中国2型糖尿病患者对口服降糖药支付意愿研究:基于离散选择实验  

Evaluation of willingness-to-pay for oral antidiabetic drugs among patients with type 2 diabetes mellitus in China:a discrete choice experiment

作　　者：张焕兰 庄铃香 谢诗桐 吴晶[3] Zhang Huanlan;Linghsiang Chuang;Xie Shitong;Wu Jing(Gongjing Healthcare(Nanjing)Co.Ltd,Nanjing 210003,China;Department of Epidemiology and Global Health,UmeåUniversity,Umeå90187,Sweden;School of Pharmaceutical Science and Technology,Medical School of Tianjin University,Tianjin 300072,China)

机构地区：[1]共景医疗科技(南京)有限公司,南京210003 [2]瑞典于默奥大学流行病学和全球健康学院,于默奥90187 [3]天津大学医学部药物科学与技术学院,天津300072

出　　处：《中华糖尿病杂志》2025年第3期369-375,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金(72174142,72404205);天津市自然科学基金(23JCQNJC01650)。

摘　　要：目的采用离散选择实验(DCE)分析2型糖尿病(T2DM)患者对口服降糖药(OAD)的支付意愿(WTP),并通过亚组分析揭示不同特征人群的WTP异质性,明确患者用药偏好。方法通过文献回顾、定性研究、专家咨询等方法确定本研究的属性和水平。于2023年5至8月在全国16个省/直辖市通过线上和线下两种方式对T2DM患者进行问卷调查,问卷内容包括个人基本信息、疾病治疗相关信息和DCE选择集。通过Stata 17.0软件构建条件logit模型测算WTP。根据人口学特征和临床特征进行亚组分析,探讨不同患者之间的WTP异质性。结果共741例T2DM患者纳入分析,其中线上456例,线下285例。WTP结果显示,血糖水平每降低1 mmol/L,受访者愿意支付5.77元/d;服药频率从3次/d和1次/d降为2周服药1次,受访者分别愿意支付23.20和12.06元/d。亚组分析显示,年收入水平较高、教育程度较高、居住在一线/新一线城市、来自城市、服药负担轻的受访者在多数属性和水平上WTP也更高(P<0.05)。结论T2DM患者在选择OAD时,愿意支付一定的费用在血糖控制效果好、服药频率低、胃肠道不良反应少、对肝肾功能不全的患者无须调整剂量的药物上,以获得相关的健康获益及服药便利性;收入水平较高、受教育程度较高以及服药负担较轻的患者,在这些属性上的WTP也相对更高。Objective To estimate the willingness-to-pay(WTP)of patients with type 2 diabetes mellitus(T2DM)for oral antidiabetic drugs(OAD)using discrete choice experiments(DCE)and to investigate the heterogeneity of WTP in different subgroups.Methods The attributes and levels were identified for this study through literature review,qualitative research,and expert consultation.From May to August 2023,a questionnaire survey,including demographic and clinical items,and DCE choice tasks,was conducted among T2DM patients in 16 provinces/municipalities in China using both online and offline sampling methods.A conditional logit model was constructed using Stata 17.0 software to estimate WTP.Subgroup analyses based on demographic and clinical characteristics was conducted to explore WTP heterogeneity among various respondent groups.Results A total of 741 T2DM patients were included in the analysis,with 456 cases from online and 285 cases from offline surveys.The WTP results showed that for each 1 mmol/L reduction in blood glucose levels,respondents were willing to pay RMB¥5.77 yuan per day.To reduce the frequency of medication from three times per day and once per day to once every two weeks,respondents were willing to pay RMB¥23.20 yuan/day and RMB¥12.06 yuan/day,respectively.Subgroup analyses showed that respondents with higher annual income,higher education level,living in first-tier or new first-tier cities,living in urban areas,and with a lower medication burden generally had higher WTP for most attributes and levels(all P<0.05).Conclusion Patients with T2DM are willing to pay a certain fee for OAD that offer better glycemic control,less frequent dosing,fewer gastrointestinal side effects,and no dose adjustment required for patients with hepatic or renal insufficiency,in order to achieve related health benefits and medication convenience.Patients with higher income,higher education,and lower medication burden tend to have a relatively higher WTP for these attributes.

关 键 词：糖尿病 2型 口服降糖药 支付意愿 离散选择实验 异质性 

分 类 号：R587.1[医药卫生—内分泌]