordan M Health Technol Assess. 2024; 28(80):1-190.

PMID: 39673446 PMC: 11664472. DOI: 10.3310/JYPL3536.

Adverse drug events in cost-effectiveness models of pharmacological interventions for diabetes, diabetic retinopathy, and diabetic macular edema: a scoping review.

Pesonen M, Jylha V, Kankaanpaa E JBI Evid Synth. 2024; 22(11):2194-2266.

PMID: 39054883 PMC: 11554252. DOI: 10.11124/JBIES-23-00511.

Utilities for Complications Associated with Type 2 Diabetes: A Review of the Literature.

Valentine W, Norrbacka K, Boye K Adv Ther. 2024; 41(7):2655-2681.

PMID: 38771477 PMC: 11213775. DOI: 10.1007/s12325-024-02878-x.

Cost-effectiveness of continuous glucose monitoring with FreeStyle Libre in Brazilian insulin-treated patients with types 1 and 2 diabetes mellitus.

Bahia L, Mello K, Lemos L, Costa N, Mulinari E, Malerbi D Diabetol Metab Syndr. 2023; 15(1):242.

PMID: 38001509 PMC: 10675900. DOI: 10.1186/s13098-023-01208-5.

Disutilities Associated with Intravenous Iron Infusions: Results from a Time Trade-off Survey and Diminishing Marginal Utility Model for Treatment Attributes in China.

Hu S, Wu D, Wu J, Zhang Y, Bogelund M, Pohlmann J Patient Relat Outcome Meas. 2023; 14:253-267.

PMID: 37789883 PMC: 10543423. DOI: 10.2147/PROM.S400389.

References

Donnelly L, Morris A, Frier B, Ellis J, Donnan P, Durrant R . Frequency and predictors of hypoglycaemia in Type 1 and insulin-treated Type 2 diabetes: a population-based study. Diabet Med. 2005; 22(6):749-55. DOI: 10.1111/j.1464-5491.2005.01501.x. View

Marrett E, Radican L, Davies M, Zhang Q . Assessment of severity and frequency of self-reported hypoglycemia on quality of life in patients with type 2 diabetes treated with oral antihyperglycemic agents: A survey study. BMC Res Notes. 2011; 4:251. PMC: 3148563. DOI: 10.1186/1756-0500-4-251. View

. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):837-53. View

Harris S, Khunti K, Landin-Olsson M, Galbo-Jorgensen C, Bogelund M, Chubb B . Descriptions of health states associated with increasing severity and frequency of hypoglycemia: a patient-level perspective. Patient Prefer Adherence. 2013; 7:925-36. PMC: 3786816. DOI: 10.2147/PPA.S46805. View

Brod M, Christensen T, Thomsen T, Bushnell D . The impact of non-severe hypoglycemic events on work productivity and diabetes management. Value Health. 2011; 14(5):665-71. DOI: 10.1016/j.jval.2011.02.001. View

Levy A, Christensen T, Johnson J . Utility values for symptomatic non-severe hypoglycaemia elicited from persons with and without diabetes in Canada and the United Kingdom. Health Qual Life Outcomes. 2008; 6:73. PMC: 2567965. DOI: 10.1186/1477-7525-6-73. View

Alvarez-Guisasola F, Yin D, Nocea G, Qiu Y, Mavros P . Association of hypoglycemic symptoms with patients' rating of their health-related quality of life state: a cross sectional study. Health Qual Life Outcomes. 2010; 8:86. PMC: 2936440. DOI: 10.1186/1477-7525-8-86. View

Vexiau P, Mavros P, Krishnarajah G, Lyu R, Yin D . Hypoglycaemia in patients with type 2 diabetes treated with a combination of metformin and sulphonylurea therapy in France. Diabetes Obes Metab. 2008; 10 Suppl 1:16-24. DOI: 10.1111/j.1463-1326.2008.00883.x. View

Luo N, Johnson J, Coons S . Using instrument-defined health state transitions to estimate minimally important differences for four preference-based health-related quality of life instruments. Med Care. 2010; 48(4):365-71. DOI: 10.1097/mlr.0b013e3181c162a2. View

10.

Fidler C, Elmelund Christensen T, Gillard S . Hypoglycemia: an overview of fear of hypoglycemia, quality-of-life, and impact on costs. J Med Econ. 2011; 14(5):646-55. DOI: 10.3111/13696998.2011.610852. View

11.

Weinstein M, Torrance G, McGuire A . QALYs: the basics. Value Health. 2009; 12 Suppl 1:S5-9. DOI: 10.1111/j.1524-4733.2009.00515.x. View

12.

Walters S, Brazier J . Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res. 2005; 14(6):1523-32. DOI: 10.1007/s11136-004-7713-0. View

13.

Currie C, Morgan C, Poole C, Sharplin P, Lammert M, McEwan P . Multivariate models of health-related utility and the fear of hypoglycaemia in people with diabetes. Curr Med Res Opin. 2006; 22(8):1523-34. DOI: 10.1185/030079906X115757. View

14.

Drummond M . Introducing economic and quality of life measurements into clinical studies. Ann Med. 2001; 33(5):344-9. DOI: 10.3109/07853890109002088. View

15.

Clarke P, Gray A, Holman R . Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). Med Decis Making. 2002; 22(4):340-9. DOI: 10.1177/0272989X0202200412. View

16.

Evans M, Khunti K, Mamdani M, Galbo-Jorgensen C, Gundgaard J, Bogelund M . Health-related quality of life associated with daytime and nocturnal hypoglycaemic events: a time trade-off survey in five countries. Health Qual Life Outcomes. 2013; 11:90. PMC: 3679729. DOI: 10.1186/1477-7525-11-90. View

17.

. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 2005; 28(5):1245-9. DOI: 10.2337/diacare.28.5.1245. View

18.

Allen K, Frier B . Nocturnal hypoglycemia: clinical manifestations and therapeutic strategies toward prevention. Endocr Pract. 2004; 9(6):530-43. DOI: 10.4158/EP.9.6.530. View